Scrotal mass
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Scrotal Mass Microchapters |
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Scrotal mass On the Web |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Niloofarsadaat Eshaghhosseiny, MD[2]Sujit Routray, M.D. [3]
Synonyms and keywords: Scrotal lump
Overview
Historical Perspective
Classification
Pathophysiology
Causes
- Scrotal mass may be caused by tumor, infection, injury, inflammation, or fluid buildup, which can cause different types of masses.[1]
| Common Causes of Scrotal Mass Adapted from American Academy of Family Physicians.[2] | ||||
|---|---|---|---|---|
| Cause | Clinical Presentation | Diagnosis | Treatment | |
| Testicular torsion | Acute unilateral pain and swelling High position of the testicle Abnormal cremasteric reflex Nausea/vomiting |
Mostly clinical, with or without sonography | Surgery | |
| Torsion of the testicular appendage | Acute unilateral pain No swelling Blue dot sign(bluish discoloration of the scrotum over the superior pole) |
Sonography | Pain control | |
| Epididymis/orchitis | Acute unilateral pain and swelling Normal position of the testicle Erythema of the scrotal skin Fever Dysuria |
Mostly clinical, with or without sonography | Ceftriaxone and doxyxycline | |
| Hematocele | History of trauma Pain and swelling |
Sonography or surgerical exploraion | Main focus on pain control. Surgery, if needed | |
| Inguinal hernia | Unilateral bulge in the scrotum Pain with Valsalva maneuvers |
Physical examination, sonography | Surgery | |
| Hydrocele | Swelling | Transillumination, sonography | Main focus on pain control. Surgery, if needed | |
| Varicocele | Dull testicular ache while in standing position Scrotal mass |
"Bag of worms" on palpation | Scrotal support, surgery if needed | |
| Testicular cancer | Unilateral, firm nodule | Sonography, positive tumor markers | Surgery | |
| Skin cancer | History of carcinogens Erosive, vascular, hyperkeratotic, or nonhealing; irregular border; color changes |
Biopsy | Surgery | |
Causes by Anatomic Origin
| Scrotal Mass Adapted from American Academy of Family Physicians.[2] | ||||
|---|---|---|---|---|
| Anatomical Origin | Lesion/Condition | Onset/Progression | Pain/Tenderness | Aggravating/Alleviating Factors, Associated Symptoms |
| Skin | Sebaceous cyst | Acute/chronic, stable | No | --- |
| Squamous cell carcinoma | Chronic, progressive | No | --- | |
| Tunica vaginalis testis | Hydrocele | Acute/chronic, stable | No | Positive transillumination |
| Hematocele | Acute, caused by trauma | Yes | Negative transillumination | |
| Processus vaginalis testis | Indirect inguinal hernia | Acute/chronic, stable or progressive | No; yes, if strangulated | May enlarge with Valsalva-type maneuvers; size may fluctuate |
| Hydrocele | Chronic, stable | No | --- | |
| Pampiniform plexus | Varicocele | Chronic, stable | No | Characteristic "bag of worms" consistency |
| Epididymis | Epididymitis | Acute, progressive | Yes | May have symptoms of urinary tract infection (fever, chills, dysuria, frequency, and urgency) |
| Spermatocele | Chronic, stable | No | --- | |
| Testis | Testicular torsion | Acute, progressive | Yes | Elevation of testis may aggravate pain; abnormal testicular lie; cremasteric reflex usually absent |
| Appendix testis torsion | Acute, stable | Yes | Blue dot sign | |
| Orchitis | Acute, self-limited | Yes | Elevation of testis may relieve pain, may have systemic symptoms of viral illness | |
| Testicular cancer | Chronic, progressive | No | --- | |
Causes by Organ System
| Cardiovascular | No underlying causes |
| Chemical / poisoning | No underlying causes |
| Dermatologic | Sebaceous cyst |
| Drug Side Effect | No underlying causes |
| Ear Nose Throat | No underlying causes |
| Endocrine | No underlying causes |
| Environmental | No underlying causes |
| Gastroenterologic | No underlying causes |
| Genetic | No underlying causes |
| Hematologic | Thrombosis spermatic vein |
| Iatrogenic | No underlying causes |
| Infectious Disease | Mumps, Filariasis, Leprosy, Orchitis, Syphilitic gumma, Tuberculosis, Amebiasis, Epididymitis, Granulomatous epididymitis, Seminal vesiculitis |
| Musculoskeletal / Ortho | No underlying causes |
| Neurologic | No underlying causes |
| Nutritional / Metabolic | No underlying causes |
| Obstetric/Gynecologic | No underlying causes |
| Oncologic | Benign: Germ cell tumor, Teratoma, Thecoma, Sertoli-Leydig cell tumor, Fibroma, Chimney sweeps' carcinoma, Epididymis cyst, Seminal vesicle cyst, Urethral gland cyst
Malignant: Germ cell tumor, Seminoma, Embryonal carcinoma, Yolk sac tumor, Choriocarcinoma, Teratoma, Granulosa cell tumor, Sertoli-Leydig cell tumor, Adenocarcinoma, Mesothelioma, Rhabdomyosarcoma, Chimney sweeps' carcinoma, Diffuse large B-cell lymphoma Metastatic tumors: Diffuse large B-cell lymphoma |
| Opthalmologic | No underlying causes |
| Overdose / Toxicity | No underlying causes |
| Psychiatric | No underlying causes |
| Pulmonary | No underlying causes |
| Renal / Electrolyte | No underlying causes |
| Rheum / Immune / Allergy | No underlying causes |
| Sexual | No underlying causes |
| Trauma | Testicular injury, Testicular hematoma, Spermatic cord injury, Fracture of testis |
| Urologic | Hematocele，Hydrocele，Spermatocele, Varicocele, Testicular torsion, Epididymis torsion, Spermatic cord torsion, Inguinal hernia, Richter hernia, Femoral hernia, Incarcerated hernia, Irreducible hernia, Strangulated hernia, Testicular abscess, Scrotum abscess, Idiopathic scrotal edema, Seminal vesicle calculus |
| Miscellaneous | No underlying causes |
References
- ↑ Causes of scrotal masses. The Urology Group 2016. http://urologygroup.com/conditions-we-treat/scrotal-masses/. Accessed on March 17, 2016
- ↑ 2.0 2.1 Scrotal mass. American Academy of Family Physicians 2016. http://www.aafp.org/afp/2008/1115/p1165.html. Accessed on March 18, 2016
Differential Diagnosis
Epidemiology and Demographics
Risk Factors
Screening
Diagnosis
Diagnostic study of choice | Evaluation of Scrotal Mass | History and Symptoms | Physical Examination | Laboratory Findings | Electrocardiogram | X-Ray Findings | CT-Scan Findings | MRI Findings | Biopsy | Other Imaging Findings | Other Diagnostic Studies