Scrotal mass differential diagnosis: Difference between revisions

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Revision as of 17:03, 26 January 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Preeti Singh, M.B.B.S.[2]

Overview

Scrotal masses may be differentiated according to clinical features, laboratory findings, imaging features, histological features, and genetic studies from other diseases that cause testicular mass with discomfort, back pain, abdominal discomfort, or abdominal mass. Common differential diagnoses include yolk sac tumor, teratoma, choriocarcinoma, embryonal cell carcinoma, seminoma, and testicular lymphoma (usually non-Hodgkin lymphoma).

Differential Diagnosis

The table below summarizes the findings that differentiates scrotal mass according to the clinical features, laboratory findings, imaging features, histological features, and genetic studies.

		Symptoms				Physical examination					Lab Findings		Past Medical History	Histopathology
Scrotal Swelling	Diseases	Clinical manifestations									Para-clinical findings				Gold standard	Associated
Painful		Symptoms				Physical examination					Para-clinical findings
		Unilateral /Bilateral swelling	Onset	Fever	Urinary symptoms	Tenderness	Erythema	Discharge	Inguinal Lymphadenopathy	Cremasteric Reflex	Blood/Urine Analysis	Doppler U/S	Past Medical History	Histopathology
	Epididymitis^[1]	Unilateral	Gradual	±	Dysuria, frequency, and/or urgency	+	-	Pyuria	Painful local lymphadenopathy	+		Leukocytosis	Enlarged (>17 mm) epididymis with a hypoechoic, hyperechoic, or heterogeneous echotexture, increased blood flow	Hydrocele Urinary tract infection	Acute infection is characterized by infiltration of neutrophils. Chronic cases are characterized by granulomatous inflammation.	Ultrasound for diagnosis (Testicular massesor swollen testicles with hypoechoic and hypervascular areas)	Phen sign +ve
	Orchitis (Mumps)	Bilateral	Abrupt	±	Dysuria	+	-	±	Painful local lymphadenopathy	+	Leukocytosis		Mumps, coxsackievirus infection Concurrent epididymitis Congenital abnornmalities		Ultrasound for diagnosis (Testicular massesor swollen testicles with hypoechoic and hypervascular areas)	Phen sign +ve
	Testicular Torsion^[2]	Unilateral	Sudden	-		+	+	Blood in semen may be present	Absent	-	Normal	Absent or decreased arterial perfusion of the testis	Previous history of testicular torsion Family history of testicular torsion Prematurity Undescended testes Low birth weight		Doppler ultrasound> CT scan	Phen sign +ve
	Hematocele	Unilateral or bilateral	Sudden	-		+	+	Blood in semen	Absent						Ultrasonography: to check for testicular rupture.
	Incarcerated Hernia^[3]^[4]	Unilateral	Sudden	+	Absent	+	+	-	Absent								-	Testicular Abcess		-							-	Brucellosis	-
	Histoplasma
	Gonorrhea
	Fournier's gangrene

Scrotal Swelling	Diseases	Unilateral /Bilateral swelling	Onset	Fever	Urinary symptoms	Tenderness	Erythema	Discharge	Inguinal Lymphadenopathy	Cremasteric Reflex	Blood/Urine Analysis	Doppler U/S	Past Medical History	Histopathology	Gold standard	Additional findings
Painless	Fragile X Macroorchidism	Bilateral				-		+
	Testicular Tumors					±		+
	Henoch-Schonlein purpura					-		-
	Hydrocele^[5]		Gradual	-	Absent	-	-	-	Absent	+					Ultrasound: simple fluid collection	Transillumination test +ve.
	Varicocele^[6]	Unilateral (Mainly left)	Gradual	Local warmth	Absent	-	±	-	Absent	+			Renal cancer Nephrectomy Nut-cracker syndrome	style="background: #F5F5F5; padding: 5px; text-align: left;"\|	Ultrasonography: tortuous, tubular, anechoic structures adjacent to the testis corresponding to dilated veins of the pampiniform plexus with calibers of 2–3 mm during the Valsalva maneuver		-	Spermatocele^[7]	Gradual	-	-	-	Absent	+	Falling snow, resulting from internal echoes moving away from the transducer	Ultrasonography: hypoechoic with posterior acoustic enhancement
	Inguino-scrotal hernia^[8]^[3]					-		-	Absent
	Scrotal edema	Bilateral and can extend to perineum				-	-	-			Eosinophilia					Occurs between 4-12 years of age.
		Epididymal cyst^[9]					±									Ultrasonography: posterior acoustic enhancement, well defined anechoic lesions, larger cysts may contain septations
	Scrotal oedema
	Sebaceous cyst
	Carcinoma of the scrotum
	Chylocele (Filariasis)		Gradually/Rapidly
	Cystic dysplasia
	Srotoliths

