TESTICULAR MASS
TESTICULAR MASS: Excerpt from Differential Diagnosis in Primary Care
Like that of most masses, the differential diagnosis of testicular masses is the best analyzed by the anatomic and histologic approach (Table 57). The skin may be involved by many inflammatory conditions leading to swelling, including carbuncles, cellulitis, and dermatitis of various types. The tunica vaginalis is involved with hernias and hydroceles, which may be differentiated by using transillumination. The venous plexus of the scrotum and testes is involved by varicoceles and phlebitis (usually of the left venous plexus), and a varicocele may be the sign of a carcinoma of the kidney when the left spermatic vein is obstructed. Thus, one readily sees how frequently obstruction is a pathophysiologic mechanism in tumors here or elsewhere.
TESTICULAR MASS
TABLE 57. TESTICULAR MASS
| |
V |
I |
N |
D |
I |
C |
A |
T |
E |
O |
| |
Vascular |
Inflammation |
Neoplasm |
Degenerative |
Intoxication |
Congenital |
Allergic Autoimmune |
Trauma |
Endocrine |
Obstruction |
Skin |
|
Carbuncle |
Carcinoma |
|
|
|
Urticaria |
Contusion |
|
Sebaceous cyst |
Subcutaneous Tissue |
|
Cellulitis |
|
|
|
|
|
Direct inguinal hernia |
|
|
Tunica Vaginalis |
|
|
|
|
|
Indirect inguinal hernia |
|
Hematoma |
|
|
| |
|
|
|
|
|
Hydrocele |
|
|
|
|
Venous Plexus |
|
Phlebitis |
Obstruction from renal carcinoma |
|
|
Varicocele |
|
|
|
|
Testis |
|
Orchitis |
Seminoma |
|
|
Teratoma |
|
|
|
|
| |
|
Syphilis |
Chorioepithelioma |
|
|
Hydatid cyst of Morgagni |
|
|
|
|
Epididymis |
|
Bacterial epididymitis |
|
|
|
Cyst |
|
|
|
Spermatocele |
| |
|
Tuberculosis |
|
|
|
|
|
|
|
|
Artery |
Torsion |
|
|
|
|
Torsion |
|
|
|
|
Vas Deferens |
|
|
Secondary to obstruction by carcinoma of prostate |
|
|
|
|
|
|
Prostate disease |
Lymphatics |
|
Filariasis |
|
|
|
|
|
|
|
|
The testis is swollen in carcinomas (e.g., seminomas, choriocarcinomas, teratomas, Leydig cell tumors) and in orchitis (secondary to mumps, bacterial diseases, syphilis, or tuberculosis). The epididymis is frequently inflamed and swollen when there is orchitis and only rarely is inflamed by itself. It may also be enlarged from a spermatocele or from a vas deferens obstruction caused by prostatic disease (inflammation or neoplasm). Finally, arterial occlusion caused by torsion of the testicle may cause a testicular mass.
Approach to the Diagnosis
Testicular masses may be differentiated by transillumination (hydroceles and spermatoceles transilluminates, whereas hernias and tumors do not). Hernias may also be differentiated by reducing them (some will not reduce, however, if they are incarcerated) and auscultation may reveal bowel sounds. In noncommunicating hydroceles and testicular tumors, one may get above the swelling, whereas in torsion and hernias one cannot. In torsion, the tenderness is increased by elevation of the testicle, whereas in orchitis the tenderness is relieved if elevation is done for an hour or more. Surgery may be the only way to differentiate the cause of the mass.
Other Useful Tests
- CBC (orchitis)
- Sedimentation rate (orchitis)
- Urinalysis (UTI)
- Urethral smear (infection)
- Urine culture (UTI)
- Urine gonadotropin (testicular tumor)
- Prostatic fluid smear and culture (prostatitis)
- Mumps skin test and serology (mumps orchitis)
- Small-bowel series (hernia)
- CT scan of the abdomen and pelvis (metastatic tumor)
- Urology consult
- Sonogram (torsion, hydrocele)
Book Source Details
- Book Title: Differential Diagnosis in Primary Care
- Author(s): R. Douglas Collins
- Year of Publication: 2007
- Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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