Materiały źródłowe

• #1 Scrotal masses – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/scrotal-masses/symptoms-causes/syc-20352604

  Scrotal masses are lumps or swelling in the scrotum, the bag of skin that holds the testicles. […] It’s key to get a scrotal mass checked by a health care professional, even if you don’t have pain or other symptoms. Some masses could be cancer. Or they could be caused by another medical condition that affects the health of the testicles and how well they work. […] See a health care professional if you notice a lump in your scrotum or other unusual changes. Get a checkup even if you have a mass that isn’t painful or tender. […] Many health conditions can cause a scrotal mass or an unusual change in the scrotum. These include: […] Testicular cancer. This is cancer that starts in the testicles. It often causes a painless lump or swelling in the scrotum. But some people with testicular cancer don’t have any symptoms. See your doctor or other health care professional if you notice a new lump in your scrotum.

• #1 Lump On Testicle (Scrotal Mass): Causes & Treatment

  https://my.clevelandclinic.org/health/symptoms/21026-scrotal-masses

  Lumps or swelling on your testicles (scrotal masses) are usually benign. But in rare cases, they may be a sign of cancer. A healthcare provider should examine your scrotum and testicles and order tests to determine the cause of any lumps or swelling. […] A testicular lump can be a symptom of other medical conditions, most of which aren’t serious. Most scrotal masses are benign (not cancerous). However, some testicle lumps can affect fertility. In some cases, they can even be a sign of a serious condition, such as testicular cancer. […] Call a healthcare provider right away to schedule an appointment if you notice a lump on your testicle. A provider can diagnose what kind of scrotal mass you have and, if necessary, recommend the most appropriate treatment. […] Testicular lumps are common. Most lumps you may discover on or around your testicles aren’t cancerous. But you should still schedule an appointment with a healthcare provider to get an official diagnosis and proper treatment, if necessary.

• #1 Scrotal masses – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/scrotal-masses/diagnosis-treatment/drc-20352609

  To find out what kind of scrotal mass you have, you may need tests such as: […] A physical exam. During this exam, a doctor or other health care professional feels your scrotum, its contents and nearby areas of the groin while you stand and lie down. […] Transillumination. Shining a bright light through the scrotum might provide information about the size, location and makeup of a scrotal mass. […] Ultrasound. This test uses sound waves to make an image of the inside of the body. It can provide detailed information about the size, location and makeup of a scrotal mass. It also can show the condition of the testicles. An ultrasound often is needed to diagnose a scrotal mass. […] Urine test. Lab tests of a sample of urine might find an infection caused by a virus or bacteria. A urine test also might detect the presence of blood or pus in the urine.

• #1 What Are Scrotal Masses? Causes, Symptoms, Diagnosis, Treatment, and More

  https://www.webmd.com/men/what-to-scrotal-masses

  How Are Scrotal Masses Diagnosed? […] When you go to a doctor with a lump on your testicle, they will first ask you about your medical history. Then, they will use the following tests to identify the cause of the epididymal mass: […] Blood or urine test: These tests show if you have an infection. They may also show signs of severe conditions like cancer. […] Physical exam: The doctor will touch the mass and feel its contents and hardness to identify what it may contain. […] Transillumination. This is a procedure in which a bright light is shone on your testicle. The doctor uses this to see the size and location of the mass. […] Imaging: A doctor can use ultrasound to check the lump’s location and rule out certain conditions, like cancer or a hernia.

• #1 Testicular Cancer Clinical Presentation: History, Physical, Causes

  https://emedicine.medscape.com/article/279007-clinical

  In patients with localized disease, painless swelling or a nodule in one testicle is the most common presenting sign. […] Any solid, firm mass within the testis should be considered testicular cancer until proven otherwise. Prompt diagnosis and early treatment are required for cure. […] Testicular cancer may be painless, in which case the patient may be unaware of its presence. In patients with scrotal pain, testicular cancer must be differentiated from epididymitis. The clinician should consider the full differential diagnosis of a testicular mass, which includes not only epididymitis but the following: Epididymo-orchitis, Testicular torsion, Hydrocele, Hernia, Hematoma, Spermatocele, Varicocele, Syphilitic gumma. […] Physical examination of the testicles is performed by fully palpating all areas of the testicle between thumb and fingers. Examination should begin with bimanual examination of the scrotal contents, starting with the normal testis. This permits the examiner to evaluate the relative size, contour, and consistency of the normal testis. Other areas of emphasis include examination of the abdomen for lymphadenopathy and hepatomegaly. The examination should also include evaluation for supraclavicular nodes, bone tenderness, and gynecomastia.

• #1 Evaluation of Scrotal Masses | AAFP

  https://www.aafp.org/pubs/afp/issues/2008/1115/p1165.html

  Any patient reporting swelling of the scrotum should be evaluated immediately. […] If testicular torsion is suspected, emergent surgical consultation with or without Doppler ultrasonography should be obtained. […] Color Doppler ultrasonography is the test of choice for immediate evaluation of scrotal masses. […] Because of potential emergencies (e.g., testicular torsion) and potentially life-threatening diseases (e.g., testicular carcinoma), any patient with a new or changing scrotal mass should be evaluated immediately in the office or emergency department. […] Careful physical examination should include attention to the location of the swelling in relation to the normal anatomic structures within the scrotum, and transillumination to check for testicular masses. […] Patients with suspected torsion should be evaluated emergently by a urologist, because surgery must be performed immediately to maximize the likelihood of salvaging the testis.

• #1 Diagnosing Scrotal Masses: Essential Tests And Procedures – Doral Health & Wellness NY

  https://doralhw.org/2024/10/21/diagnosing-scrotal-masses-essential-tests-and-procedures/

  Transillumination A transillumination test is a simple test where a light is shined through your scrotum to differentiate between fluid-filled and solid masses. Fluid-filled masses (like hydroceles) will allow light to pass through, whereas solid masses (like tumors) will not. […] Biopsy In cases where cancer is suspected, a testicular biopsy may be performed to analyze the tissue sample. However, a biopsy is generally avoided if cancer is suspected, as surgical removal of the entire testicle (orchiectomy) is the preferred method to avoid spreading cancer cells. […] CT Scan (Computed Tomography) If testicular cancer is suspected, a CT scan may be done to check for cancer spread (metastasis) to other areas of your body, such as the lymph nodes, lungs, or abdomen. […] These diagnostic tests will help your medical provider determine whether the mass is benign or malignant and whether additional treatment is necessary. If you notice any lumps or changes in your scrotum, its important to seek medical attention immediately. […] If you notice any lumps, swelling, pain, or changes in your scrotum, seek medical advice to ensure the proper diagnosis and treatment.