References

↑ Yu KJ, Wang TM, Chen HW, Wang HH (2012). "The dilemma in the diagnosis of acute scrotum: clinical clues for differentiating between testicular torsion and epididymo-orchitis". Chang Gung Med J. 35 (1): 38–45. PMID 22483426.
↑ Gunther P, Schenk JP, Wunsch R, Holland-Cunz S, Kessler U, Troger J, Waag KL (November 2006). "Acute testicular torsion in children: the role of sonography in the diagnostic workup". Eur Radiol. 16 (11): 2527–32. doi:10.1007/s00330-006-0287-1. PMID 16724203.
↑ ^3.0 ^3.1 Jenkins JT, O'Dwyer PJ (2008). "Inguinal hernias". BMJ. 336 (7638): 269–72. doi:10.1136/bmj.39450.428275.AD. PMC 2223000. PMID 18244999.
↑ Berger D (2016). "Evidence-Based Hernia Treatment in Adults". Dtsch Arztebl Int. 113 (9): 150–7, quiz 158. doi:10.3238/arztebl.2016.0150. PMC 4802357. PMID 26987468.
↑ Yang DM, Kim HC, Lim JW, Jin W, Ryu CW, Kim GY, Cho H (2007). "Sonographic findings of groin masses". J Ultrasound Med. 26 (5): 605–14. PMID 17460003.
↑ Yang DM, Kim HC, Lim JW, Jin W, Ryu CW, Kim GY, Cho H (2007). "Sonographic findings of groin masses". J Ultrasound Med. 26 (5): 605–14. PMID 17460003.
↑ Yang DM, Kim HC, Lim JW, Jin W, Ryu CW, Kim GY, Cho H (2007). "Sonographic findings of groin masses". J Ultrasound Med. 26 (5): 605–14. PMID 17460003.
↑ Berger D (2016). "Evidence-Based Hernia Treatment in Adults". Dtsch Arztebl Int. 113 (9): 150–7, quiz 158. doi:10.3238/arztebl.2016.0150. PMC 4802357. PMID 26987468.
↑ Yang DM, Kim HC, Lim JW, Jin W, Ryu CW, Kim GY, Cho H (2007). "Sonographic findings of groin masses". J Ultrasound Med. 26 (5): 605–14. PMID 17460003.

[pmid22483426-1] Yu KJ, Wang TM, Chen HW, Wang HH (2012). "The dilemma in the diagnosis of acute scrotum: clinical clues for differentiating between testicular torsion and epididymo-orchitis". Chang Gung Med J. 35 (1): 38–45. PMID 22483426.

[pmid16724203-2] Gunther P, Schenk JP, Wunsch R, Holland-Cunz S, Kessler U, Troger J, Waag KL (November 2006). "Acute testicular torsion in children: the role of sonography in the diagnostic workup". Eur Radiol. 16 (11): 2527–32. doi:10.1007/s00330-006-0287-1. PMID 16724203.

[pmid18244999-3] 3.0 ^3.1 Jenkins JT, O'Dwyer PJ (2008). "Inguinal hernias". BMJ. 336 (7638): 269–72. doi:10.1136/bmj.39450.428275.AD. PMC 2223000. PMID 18244999.

[pmid26987468-4] Berger D (2016). "Evidence-Based Hernia Treatment in Adults". Dtsch Arztebl Int. 113 (9): 150–7, quiz 158. doi:10.3238/arztebl.2016.0150. PMC 4802357. PMID 26987468.

[pmid174600034-5] Yang DM, Kim HC, Lim JW, Jin W, Ryu CW, Kim GY, Cho H (2007). "Sonographic findings of groin masses". J Ultrasound Med. 26 (5): 605–14. PMID 17460003.

[pmid174600033-6] Yang DM, Kim HC, Lim JW, Jin W, Ryu CW, Kim GY, Cho H (2007). "Sonographic findings of groin masses". J Ultrasound Med. 26 (5): 605–14. PMID 17460003.

