Scrotal mass overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sujit Routray, M.D. [2]
Overview
Scrotal mass may be classified into two subtypes: testicular and extratesticular.[1][2][3] Scrotal mass may be caused by tumor, infection, injury, inflammation, or fluid buildup, which can cause different types of masses.[4] 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.[1][2][3] Common differential diagnoses include yolk sac tumor, teratoma, choriocarcinoma, embryonal cell carcinoma, seminoma, and testicular lymphoma (usually non-Hodgkin lymphoma). If there is an acutely painful scrotum,there should be a strong suspicion for testicular torsion, which is an emergency condition, and emergent surgical referral should be strongly considered. Sonography may be performed if testicular torsion is not suspected to confirm the diagnosis.[5] According to the TNM classification and stage groupings, there are 3 stages of testicular cancer based on the size and extent of the primary tumor, number and location of any regional lymph nodes (abdominal retroperitoneal) infiltrated by tumor cells, distant metastasis, and serum tumor marker levels.[6] Symptoms related with scrotal mass will vary, depending on the cause of the mass, which include enlarged scrotum, painless or painful testicle lump, and feeling of heaviness in the scrotum.[7] Common physical examination findings of scrotal mass include a tender mass which is having a smooth, twisted, or irregular shape and liquid, firm, or solid in consistency. The ipsilateral inguinal lymph nodes may be enlarged or tender.[8] The laboratory findings related with scrotal mass may vary, depending on the cause of the mass. Laboratory findings consistent with the diagnosis of testicular tumors, may include elevated serum tumor markers such as AFP, LDH, or HCG. Imaging studies for scrotal mass include scrotal ultrasound, MRI, and chest x-ray.[9] Biopsy should be performed in patients with scrotal skin lesions to rule out skin cancer.[10]
Classification
Scrotal mass may be classified into two subtypes: testicular and extratesticular.[1][2][3]
Causes
Scrotal mass may be caused by tumor, infection, injury, inflammation, or fluid buildup, which can cause different types of masses.[4]
Differential Diagnosis
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.[1][2][3] Common differential diagnoses include yolk sac tumor, teratoma, choriocarcinoma, embryonal cell carcinoma, seminoma, and testicular lymphoma (usually non-Hodgkin lymphoma).
Epidemiology and Demographics
To know about the epidemiology and demographics of the testicular tumors which present as scrotal masses, click here.
Screening
According to the the U.S. Preventive Service Task Force (USPSTF), there is insufficient evidence to recommend routine screening for testicular cancer.[11]
Diagnosis
Evaluation of Scrotal Mass
If there is an acutely painful scrotum,there should be a strong suspicion for testicular torsion, which is an emergency condition, and emergent surgical referral should be strongly considered. Sonography may be performed if testicular torsion is not suspected to confirm the diagnosis.[5]
Staging
According to the TNM classification and stage groupings, there are 3 stages of testicular cancer based on the size and extent of the primary tumor, number and location of any regional lymph nodes (abdominal retroperitoneal) infiltrated by tumor cells, distant metastasis, and serum tumor marker levels.[6]
History and Symptoms
Symptoms related with scrotal mass will vary, depending on the cause of the mass, which include enlarged scrotum, painless or painful testicle lump, and feeling of heaviness in the scrotum.[7]
Physical Examination
Common physical examination findings of scrotal mass include a tender mass which is having a smooth, twisted, or irregular shape and liquid, firm, or solid in consistency. The ipsilateral inguinal lymph nodes may be enlarged or tender.[8]
Laboratory Studies
The laboratory findings related with scrotal mass may vary, depending on the cause of the mass. Laboratory findings consistent with the diagnosis of testicular tumors, may include elevated serum tumor markers such as AFP, LDH, or HCG.
Imaging
Imaging studies for scrotal mass include scrotal ultrasound, MRI, and chest x-ray.[9]
Biopsy
Biopsy should be performed in patients with scrotal skin lesions to rule out skin cancer.[10]
References
- ↑ 1.0 1.1 1.2 1.3 Extratesticular scrotal mass (differential). Radiopaedia 2016. Dr Matt A. Morgan et al. , Accessed on March 15, 2016
- ↑ 2.0 2.1 2.2 2.3 Unilateral testicular lesions. Dr Yuranga Weerakkody and Dr Vinod G Maller et al. Radiopaedia 2016. http://radiopaedia.org/articles/unilateral-testicular-lesions. Accessed on March 15, 2016
- ↑ 3.0 3.1 3.2 3.3 Bilateral testicular lesions. Radiopaedia 2016. Dr Matt A. Morgan and Dr Vinod G Maller et al. Radiopaedia 2016. http://radiopaedia.org/articles/bilateral-testicular-lesions. Accessed on March 15, 2016
- ↑ 4.0 4.1 Causes of scrotal masses. The Urology Group 2016. http://urologygroup.com/conditions-we-treat/scrotal-masses/. Accessed on March 17, 2016
- ↑ 5.0 5.1 Scrotal mass. American Academy of Family Physicians 2016. http://www.aafp.org/afp/2008/1115/p1165.html. Accessed on March 18, 2016
- ↑ 6.0 6.1 Staging testicular cancer. Canadian cancer society 2016. http://www.cancer.ca/en/cancer-information/cancer-type/testicular/staging/?region=on. Accessed on February 29, 2016
- ↑ 7.0 7.1 Symptoms of scrotal mass. US National Library of Medicine 2016. https://www.nlm.nih.gov/medlineplus/ency/article/001283.htm. Accessed on March 22, 2016
- ↑ 8.0 8.1 Exams and tests for scrotal mass. US National Library of Medicine 2016. https://www.nlm.nih.gov/medlineplus/ency/article/001283.htm. Accessed on March 22, 2016
- ↑ 9.0 9.1 Woodward, Paula J.; Schwab, Cornelia M.; Sesterhenn, Isabell A. (2003). "From the Archives of the AFIP". RadioGraphics. 23 (1): 215–240. doi:10.1148/rg.231025133. ISSN 0271-5333.
- ↑ 10.0 10.1 Crawford P, Crop JA (2014). "Evaluation of scrotal masses". Am Fam Physician. 89 (9): 723–7. PMID 24784335.
- ↑ Screening of testicular cancer. U.S. Preventive Service Task Force 2016. http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/testicular-cancer-screening?ds=1&s=testicular%20cancer