• #1 Scrotal Masses | The Urology Group

  https://www.urologygroup.com/condition/scrotal-masses/

  Cysts, inflammation and enlarged veins can all form masses in the scrotum, and many do not require treatment outside of medications. However, in some cases a scrotal mass could indicate testicular cancer. […] A scrotal mass is a lump or bulge that can be felt in the scrotum. […] Testicular cancer is less common than the other causes of scrotal masses, but it is the most serious. […] If a mass is found, the physician may recommend an ultrasound, or he/she might place a strong light behind the testicle to see whether light passes through. […] Any mass should be screened. Because other problems can cause symptoms similar to those of testicular cancer, the physician may order tests to screen out other problems, or to be sure the cancer has not spread. […] A testicular tumor is too solid, but light will pass through a mass or swelling caused by a hydrocele, which is fluid.

• #1 Evaluation of Scrotal Masses | AAFP

  https://www.aafp.org/pubs/afp/issues/2008/1115/p1165.html

  Ultrasonography with color Doppler imaging has become the accepted standard for evaluation of the acutely swollen scrotum. […] For the swollen testis, ultrasonography usually demonstrates normal parenchyma in cases of torsion and orchitis, and a heterogeneous appearance in carcinoma. […] When testicular torsion is suspected, emergent surgical consultation should be obtained before ultrasonography is performed, because surgical exploration as soon as possible is critical to salvaging the testis and should not be delayed for imaging unless the diagnosis is in doubt.

• #1 Evaluation of Scrotal Masses | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0501/p723.html

  Any patient presenting with acute scrotal pain and a mass or swelling should be evaluated for testicular torsion by scrotal ultrasonography or surgical exploration within six hours of symptom onset. […] Testicular torsion should be suspected in patients with rapid onset of acute unilateral scrotal pain and swelling, nausea or vomiting, high position of the testicle, and an abnormal cremasteric reflex. […] Ultrasonography can reliably differentiate extratesticular masses from intratesticular masses. […] In one study, experienced pediatric radiologists using high-resolution ultrasonography detected the twist of the spermatic cord in testicular torsion 96% of the time and reliably diagnosed other scrotal disorders. […] A study showed a C-reactive protein level of more than 24 mg per L (228.6 nmol per L) to be 96% sensitive and 85% specific for epididymitis/orchitis.

• #1

  https://link.springer.com/article/10.1007/BF02742924

  Ultrasound is the mainstay for imaging of the scrotum. It is used primarily for determining the location and nature of palpable lesions and to demonstrate nonpalpable lesions. Scrotal US is characterized by high sensitivity in the detection of intrascrotal abnormalities and is a very good mode for differentiating testicular from paratesticular lesions. […] However, scrotal US is limited in determining whether a focal testicular lesion is benign or malignant. The limitations of gray-scale US in the assessment of an acute scrotum and in particular of testicular torsion have now been overcome by color-coded duplex sonography and power Doppler.

• #1 Evaluation of Scrotal Masses | AAFP

  https://www.aafp.org/pubs/afp/issues/2008/1115/p1165.html

  Scrotal masses can represent a wide range of medical issues, from benign congenital conditions to life-threatening malignancies and acute surgical emergencies. […] Having a clear understanding of scrotal anatomy allows the examiner to accurately identify most lesions. […] Testicular swelling may be caused by orchitis, cancer, or testicular torsion. […] Testicular torsion has an acute onset, often with no antecedent trauma; the involved testis may be retracted and palpably rotated, and will be tender on examination. […] Although history and examination may suggest the diagnosis, testicular torsion can be reliably confirmed only with color Doppler ultrasonography, which must be obtained immediately. […] Because of the possibility of emergent and life-threatening causes, and because a swollen scrotum is usually of great concern to patients, immediate evaluation is always required.

• #1 Scrotal masses – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/scrotal-masses/diagnosis-treatment/drc-20352609

  Blood test. Lab tests of a blood sample might find a bacterial or viral infection. Or they might detect higher levels of certain proteins that are linked with testicular cancer. […] Computerized tomography (CT) scan. If other tests show you have testicular cancer, you’ll likely get this series of X-rays. A CT scan of your chest, stomach area and groin can check to see if cancer has spread to other tissues or organs. […] Treatment of a scrotal mass mainly depends on its cause. […] If your scrotal mass is caused by cancer that starts in a testicle, you’ll likely see a cancer doctor called an oncologist. The oncologist may recommend treatments based on whether the cancer is in the testicle or has spread to other body parts. Your age and overall health also are factors. […] The main treatment choices include:

• #1 Diagnosing Testicular Cancer | NYU Langone Health

  https://nyulangone.org/conditions/testicular-cancer/diagnosis

  A CT scan uses X-rays and a computer to create three-dimensional, cross-sectional images of the body. Your doctor may perform CT scans of your pelvis, abdomen, and chest to see if cancer has spread beyond the testicles. Sometimes, a special dye called a contrast agent is injected into the bloodstream to enhance the detail on the CT image.

• #1 Diagnosis and Treatment of Early-Stage Testicular Cancer: AUA Guideline – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/testicular-cancer-guideline

  12. In patients with newly diagnosed GCT, clinicians should obtain cross-sectional imaging of the abdomen and pelvis with IV contrast or MRI if CT is contraindicated. (Strong Recommendation; Evidence Level: Grade B) […] […] 13. Patients should be assigned a TNM-s category to guide management decisions. (Strong Recommendation; Evidence Level: Grade B) […] […] 14. Management decisions should be based on imaging obtained within the preceding 4 weeks and serum tumor markers (hCG and AFP) within the preceding 10 days. (Expert Opinion) […] […] 15. Management decisions should be made in a multidisciplinary setting involving experienced clinicians in urology, medical oncology, radiation oncology, pathology, and radiology. (Clinical Principle) […] […] 16. Expert review of pathologic specimens should be considered in clinical scenarios where treatment decisions will be impacted. (Moderate Recommendation; Evidence Level: Grade C) […]

• #1 Testicular tumours in children: an approach to diagnosis and management with pathologic correlation | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1186/s13244-020-00867-6

  Testicular tumours are rare in children. Painless scrotal mass is the most frequent clinical presentation. Tumoural markers (alpha-fetoprotein, beta-human gonadotropin chorionic) and hormone levels (testosterone) contribute to the diagnosis and management of a testicular mass in boys. Ultrasonography is the best imaging modality to study testicular tumours. A benign tumour is suggested when ultrasonography shows a mainly cystic component, well-defined borders, echogenic rim or normal to increased echogenicity lesion when compared to the healthy testicular parenchyma. Malignant tumour is suspected when ultrasonography shows inhomogeneous, hypoechoic, not well-circumscribed or diffuse infiltration lesion. […] Ultrasonography is the best imaging modality to diagnose testicular tumours. MR can be necessary as an adjunct method when scrotal US findings are uncertain.