[pmid174600032-7] Yang DM, Kim HC, Lim JW, Jin W, Ryu CW, Kim GY, Cho H (2007). "Sonographic findings of groin masses". J Ultrasound Med. 26 (5): 605–14. PMID 17460003.

[pmid269874682-8] Berger D (2016). "Evidence-Based Hernia Treatment in Adults". Dtsch Arztebl Int. 113 (9): 150–7, quiz 158. doi:10.3238/arztebl.2016.0150. PMC 4802357. PMID 26987468.

[pmid17460003-9] Yang DM, Kim HC, Lim JW, Jin W, Ryu CW, Kim GY, Cho H (2007). "Sonographic findings of groin masses". J Ultrasound Med. 26 (5): 605–14. PMID 17460003.

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@@ Line 266: / Line 266: @@
 !Additional findings
 |-
-| rowspan="8" |Painless
+| rowspan="14" |Painless
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Fragile X syndrome|Fragile X]][[Macroorchidism]]
 | style="background: #F5F5F5; padding: 5px;" |Bilateral
@@ Line 319: / Line 319: @@
 |-
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hydrocele]]<ref name="pmid174600034">{{cite journal |vauthors=Yang DM, Kim HC, Lim JW, Jin W, Ryu CW, Kim GY, Cho H |title=Sonographic findings of groin masses |journal=J Ultrasound Med |volume=26 |issue=5 |pages=605–14 |year=2007 |pmid=17460003 |doi= |url=}}</ref>
-| style="background: #F5F5F5; padding: 5px; text-align: center;"|
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |
-| style="background: #F5F5F5; padding: 5px; text-align: left;"|Gradual
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |Gradual
-| style="background: #F5F5F5; padding: 5px; text-align: center;"| -
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
-| style="background: #F5F5F5; padding: 5px; text-align: center;"|Absent
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Absent
-| style="background: #F5F5F5; padding: 5px; text-align: center;"|<nowiki>-</nowiki>
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>-</nowiki>
-| style="background: #F5F5F5; padding: 5px; text-align: center;"|<nowiki>-</nowiki>
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>-</nowiki>
-| style="background: #F5F5F5; padding: 5px; text-align: center;"|<nowiki>-</nowiki>
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>-</nowiki>
-| style="background: #F5F5F5; padding: 5px; text-align: left;"|Absent
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |Absent
-| style="background: #F5F5F5; padding: 5px; text-align: center;"| +
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
-| style="background: #F5F5F5; padding: 5px; text-align: center;"|
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |
-| style="background: #F5F5F5; padding: 5px; text-align: center;"|
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |
-| style="background: #F5F5F5; padding: 5px; text-align: center;"|
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |
-| style="background: #F5F5F5; padding: 5px; text-align: center;"|
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |
-| style="background: #F5F5F5; padding: 5px; text-align: left;"|[[Ultrasound|Ultrasound:]]
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |[[Ultrasound|Ultrasound:]]
 simple fluid collection
-| style="background: #F5F5F5; padding: 5px; text-align: left;"|Transillumination test +ve.
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |Transillumination test +ve.
 |-
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Varicocele]]<ref name="pmid174600033">{{cite journal |vauthors=Yang DM, Kim HC, Lim JW, Jin W, Ryu CW, Kim GY, Cho H |title=Sonographic findings of groin masses |journal=J Ultrasound Med |volume=26 |issue=5 |pages=605–14 |year=2007 |pmid=17460003 |doi= |url=}}</ref>
-| style="background: #F5F5F5; padding: 5px; text-align: left;"|Unilateral
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |Unilateral
 (Mainly left)
-| style="background: #F5F5F5; padding: 5px; text-align: left;"|Gradual
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |Gradual
-| style="background: #F5F5F5; padding: 5px; text-align: left;"|Local warmth
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |Local warmth
-| style="background: #F5F5F5; padding: 5px; text-align: left;"|Absent
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |Absent
-| style="background: #F5F5F5; padding: 5px; text-align: center;"|<nowiki>-</nowiki>
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>-</nowiki>
-| style="background: #F5F5F5; padding: 5px; text-align: center;"|±
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |±
-| style="background: #F5F5F5; padding: 5px; text-align: center;"|<nowiki>-</nowiki>
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>-</nowiki>
-| style="background: #F5F5F5; padding: 5px; text-align: left;"|Absent
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |Absent
-| style="background: #F5F5F5; padding: 5px; text-align: center;"| +
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
-| style="background: #F5F5F5; padding: 5px; text-align: center;"|
