TESTICULAR MASS

TESTICULAR MASS: Excerpt from Differential Diagnosis in Primary Care

Like that of most masses, the differential diagnosis of testicular masses is 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. Edema of the skin and subcutaneous tissue is found in cirrhosis, CHF, nephrosis, and filariasis. 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

	V	I	N	D
	Vascular	Inflammation	Neoplasm	Degenerative
Skin		Carbuncle	Carcinoma
Subcutaneous Tissue		Cellulitis
Tunica Vaginalis
Venous Plexus		Phlebitis	Obstruction from renal carcinoma
Testis		Orchitis Syphilis	Seminoma Chorioepithelioma
Epididymis		Bacterial epididymitis Tuberculosis
Artery	Torsion
Vas Deferens			Secondary to obstruction by carcinoma of prostate
Lymphatics		Filariasis

---

---

TESTICULAR MASS

I	C	A	T	E	O
Intoxication	Congenital	Allergic-	Trauma	Endocrine	Obstruction
		Autoimmune
		Urticaria	Contusion		Sebaceous cyst
			Direct inguinal hernia
	Indirect inguinal hernia Hydrocele		Hematoma
	Varicocele
	Teratoma Hydatid cyst of Morgagni
	Cyst				Spermatocele
	Torsion
					Prostate disease

---

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 transilluminate, 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. Serum alpha-fetoprotein beta-human chorionic gonadotropin (HCG) or lactic dehydrogenase (LDH) will be elevated in testicular tumors. Surgery may be the only way to differentiate the cause of the mass.

Other Useful Tests

1. CBC (orchitis)
2. Sedimentation rate (orchitis)
3. Urinalysis (urinary tract infection [UTI])
4. Urethral smear (infection)
5. Urine culture (UTI)
6. Urine gonadotropin (testicular tumor)
7. Prostatic fluid smear and culture (prostatitis)
8. Mumps skin test and serology (mumps orchitis)
9. Small-bowel series (hernia)
10. CT scan of the abdomen and pelvis (metastatic tumor)
11. Urology consult
12. Sonogram (torsion, hydrocele)
13. Radionuclide scan (torsion)
14. Prostate-specific antigen (PSA) (prostatic carcinoma)

Pictures

Book Source Details

• Book Title: Differential Diagnosis in Primary Care
• Author(s): R. Douglas Collins MD, FACP
• Year of Publication: 2007
• Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.

More About Testicular torsion

• Back to disease: Testicular torsion: Introduction
• Next Book Extract About Testicular torsion: Intoeing–Tibial Torsion (The 5-Minute Pediatric Consult)
• More Book Extracts: All Online Books for Testicular torsion

More Medical Textbooks Online about Testicular torsion

Review other book chapters online related to Testicular torsion:

Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Differential Diagnosis in Primary Care Authors: R. Douglas Collins MD, FACP Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 0-7817-6812-8

 » Next page: Intoeing–Tibial Torsion (The 5-Minute Pediatric Consult)

Rate This Website

What do you think about the features of this website? Take our user survey and have your say:

Website User Survey

Medical Tools & Articles:

Next articles:

• Intoeing–Tibial Torsion (The 5-Minute Pediatric Consult)
• Surveys relating to Testicular torsion
• Ask Question about Testicular torsion

Tools & Services:

• Bookmark this page
• Symptom Search
• Symptom Checker
• Medical Dictionary
• Give your feedback

Medical Articles:

• Disease & Treatments Search
• Misdiagnosis Center
• Full list of interesting articles

Forums & Message Boards

• Ask or answer a question at the Boards:
• I cannot get a diagnosis. Please help.
• Tell us your medical story.
• Share your misdiagnosis story.
• What is the best treatment for my condition?
• See all the Boards.

Enter your search terms Submit search form
Search The Web Search wrongdiagnosis.com