• #1 EAU Guidelines on Testicular Cancer – Uroweb

  https://uroweb.org/guidelines/testicular-cancer/chapter/diagnostic-evaluation

  Testicular cancer usually presents as a painless testicular mass or incidental finding on ultrasound (US). Pain, either scrotal or abdominal/back, may occur and result in delayed diagnosis. […] High-frequency (10 MHz) testicular US is recommended. Scrotal US is also recommended for all men with retroperitoneal or visceral masses with/or without elevated serum -hCG or Alpha-fetoprotein (AFP) in the absence of a palpable testicular mass. […] Small, usually non-palpable incidental masses, may be incidental findings on scrotal US which may be benign. Of lesions with small diameter, virtually all 3mm, 87% of those 5mm, and 70% 10mm are benign. […] Scrotal magnetic resonance imaging (MRI) provides higher sensitivity and specificity than US in the diagnosis of TC, but its high cost does not justify its routine use for this purpose.

• #1

  https://www.beaumont.org/treatments/testicular-cancer-diagnosis

  Procedures for determining stage include the following: […] computed tomography scan (Also called a CT or CAT scan.) – a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays. […] magnetic resonance imaging (MRI) – a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.

• #1 Scrotal Lumps – TeachMeSurgery

  https://teachmesurgery.com/urology/presentations/scrotal-lumps/

  In those where testicular cancer is suspected, blood tests for testicular tumour markers may also be sent, including lactate dehydrogenase (LDH), alpha-fetoprotein (AFP), and beta-human chorionic gonadotrophin (beta-hCG). […] Ensure to assess for features of malignancy in all cases of scrotal swelling and send for urgent investigation if suspected.

• #1 EAU Guidelines on Testicular Cancer – Uroweb

  https://uroweb.org/guidelines/testicular-cancer/chapter/diagnostic-evaluation

  Serum AFP, beta subunit of human Chorionic Gonadotropin (-hCG) and LDH should be determined before orchidectomy as they support the diagnosis of TC and may be indicative of GCT histology. […] Tumour markers need to be repeated following orchidectomy providing staging and prognostic information. […] Orchidectomy including division of the spermatic cord at the internal inguinal ring represents the standard of care for patients with a TGTC. A scrotal approach should be avoided when TC is suspected as it results in a higher local recurrence rate. […] Testis-sparing surgery is a valid treatment option in men with interstitial cell or benign testicular tumours and may prevent hypogonadism and infertility in young men. […] In both settings, TSS should be offered together with frozen section examination (FSE).

• #1 Diagnosing Scrotal Masses: Essential Tests And Procedures – Doral Health & Wellness NY

  https://doralhw.org/2024/10/21/diagnosing-scrotal-masses-essential-tests-and-procedures/

  Diagnosing Scrotal Masses: Essential Tests and Procedures […] Scrotal masses are the abnormal growth or lump in your scrotum, the sac that holds your testicles. These masses can be caused by a variety of conditions, some of which are benign (non-cancerous), while others can be more serious. […] There are several procedures and tests that you need to undergo to properly diagnose your scrotal masses. These procedures help your medical providers accurately identify the nature, cause and the potential severity of your condition. The common tests and procedures can include: […] Medical History and Physical Exam […] Diagnostic Imaging […] Blood Tests […] Urinalysis A urine test is used to check for signs of infection or blood in your urine, which could indicate conditions such as epididymitis or urinary tract infections.

• #1 Scrotal mass differential diagnosis – wikidoc

  https://www.wikidoc.org/index.php/Scrotal_mass_differential_diagnosis

  Scrotal masses must be differentiated from other diseases that cause scrotal swelling, scrotal pain, such as testicular torsion, epididymitis, testicular tumors, inguinal herniation and many other diseases. […] The table below summarizes the findings that differentiates scrotal mass according to the clinical features, laboratory findings, imaging features, histological features, and genetic studies. […] Ultrasound for diagnosis (Testicular masses or swollen testicles with hypoechoic and hypervascular areas). […] Doppler ultrasound CT scan. […] Scrotal ultrasound shows the torsed appendage as a lesion of low echogenicity with a central hypoechogenic area. […] Scrotal wall may show the classical „blue dot” sign, which is due to infarction and necrosis of the appendix testis. […] Biopsy. […] Histological examination. […] The keratinocytes are pleomorphic with hyperchromatic nuclei. […] Numerous mitoses are present. […] Ultrasound demonstrates living worms which has been described as „filarial dance” sign.

• #1 Evaluation of Scrotal Masses | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0501/p723.html

  Scrotal masses are caused by a variety of disorders, ranging from benign conditions to those requiring emergent surgical intervention. Painful scrotal masses require urgent evaluation. Characteristics that suggest testicular torsion include rapid symptom onset, nausea and vomiting, high position of the testicle, and abnormal cremasteric reflex. Doppler ultrasonography or surgical exploration is required to confirm the diagnosis. Surgical repair must occur within six hours of symptom onset to reliably salvage the testicle. […] If ultrasonography shows an intratesticular mass, timely urology referral is indicated. […] A biopsy should be performed to rule out cancer in patients with scrotal skin lesions that are erosive, vascular, hyperkeratotic, or nonhealing, or that change color or have irregular borders.

• #1 Evaluation of Scrotal Masses | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0501/p723.html

  If repaired within six hours of symptom onset, the salvage rate of the testicle is as high as 80% to 100%; thus, clinicians should not delay surgical consultation if diagnostic imaging is not immediately available. […] Testicular malignancies cause pain in 15% of cases. […] Urgent referral to a urologist is indicated for patients with intratesticular masses, even though smaller masses are less likely to be cancerous. […] When cancer is a concern in a patient with a testicular mass, laboratory testing includes -fetoprotein, beta subunit of human chorionic gonadotropin, and lactate dehydrogenase levels. […] An incidental mass less than 5 mm in diameter in a patient with negative serum tumor markers is likely benign.

• #1 Evaluation of scrotal masses – PubMed

  https://pubmed.ncbi.nlm.nih.gov/24784335/

  Scrotal masses are caused by a variety of disorders, ranging from benign conditions to those requiring emergent surgical intervention. Painful scrotal masses require urgent evaluation. Characteristics that suggest testicular torsion include rapid symptom onset, nausea and vomiting, high position of the testicle, and abnormal cremasteric reflex. Doppler ultrasonography or surgical exploration is required to confirm the diagnosis. Surgical repair must occur within six hours of symptom onset to reliably salvage the testicle. […] Epididymitis/orchitis have a slower onset and are associated with a C-reactive protein level greater than 24 mg per L (228.6 nmol per L) and increased blood flow on ultrasonography. Acute onset of pain with near normal physical examination and ultrasound findings is consistent with torsion of the testicular appendage. Testicular malignancies cause pain in 15% of cases. If ultrasonography shows an intratesticular mass, timely urology referral is indicated. Inguinal hernias are palpated separate to the testicle and can cause pain. Emergent surgery is indicated for a strangulated hernia. Hydrocele, varicocele, and scrotal skin lesions may be managed in nonurgent settings. A biopsy should be performed to rule out cancer in patients with scrotal skin lesions that are erosive, vascular, hyperkeratotic, or nonhealing, or that change color or have irregular borders.

