66 TESTICULAR MASSES General Discussion When evaluating a scrotal mass, it should be classified as extratesticular or intratesticular, solid or cystic, and painless or painful. Masses which arise from the testicle are more likely to represent malignancies, while extratesticular masses are more likely to be benign. Likewise, solid masses are much more likely to represent neoplastic conditions, especially when painless. Transillumination using a hand-held light source may help differentiate between solid and cystic structures. Extratesticular tumors are uncommon but do occur in the form of para-testicular rhabdomyosarcoma or adenomatoid tumors of the epididymis. Cystic lesions of the scrotum are much more common than solid lesions. A cystic mass within the epididymis is usually a spermatocele. A cyst within the spermatic cord usually represents a hydrocele. A cystic mass that surrounds the entire testicle usually represents a hydrocele. Although a careful physical examination may be diagnostic, confirmation using scrotal ultrasonography is recommended to confirm the location of the mass and to differentiate between solid and cystic lesions. A testicular tumor usually presents as a painless mass, though the patient may complain of scrotal heaviness or a dull ache. If testicular cancer is suspected, the patient should also be examined for lymphadenopathy, gynecomastia, and abdominal masses. A hydrocele is a collection of peritoneal fluid between the layers of the tunica vaginalis surrounding the testicle. A hydrocele usually presents as a painless scrotal swelling that can be transilluminated. The swelling often worsens during the course of the day, and the patient may complain of weight and bulk as a result of the hydrocele. A new hydrocele or one that hemorrhages as a result of minor trauma may indicate an underlying testicular cancer. A spermatocele usually presents as a painless cystic mass superior and posterior to the testis. This mass is separate from the testis, is freely mobile, and transilluminates easily. A varicocele is present in up to 20% of all males and is a tortuous and dilated pampiniform venous plexus and internal spermatic vein. Varicoceles often are described as a “bag of worms” superior to, and distinct from, the testicle. Varicoceles usually first appear near mid-puberty. Most varicoceles occur on the left side and often are asymptomatic, though they may cause male infertility. The dilatation and tortuosity are most noticeable when the patient is upright, and may be accentuated if the patient performs a Valsalva maneuver. Causes of Testicular Masses Acute orchitis Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: ARTHRITIS AND ARTHRALGIA HAIR LOSS HYPOTHYROIDISM SYNCOPE Stay updated, free articles. Join our Telegram channel Join Tags: Instant Work-ups A Clinical Guide to Medicine Aug 17, 2016 | Posted by admin in PEDIATRICS | Comments Off on TESTICULAR MASSES Full access? Get Clinical Tree
66 TESTICULAR MASSES General Discussion When evaluating a scrotal mass, it should be classified as extratesticular or intratesticular, solid or cystic, and painless or painful. Masses which arise from the testicle are more likely to represent malignancies, while extratesticular masses are more likely to be benign. Likewise, solid masses are much more likely to represent neoplastic conditions, especially when painless. Transillumination using a hand-held light source may help differentiate between solid and cystic structures. Extratesticular tumors are uncommon but do occur in the form of para-testicular rhabdomyosarcoma or adenomatoid tumors of the epididymis. Cystic lesions of the scrotum are much more common than solid lesions. A cystic mass within the epididymis is usually a spermatocele. A cyst within the spermatic cord usually represents a hydrocele. A cystic mass that surrounds the entire testicle usually represents a hydrocele. Although a careful physical examination may be diagnostic, confirmation using scrotal ultrasonography is recommended to confirm the location of the mass and to differentiate between solid and cystic lesions. A testicular tumor usually presents as a painless mass, though the patient may complain of scrotal heaviness or a dull ache. If testicular cancer is suspected, the patient should also be examined for lymphadenopathy, gynecomastia, and abdominal masses. A hydrocele is a collection of peritoneal fluid between the layers of the tunica vaginalis surrounding the testicle. A hydrocele usually presents as a painless scrotal swelling that can be transilluminated. The swelling often worsens during the course of the day, and the patient may complain of weight and bulk as a result of the hydrocele. A new hydrocele or one that hemorrhages as a result of minor trauma may indicate an underlying testicular cancer. A spermatocele usually presents as a painless cystic mass superior and posterior to the testis. This mass is separate from the testis, is freely mobile, and transilluminates easily. A varicocele is present in up to 20% of all males and is a tortuous and dilated pampiniform venous plexus and internal spermatic vein. Varicoceles often are described as a “bag of worms” superior to, and distinct from, the testicle. Varicoceles usually first appear near mid-puberty. Most varicoceles occur on the left side and often are asymptomatic, though they may cause male infertility. The dilatation and tortuosity are most noticeable when the patient is upright, and may be accentuated if the patient performs a Valsalva maneuver. Causes of Testicular Masses Acute orchitis Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: ARTHRITIS AND ARTHRALGIA HAIR LOSS HYPOTHYROIDISM SYNCOPE Stay updated, free articles. Join our Telegram channel Join Tags: Instant Work-ups A Clinical Guide to Medicine Aug 17, 2016 | Posted by admin in PEDIATRICS | Comments Off on TESTICULAR MASSES Full access? Get Clinical Tree