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |
-| style="background: #F5F5F5; padding: 5px; text-align: center;"|
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |
-| style="background: #F5F5F5; padding: 5px; text-align: center;"|
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |
 * [[Renal cancer]]
 * [[Nephrectomy]]
 * Nut-cracker syndrome
-|style="background: #F5F5F5; padding: 5px; text-align: left;"| style="background: #F5F5F5; padding: 5px; text-align: left;"|
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |<nowiki> style="background: #F5F5F5; padding: 5px; text-align: left;"|</nowiki>
-|style="background: #F5F5F5; padding: 5px; text-align: left;"|[[Ultrasonography:]]
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |[[Ultrasonography:]]
 [[tortuous]], [[tubular]], anechoic structures adjacent to the testis corresponding to dilated veins of the [[pampiniform plexus]] with calibers of 2–3 mm during the [[Valsalva maneuver]]
-|style="background: #F5F5F5; padding: 5px; text-align: left;"|
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |
-|style="background: #F5F5F5; padding: 5px; text-align: center;"|-
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Spermatocele]]<ref name="pmid174600032">{{cite journal |vauthors=Yang DM, Kim HC, Lim JW, Jin W, Ryu CW, Kim GY, Cho H |title=Sonographic findings of groin masses |journal=J Ultrasound Med |volume=26 |issue=5 |pages=605–14 |year=2007 |pmid=17460003 |doi= |url=}}</ref>
-|style="background: #F5F5F5; padding: 5px; text-align: left;"|
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |
-|style="background: #F5F5F5; padding: 5px; text-align: left;"|Gradual
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |Gradual
-|style="background: #F5F5F5; padding: 5px; text-align: left;"|
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |
-|style="background: #F5F5F5; padding: 5px; text-align: left;"|
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |
-|style="background: #F5F5F5; padding: 5px; text-align: left;"|<nowiki>-</nowiki>
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |<nowiki>-</nowiki>
-|style="background: #F5F5F5; padding: 5px; text-align: left;"|<nowiki>-</nowiki>
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |<nowiki>-</nowiki>
-|style="background: #F5F5F5; padding: 5px; text-align: left;"|<nowiki>-</nowiki>
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |<nowiki>-</nowiki>
-|style="background: #F5F5F5; padding: 5px; text-align: left;"|Absent
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |Absent
-|style="background: #F5F5F5; padding: 5px; text-align: center;"| +
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
-|style="background: #F5F5F5; padding: 5px; text-align: left;"|
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |
-|style="background: #F5F5F5; padding: 5px; text-align: left;"|
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |
 * Falling snow, resulting from internal echoes moving away from the transducer
-|style="background: #F5F5F5; padding: 5px; text-align: left;"|
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |
-|style="background: #F5F5F5; padding: 5px; text-align: left;"|
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |
-|style="background: #F5F5F5; padding: 5px; text-align: left;"|[[Ultrasonography]]:
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |[[Ultrasonography]]:
 hypoechoic with posterior acoustic enhancement
-|style="background: #F5F5F5; padding: 5px; text-align: left;"|
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |
 |-
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Inguinal hernia|Inguino-scrotal hernia]]<ref name="pmid269874682">{{cite journal |vauthors=Berger D |title=Evidence-Based Hernia Treatment in Adults |journal=Dtsch Arztebl Int |volume=113 |issue=9 |pages=150–7; quiz 158 |year=2016 |pmid=26987468 |pmc=4802357 |doi=10.3238/arztebl.2016.0150 |url=}}</ref><ref name="pmid18244999" />
@@ Line 430: / Line 430: @@
 |
 |-
-|
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |Scrotal oedema
 |
@@ Line 448: / Line 447: @@
 |
 |-
-|
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Sebaceous cyst]]
 |
@@ Line 466: / Line 464: @@
 |
 |-
-|
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Scrotum Carcinoma|Carcinoma of the scrotum]]
 |
@@ Line 484: / Line 481: @@
 |
 |-
-|
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[filariasis|Chylocele]] ([[Filariasis]])
 |
@@ Line 502: / Line 498: @@
 |
 |-
-|
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Congenital cystic dysplasia|Cystic dysplasia]]
 |
@@ Line 520: / Line 515: @@
 |
 |-
-|
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Srotoliths]]
 |

Scrotal mass differential diagnosis: Difference between revisions

Revision as of 17:03, 26 January 2019

Overview

Differential Diagnosis

References

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