• #1 Scrotal masses – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/scrotal-masses/diagnosis-treatment/drc-20352609

  Radical inguinal orchiectomy. This is the main treatment for testicular cancer. It’s surgery to remove the affected testicle and the spermatic cord through a cut in the groin. Lymph nodes in your stomach area also might be removed if the cancer has spread to them. […] Chemotherapy. This uses powerful chemicals to kill cancer cells. Most often, you receive chemo through a needle in a vein. It’s often used to cure testicular cancer that has spread beyond the testicle. It also is used to lower the chances of the cancer coming back after a testicle is removed with surgery. Chemo isn’t a treatment for cancer that’s only in the testicle. […] Radiation therapy also may be used. It sends high-dose X-rays or other high-energy radiation to specific parts of the body. This can kill cancer cells or slow them from growing. With testicular cancer, the main use for radiation is to destroy cancer cells that have spread to the lymph nodes. Your provider may recommend this treatment after surgery to remove an affected testicle. […] Most cases of early testicular cancer can be cured. And even if the disease spreads beyond the testicle, it still may be curable. But you’ll need follow-up care to watch for signs that the cancer has come back.

• #1 Diagnosis & Staging – Testicular Cancer Society

  https://testicularcancersociety.org/pages/diagnosis-staging

  Transscrotal Biopsy is to be condemned and SHOULD NOT BE PERFORMED. The lymph system of the testicles drain into the abdomen while the lymph system of the scrotum drains into the lower legs. By doing a biopsy through the scrotum, cancerous cells can be left in the scrotum and the lymph drainage can be altered. This means that any cancer can spread in a way that is not as predictable as normal testicular cancer spread.

• #1 Diagnosis for Testicular Cancer | Cancer Council NSW

  https://www.cancercouncil.com.au/testicular-cancer/diagnosis/

  Your doctor will usually examine your testicles, scrotum and groin for a lump or swelling. […] If they find a lump that might be testicular cancer, you will have an ultrasound scan, and then you may have a blood test to look for tumour markers. However, a diagnosis of testicular cancer can only be made by removing the testicle for checking (orchidectomy). Most people will have a CT scan before surgery to see if the cancer has spread to other parts of the body. […] Early diagnosis and treatment can lead to better outcomes, so it is important to see your GP as soon as you notice a lump.

• #1 Testicular Cancer: Diagnosis and Treatment – University Cancer & Blood Center

  https://www.universitycancer.com/testicular-cancer-diagnosis-and-treatment/

  The most common sign of testicular cancer is a lump in the testicle. […] Doctors may use ultrasounds of your testicles to examine the location and nature of the lump. Blood tests can also be used to detect the proteins generated by testicular cancer cells. […] Diagnosing the type of testicular cancer and its stage is important for determining the proper treatment course. […] Once cancer has been diagnosed, doctors can use blood tests and computerized tomography (CT) scans to determine if it has spread beyond the testicle. […] The best treatment option will depend on the type and stage of testicular cancer you are diagnosed with.

• #1 Testicular Cancer Diagnosis | Testicular Cancer Testing | American Cancer Society

  https://www.cancer.org/cancer/types/testicular-cancer/detection-diagnosis-staging/how-diagnosed.html

  Ultrasound of the testicles is often the first test done if the doctor thinks you might have testicular cancer. […] Some blood tests can help diagnose testicular tumors. […] A testicular tumor might also increase the levels of an enzyme called lactate dehydrogenase (LDH). […] Most types of cancer are diagnosed by removing a small piece of the tumor and looking at it under a microscope for cancer cells. […] If testicular cancer is found, your doctor will order imaging tests of other parts of your body to check for spread outside the testicle. […] Imaging tests use x-rays, magnetic fields, sound waves, or radioactive substances to create pictures of the inside of your body.

• #1 How We Diagnose Testicular Cancer | Dana-Farber Cancer Institute

  https://www.dana-farber.org/cancer-care/types/testicular-cancer/diagnosis

  First, the doctor will examine your testicles for lumps or swelling. […] A blood test will be performed to test for certain proteins in your blood. These proteins are called tumor markers and can be used to diagnose testicular cancer. […] If the doctor thinks that you may have testicular cancer, the next step is to have an ultrasound, a quick and painless scan that looks at the inside of your testicles. […] If your blood test is positive for testicular cancer tumor markers, or if your ultrasound reveals a cancerous-appearing lump in your testicle, you will be referred to a specialist called a urologist. […] Unlike other cancers for which a biopsy (the removal of a sample of cells for examination) is performed, when testicular cancer is suspected the entire testicle is removed in a procedure called an orchiectomy through an incision in the groin and pulling the testicle up from the scrotum.

• #1 How We Diagnose Testicular Cancer | Dana-Farber Cancer Institute

  https://www.dana-farber.org/cancer-care/types/testicular-cancer/diagnosis

  Removing the entire testicle out of the scrotum is the only safe way to diagnose for testicular cancer. […] The removed testicle will be sent to our pathology laboratory for a thorough examination under a microscope. […] A pathologist is a specially trained doctor who identifies cancerous cells and tumors. […] Most testicular cancers are classified as germ cell tumors. […] In order to decide what treatment is best for you, it is important to know whether or not your testicular cancer has spread beyond the testicle. […] Testicular cancer is divided or staged into groups based on how far the cancer has spread to other parts of the body. […] Stage 1 means that the X-rays/CT scans do not show any evidence of cancer beyond the testicle. […] Stage 2 means that the CT scan has identified cancer that has spread beyond the testicle to the lymph nodes in the abdomen.

• #1 How We Diagnose Testicular Cancer | Dana-Farber Cancer Institute

  https://www.dana-farber.org/cancer-care/types/testicular-cancer/diagnosis

  Stage 3 means that the cancer has spread beyond the testicle and abdominal lymph nodes to additional areas in the body. […] If you have been diagnosed with testicular cancer by another doctor, and would like a second opinion, please contact us at Dana-Farber Brigham Cancer Center. […] Our expertise can be invaluable when deciding where to pursue treatment.

• #1 Diagnosis and Treatment of Early-Stage Testicular Cancer: AUA Guideline – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/testicular-cancer-guideline

  1. A solid mass in the testis identified by physical exam or imaging should be managed as a malignant neoplasm until proven otherwise. (Clinical Principle) […] […] 2. In a man with a solid mass in the testis suspicious for malignant neoplasm, serum tumor markers (AFP, hCG, and LDH) should be drawn and measured prior to any treatment, including orchiectomy. (Moderate Recommendation; Evidence Level: Grade C) […] […] 3. Scrotal ultrasound with Doppler should be obtained in patients with a unilateral or bilateral scrotal mass suspicious for neoplasm. (Strong Recommendation; Evidence Level: Grade B) […] […] 4. Testicular microlithiasis in the absence of solid mass and risk factors for developing a germ cell tumor (GCT) does not confer an increased risk of malignant neoplasm and does not require further evaluation. (Moderate Recommendation; Evidence Level: Grade C) […]

• #1 Diagnosis and Treatment of Early-Stage Testicular Cancer: AUA Guideline – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/testicular-cancer-guideline

  5. Patients with normal serum tumor markers (hCG and AFP) and indeterminate findings on physical exam or testicular ultrasound for testicular neoplasm should undergo repeat imaging in six to eight weeks. (Clinical Principle) […] […] 6. Magnetic Resonance Imaging (MRI) should not be used in the initial evaluation and diagnosis of a testicular lesion suspicious for neoplasm. (Moderate Recommendation; Evidence Level: Grade C) […] […] 7. Patients with a testicular lesion suspicious for malignant neoplasm and a normal contralateral testis should undergo a radical inguinal orchiectomy; testis-sparing surgery (TSS) is not recommended. Transscrotal orchiectomy is discouraged. (Strong Recommendation; Evidence Level: Grade B) […] […] 8. Patients who have undergone scrotal orchiectomy for malignant neoplasm should be counseled regarding the increased risk of local recurrence and may rarely be considered for adjunctive therapy (excision of scrotal scar or radiotherapy) for local control. (Moderate Recommendation; Evidence Level: Grade C) […]

• #1 Lump On Testicle (Scrotal Mass): Causes & Treatment

  https://my.clevelandclinic.org/health/symptoms/21026-scrotal-masses

  A healthcare provider will: Review your medical history. Ask questions about your symptoms and sexual health. Conduct a physical examination. […] They may also order several tests to identify the cause of the scrotal mass, including: Testicular ultrasound. A pelvic ultrasound is a noninvasive imaging test that can show the lumps location and help your provider rule out conditions such as a hernia or testicular cancer. […] With proper treatment, symptoms from testicular lumps can resolve. It’s important to seek treatment as soon as you notice any changes to your testicles to avoid any possible complications. […] Treatment for a scrotal lump depends on the cause. If your testicular lump doesn’t cause you any pain or discomfort and isn’t a sign of a serious condition, you might not need treatment. […] The earlier you see a healthcare provider to diagnose your scrotal mass, the better your chances of avoiding serious complications. […] It’s important to see a healthcare provider as soon as you notice a lump on your testicle.

• #1 Scrotal masses

  https://johnsonmemorial.org/jmh-health/disease-conditions/con-20303982

  Lab tests of a blood sample might find a bacterial or viral infection. Or they might detect higher levels of certain proteins that are linked with testicular cancer. […] If your scrotal mass is caused by cancer that starts in a testicle, you’ll likely see a cancer doctor called an oncologist. The oncologist may recommend treatments based on whether the cancer is in the testicle or has spread to other body parts. Your age and overall health also are factors.

• #1 Testicular Cancer: Symptoms, Signs, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/12183-testicular-cancer

  Testicular cancer isn’t preventable, but you can perform testicular self-exams (TSE) to identify changes in your testicles that you should bring to your provider’s attention. […] The prognosis for testicular cancer is excellent. This form of cancer is treated successfully in more than 95% of cases. […] Testicular cancer is curable. While a cancer diagnosis is always serious, the good news about testicular cancer is that it is treated successfully in 95% of cases. […] Don’t delay scheduling a provider visit if you notice a change in one or both testicles.

• #1 Testicular Cancer Screening | Finding Testicular Cancer Early | American Cancer Society

  https://www.cancer.org/cancer/types/testicular-cancer/detection-diagnosis-staging/detection.html

  Most testicular cancers can be found at an early stage, when they’re small and haven’t spread. […] Most doctors agree that examining a mans testicles should be part of a general physical exam during a routine check-up. […] The American Cancer Society advises men to be aware of testicular cancer and to see a doctor right away if they find a lump in a testicle. […] If your testicle seems larger, have a doctor examine you to be sure you have one of these conditions and not a tumor. The doctor may order an ultrasound exam (see Tests for Testicular Cancer). This is an easy and painless way of finding a tumor. […] Always report any changes to your doctor without delay.

• #2 Evaluation of Scrotal Masses | AAFP

  https://www.aafp.org/pubs/afp/issues/2008/1115/p1165.html

  Scrotal masses can represent a wide range of medical issues, from benign congenital conditions to life-threatening malignancies and acute surgical emergencies. […] Having a clear understanding of scrotal anatomy allows the examiner to accurately identify most lesions. […] Testicular swelling may be caused by orchitis, cancer, or testicular torsion. […] Testicular torsion has an acute onset, often with no antecedent trauma; the involved testis may be retracted and palpably rotated, and will be tender on examination. […] Although history and examination may suggest the diagnosis, testicular torsion can be reliably confirmed only with color Doppler ultrasonography, which must be obtained immediately. […] Because of the possibility of emergent and life-threatening causes, and because a swollen scrotum is usually of great concern to patients, immediate evaluation is always required.

• #2 A practical approach to diagnosing scrotal masses: correct diagnosis is most likely when knowledge of various scrotal lesions is combined with a thorough patient history and careful physical examination – Document – Gale Academic OneFile

  https://go.gale.com/ps/i.do?id=GALE%7CA108276400&sid=googleScholar&v=2.1&it=r&linkaccess=abs&issn=15471896&p=AONE&sw=w

  Scrotal masses are often found incidentally–a 24-year-old man discovers a mass while in the shower, a nursing home attendant feels a mass while bathing an elderly patient, a mother changing the diaper of a newborn notices scrotal enlargement, of a clinician palpates a mass during a routine examination. […] To differentiate emergent from nonemergent lesions, practitioners must be able to identify the various types of scrotal masses and distinguish those that are intratesticular from those that are extratesticular. […] This article will review the etiology, clinical presentation, diagnosis, and treatment of common scrotal masses. […] A thorough history will facilitate the correct diagnosis of a scrotal mass.

• #2 Testicular Cancer Clinical Presentation: History, Physical, Causes

  https://emedicine.medscape.com/article/279007-clinical

  In patients with localized disease, painless swelling or a nodule in one testicle is the most common presenting sign. […] Any solid, firm mass within the testis should be considered testicular cancer until proven otherwise. Prompt diagnosis and early treatment are required for cure. […] Testicular cancer may be painless, in which case the patient may be unaware of its presence. In patients with scrotal pain, testicular cancer must be differentiated from epididymitis. The clinician should consider the full differential diagnosis of a testicular mass, which includes not only epididymitis but the following: Epididymo-orchitis, Testicular torsion, Hydrocele, Hernia, Hematoma, Spermatocele, Varicocele, Syphilitic gumma. […] Physical examination of the testicles is performed by fully palpating all areas of the testicle between thumb and fingers. Examination should begin with bimanual examination of the scrotal contents, starting with the normal testis. This permits the examiner to evaluate the relative size, contour, and consistency of the normal testis. Other areas of emphasis include examination of the abdomen for lymphadenopathy and hepatomegaly. The examination should also include evaluation for supraclavicular nodes, bone tenderness, and gynecomastia.

• #2 Scrotal masses – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/scrotal-masses/diagnosis-treatment/drc-20352609

  To find out what kind of scrotal mass you have, you may need tests such as: […] A physical exam. During this exam, a doctor or other health care professional feels your scrotum, its contents and nearby areas of the groin while you stand and lie down. […] Transillumination. Shining a bright light through the scrotum might provide information about the size, location and makeup of a scrotal mass. […] Ultrasound. This test uses sound waves to make an image of the inside of the body. It can provide detailed information about the size, location and makeup of a scrotal mass. It also can show the condition of the testicles. An ultrasound often is needed to diagnose a scrotal mass. […] Urine test. Lab tests of a sample of urine might find an infection caused by a virus or bacteria. A urine test also might detect the presence of blood or pus in the urine.

• #2 Evaluation of Scrotal Masses | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0501/p723.html

  Any patient presenting with acute scrotal pain and a mass or swelling should be evaluated for testicular torsion by scrotal ultrasonography or surgical exploration within six hours of symptom onset. […] Testicular torsion should be suspected in patients with rapid onset of acute unilateral scrotal pain and swelling, nausea or vomiting, high position of the testicle, and an abnormal cremasteric reflex. […] Ultrasonography can reliably differentiate extratesticular masses from intratesticular masses. […] In one study, experienced pediatric radiologists using high-resolution ultrasonography detected the twist of the spermatic cord in testicular torsion 96% of the time and reliably diagnosed other scrotal disorders. […] A study showed a C-reactive protein level of more than 24 mg per L (228.6 nmol per L) to be 96% sensitive and 85% specific for epididymitis/orchitis.

• #2 Scrotal masses – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/scrotal-masses/diagnosis-treatment/drc-20352609

  Blood test. Lab tests of a blood sample might find a bacterial or viral infection. Or they might detect higher levels of certain proteins that are linked with testicular cancer. […] Computerized tomography (CT) scan. If other tests show you have testicular cancer, you’ll likely get this series of X-rays. A CT scan of your chest, stomach area and groin can check to see if cancer has spread to other tissues or organs. […] Treatment of a scrotal mass mainly depends on its cause. […] If your scrotal mass is caused by cancer that starts in a testicle, you’ll likely see a cancer doctor called an oncologist. The oncologist may recommend treatments based on whether the cancer is in the testicle or has spread to other body parts. Your age and overall health also are factors. […] The main treatment choices include:

• #2 Scrotal Lumps – TeachMeSurgery

  https://teachmesurgery.com/urology/presentations/scrotal-lumps/

  In those where testicular cancer is suspected, blood tests for testicular tumour markers may also be sent, including lactate dehydrogenase (LDH), alpha-fetoprotein (AFP), and beta-human chorionic gonadotrophin (beta-hCG). […] Ensure to assess for features of malignancy in all cases of scrotal swelling and send for urgent investigation if suspected.

• #2 EAU Guidelines on Testicular Cancer – Uroweb

  https://uroweb.org/guidelines/testicular-cancer/chapter/diagnostic-evaluation

  Serum AFP, beta subunit of human Chorionic Gonadotropin (-hCG) and LDH should be determined before orchidectomy as they support the diagnosis of TC and may be indicative of GCT histology. […] Tumour markers need to be repeated following orchidectomy providing staging and prognostic information. […] Orchidectomy including division of the spermatic cord at the internal inguinal ring represents the standard of care for patients with a TGTC. A scrotal approach should be avoided when TC is suspected as it results in a higher local recurrence rate. […] Testis-sparing surgery is a valid treatment option in men with interstitial cell or benign testicular tumours and may prevent hypogonadism and infertility in young men. […] In both settings, TSS should be offered together with frozen section examination (FSE).

• #2 Evaluation of scrotal masses – PubMed

  https://pubmed.ncbi.nlm.nih.gov/24784335/

  Scrotal masses are caused by a variety of disorders, ranging from benign conditions to those requiring emergent surgical intervention. Painful scrotal masses require urgent evaluation. Characteristics that suggest testicular torsion include rapid symptom onset, nausea and vomiting, high position of the testicle, and abnormal cremasteric reflex. Doppler ultrasonography or surgical exploration is required to confirm the diagnosis. Surgical repair must occur within six hours of symptom onset to reliably salvage the testicle. […] Epididymitis/orchitis have a slower onset and are associated with a C-reactive protein level greater than 24 mg per L (228.6 nmol per L) and increased blood flow on ultrasonography. Acute onset of pain with near normal physical examination and ultrasound findings is consistent with torsion of the testicular appendage. Testicular malignancies cause pain in 15% of cases. If ultrasonography shows an intratesticular mass, timely urology referral is indicated. Inguinal hernias are palpated separate to the testicle and can cause pain. Emergent surgery is indicated for a strangulated hernia. Hydrocele, varicocele, and scrotal skin lesions may be managed in nonurgent settings. A biopsy should be performed to rule out cancer in patients with scrotal skin lesions that are erosive, vascular, hyperkeratotic, or nonhealing, or that change color or have irregular borders.

• #2 Evaluation of Scrotal Masses | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0501/p723.html

  If repaired within six hours of symptom onset, the salvage rate of the testicle is as high as 80% to 100%; thus, clinicians should not delay surgical consultation if diagnostic imaging is not immediately available. […] Testicular malignancies cause pain in 15% of cases. […] Urgent referral to a urologist is indicated for patients with intratesticular masses, even though smaller masses are less likely to be cancerous. […] When cancer is a concern in a patient with a testicular mass, laboratory testing includes -fetoprotein, beta subunit of human chorionic gonadotropin, and lactate dehydrogenase levels. […] An incidental mass less than 5 mm in diameter in a patient with negative serum tumor markers is likely benign.

• #2 Testicular tumours in children: an approach to diagnosis and management with pathologic correlation | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1186/s13244-020-00867-6

  Testicular tumours are rare in children. Painless scrotal mass is the most frequent clinical presentation. Tumoural markers (alpha-fetoprotein, beta-human gonadotropin chorionic) and hormone levels (testosterone) contribute to the diagnosis and management of a testicular mass in boys. Ultrasonography is the best imaging modality to study testicular tumours. A benign tumour is suggested when ultrasonography shows a mainly cystic component, well-defined borders, echogenic rim or normal to increased echogenicity lesion when compared to the healthy testicular parenchyma. Malignant tumour is suspected when ultrasonography shows inhomogeneous, hypoechoic, not well-circumscribed or diffuse infiltration lesion. […] Ultrasonography is the best imaging modality to diagnose testicular tumours. MR can be necessary as an adjunct method when scrotal US findings are uncertain.

• #2 How We Diagnose Testicular Cancer | Dana-Farber Cancer Institute

  https://www.dana-farber.org/cancer-care/types/testicular-cancer/diagnosis

  First, the doctor will examine your testicles for lumps or swelling. […] A blood test will be performed to test for certain proteins in your blood. These proteins are called tumor markers and can be used to diagnose testicular cancer. […] If the doctor thinks that you may have testicular cancer, the next step is to have an ultrasound, a quick and painless scan that looks at the inside of your testicles. […] If your blood test is positive for testicular cancer tumor markers, or if your ultrasound reveals a cancerous-appearing lump in your testicle, you will be referred to a specialist called a urologist. […] Unlike other cancers for which a biopsy (the removal of a sample of cells for examination) is performed, when testicular cancer is suspected the entire testicle is removed in a procedure called an orchiectomy through an incision in the groin and pulling the testicle up from the scrotum.

• #2 How We Diagnose Testicular Cancer | Dana-Farber Cancer Institute

  https://www.dana-farber.org/cancer-care/types/testicular-cancer/diagnosis

  Removing the entire testicle out of the scrotum is the only safe way to diagnose for testicular cancer. […] The removed testicle will be sent to our pathology laboratory for a thorough examination under a microscope. […] A pathologist is a specially trained doctor who identifies cancerous cells and tumors. […] Most testicular cancers are classified as germ cell tumors. […] In order to decide what treatment is best for you, it is important to know whether or not your testicular cancer has spread beyond the testicle. […] Testicular cancer is divided or staged into groups based on how far the cancer has spread to other parts of the body. […] Stage 1 means that the X-rays/CT scans do not show any evidence of cancer beyond the testicle. […] Stage 2 means that the CT scan has identified cancer that has spread beyond the testicle to the lymph nodes in the abdomen.

• #2 Diagnosis and Treatment of Early-Stage Testicular Cancer: AUA Guideline – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/testicular-cancer-guideline

  1. A solid mass in the testis identified by physical exam or imaging should be managed as a malignant neoplasm until proven otherwise. (Clinical Principle) […] […] 2. In a man with a solid mass in the testis suspicious for malignant neoplasm, serum tumor markers (AFP, hCG, and LDH) should be drawn and measured prior to any treatment, including orchiectomy. (Moderate Recommendation; Evidence Level: Grade C) […] […] 3. Scrotal ultrasound with Doppler should be obtained in patients with a unilateral or bilateral scrotal mass suspicious for neoplasm. (Strong Recommendation; Evidence Level: Grade B) […] […] 4. Testicular microlithiasis in the absence of solid mass and risk factors for developing a germ cell tumor (GCT) does not confer an increased risk of malignant neoplasm and does not require further evaluation. (Moderate Recommendation; Evidence Level: Grade C) […]

• #2 Scrotal masses – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/scrotal-masses/diagnosis-treatment/drc-20352609

  Radical inguinal orchiectomy. This is the main treatment for testicular cancer. It’s surgery to remove the affected testicle and the spermatic cord through a cut in the groin. Lymph nodes in your stomach area also might be removed if the cancer has spread to them. […] Chemotherapy. This uses powerful chemicals to kill cancer cells. Most often, you receive chemo through a needle in a vein. It’s often used to cure testicular cancer that has spread beyond the testicle. It also is used to lower the chances of the cancer coming back after a testicle is removed with surgery. Chemo isn’t a treatment for cancer that’s only in the testicle. […] Radiation therapy also may be used. It sends high-dose X-rays or other high-energy radiation to specific parts of the body. This can kill cancer cells or slow them from growing. With testicular cancer, the main use for radiation is to destroy cancer cells that have spread to the lymph nodes. Your provider may recommend this treatment after surgery to remove an affected testicle. […] Most cases of early testicular cancer can be cured. And even if the disease spreads beyond the testicle, it still may be curable. But you’ll need follow-up care to watch for signs that the cancer has come back.

• #3 Evaluation of Scrotal Masses | AAFP

  https://www.aafp.org/pubs/afp/issues/2008/1115/p1165.html

  Any patient reporting swelling of the scrotum should be evaluated immediately. […] If testicular torsion is suspected, emergent surgical consultation with or without Doppler ultrasonography should be obtained. […] Color Doppler ultrasonography is the test of choice for immediate evaluation of scrotal masses. […] Because of potential emergencies (e.g., testicular torsion) and potentially life-threatening diseases (e.g., testicular carcinoma), any patient with a new or changing scrotal mass should be evaluated immediately in the office or emergency department. […] Careful physical examination should include attention to the location of the swelling in relation to the normal anatomic structures within the scrotum, and transillumination to check for testicular masses. […] Patients with suspected torsion should be evaluated emergently by a urologist, because surgery must be performed immediately to maximize the likelihood of salvaging the testis.

• #3 Testicular Cancer Clinical Presentation: History, Physical, Causes

  https://emedicine.medscape.com/article/279007-clinical

  In patients with localized disease, painless swelling or a nodule in one testicle is the most common presenting sign. […] Any solid, firm mass within the testis should be considered testicular cancer until proven otherwise. Prompt diagnosis and early treatment are required for cure. […] Testicular cancer may be painless, in which case the patient may be unaware of its presence. In patients with scrotal pain, testicular cancer must be differentiated from epididymitis. The clinician should consider the full differential diagnosis of a testicular mass, which includes not only epididymitis but the following: Epididymo-orchitis, Testicular torsion, Hydrocele, Hernia, Hematoma, Spermatocele, Varicocele, Syphilitic gumma. […] Physical examination of the testicles is performed by fully palpating all areas of the testicle between thumb and fingers. Examination should begin with bimanual examination of the scrotal contents, starting with the normal testis. This permits the examiner to evaluate the relative size, contour, and consistency of the normal testis. Other areas of emphasis include examination of the abdomen for lymphadenopathy and hepatomegaly. The examination should also include evaluation for supraclavicular nodes, bone tenderness, and gynecomastia.

• #3 Scrotal masses – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/scrotal-masses/diagnosis-treatment/drc-20352609

  To find out what kind of scrotal mass you have, you may need tests such as: […] A physical exam. During this exam, a doctor or other health care professional feels your scrotum, its contents and nearby areas of the groin while you stand and lie down. […] Transillumination. Shining a bright light through the scrotum might provide information about the size, location and makeup of a scrotal mass. […] Ultrasound. This test uses sound waves to make an image of the inside of the body. It can provide detailed information about the size, location and makeup of a scrotal mass. It also can show the condition of the testicles. An ultrasound often is needed to diagnose a scrotal mass. […] Urine test. Lab tests of a sample of urine might find an infection caused by a virus or bacteria. A urine test also might detect the presence of blood or pus in the urine.

• #3 Evaluation of Scrotal Masses | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0501/p723.html

  Any patient presenting with acute scrotal pain and a mass or swelling should be evaluated for testicular torsion by scrotal ultrasonography or surgical exploration within six hours of symptom onset. […] Testicular torsion should be suspected in patients with rapid onset of acute unilateral scrotal pain and swelling, nausea or vomiting, high position of the testicle, and an abnormal cremasteric reflex. […] Ultrasonography can reliably differentiate extratesticular masses from intratesticular masses. […] In one study, experienced pediatric radiologists using high-resolution ultrasonography detected the twist of the spermatic cord in testicular torsion 96% of the time and reliably diagnosed other scrotal disorders. […] A study showed a C-reactive protein level of more than 24 mg per L (228.6 nmol per L) to be 96% sensitive and 85% specific for epididymitis/orchitis.

• #3 Scrotal Lumps – TeachMeSurgery

  https://teachmesurgery.com/urology/presentations/scrotal-lumps/

  In those where testicular cancer is suspected, blood tests for testicular tumour markers may also be sent, including lactate dehydrogenase (LDH), alpha-fetoprotein (AFP), and beta-human chorionic gonadotrophin (beta-hCG). […] Ensure to assess for features of malignancy in all cases of scrotal swelling and send for urgent investigation if suspected.

• #3 Evaluation of scrotal masses – PubMed

  https://pubmed.ncbi.nlm.nih.gov/24784335/

  Scrotal masses are caused by a variety of disorders, ranging from benign conditions to those requiring emergent surgical intervention. Painful scrotal masses require urgent evaluation. Characteristics that suggest testicular torsion include rapid symptom onset, nausea and vomiting, high position of the testicle, and abnormal cremasteric reflex. Doppler ultrasonography or surgical exploration is required to confirm the diagnosis. Surgical repair must occur within six hours of symptom onset to reliably salvage the testicle. […] Epididymitis/orchitis have a slower onset and are associated with a C-reactive protein level greater than 24 mg per L (228.6 nmol per L) and increased blood flow on ultrasonography. Acute onset of pain with near normal physical examination and ultrasound findings is consistent with torsion of the testicular appendage. Testicular malignancies cause pain in 15% of cases. If ultrasonography shows an intratesticular mass, timely urology referral is indicated. Inguinal hernias are palpated separate to the testicle and can cause pain. Emergent surgery is indicated for a strangulated hernia. Hydrocele, varicocele, and scrotal skin lesions may be managed in nonurgent settings. A biopsy should be performed to rule out cancer in patients with scrotal skin lesions that are erosive, vascular, hyperkeratotic, or nonhealing, or that change color or have irregular borders.

• #3 Testicular tumours in children: an approach to diagnosis and management with pathologic correlation | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1186/s13244-020-00867-6

  Testicular tumours are rare in children. Painless scrotal mass is the most frequent clinical presentation. Tumoural markers (alpha-fetoprotein, beta-human gonadotropin chorionic) and hormone levels (testosterone) contribute to the diagnosis and management of a testicular mass in boys. Ultrasonography is the best imaging modality to study testicular tumours. A benign tumour is suggested when ultrasonography shows a mainly cystic component, well-defined borders, echogenic rim or normal to increased echogenicity lesion when compared to the healthy testicular parenchyma. Malignant tumour is suspected when ultrasonography shows inhomogeneous, hypoechoic, not well-circumscribed or diffuse infiltration lesion. […] Ultrasonography is the best imaging modality to diagnose testicular tumours. MR can be necessary as an adjunct method when scrotal US findings are uncertain.

• #3 How We Diagnose Testicular Cancer | Dana-Farber Cancer Institute

  https://www.dana-farber.org/cancer-care/types/testicular-cancer/diagnosis

  First, the doctor will examine your testicles for lumps or swelling. […] A blood test will be performed to test for certain proteins in your blood. These proteins are called tumor markers and can be used to diagnose testicular cancer. […] If the doctor thinks that you may have testicular cancer, the next step is to have an ultrasound, a quick and painless scan that looks at the inside of your testicles. […] If your blood test is positive for testicular cancer tumor markers, or if your ultrasound reveals a cancerous-appearing lump in your testicle, you will be referred to a specialist called a urologist. […] Unlike other cancers for which a biopsy (the removal of a sample of cells for examination) is performed, when testicular cancer is suspected the entire testicle is removed in a procedure called an orchiectomy through an incision in the groin and pulling the testicle up from the scrotum.

• #3 How We Diagnose Testicular Cancer | Dana-Farber Cancer Institute

  https://www.dana-farber.org/cancer-care/types/testicular-cancer/diagnosis

  Removing the entire testicle out of the scrotum is the only safe way to diagnose for testicular cancer. […] The removed testicle will be sent to our pathology laboratory for a thorough examination under a microscope. […] A pathologist is a specially trained doctor who identifies cancerous cells and tumors. […] Most testicular cancers are classified as germ cell tumors. […] In order to decide what treatment is best for you, it is important to know whether or not your testicular cancer has spread beyond the testicle. […] Testicular cancer is divided or staged into groups based on how far the cancer has spread to other parts of the body. […] Stage 1 means that the X-rays/CT scans do not show any evidence of cancer beyond the testicle. […] Stage 2 means that the CT scan has identified cancer that has spread beyond the testicle to the lymph nodes in the abdomen.

• #3 Diagnosis and Treatment of Early-Stage Testicular Cancer: AUA Guideline – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/testicular-cancer-guideline

  1. A solid mass in the testis identified by physical exam or imaging should be managed as a malignant neoplasm until proven otherwise. (Clinical Principle) […] […] 2. In a man with a solid mass in the testis suspicious for malignant neoplasm, serum tumor markers (AFP, hCG, and LDH) should be drawn and measured prior to any treatment, including orchiectomy. (Moderate Recommendation; Evidence Level: Grade C) […] […] 3. Scrotal ultrasound with Doppler should be obtained in patients with a unilateral or bilateral scrotal mass suspicious for neoplasm. (Strong Recommendation; Evidence Level: Grade B) […] […] 4. Testicular microlithiasis in the absence of solid mass and risk factors for developing a germ cell tumor (GCT) does not confer an increased risk of malignant neoplasm and does not require further evaluation. (Moderate Recommendation; Evidence Level: Grade C) […]

• #3 Scrotal masses – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/scrotal-masses/diagnosis-treatment/drc-20352609

  Radical inguinal orchiectomy. This is the main treatment for testicular cancer. It’s surgery to remove the affected testicle and the spermatic cord through a cut in the groin. Lymph nodes in your stomach area also might be removed if the cancer has spread to them. […] Chemotherapy. This uses powerful chemicals to kill cancer cells. Most often, you receive chemo through a needle in a vein. It’s often used to cure testicular cancer that has spread beyond the testicle. It also is used to lower the chances of the cancer coming back after a testicle is removed with surgery. Chemo isn’t a treatment for cancer that’s only in the testicle. […] Radiation therapy also may be used. It sends high-dose X-rays or other high-energy radiation to specific parts of the body. This can kill cancer cells or slow them from growing. With testicular cancer, the main use for radiation is to destroy cancer cells that have spread to the lymph nodes. Your provider may recommend this treatment after surgery to remove an affected testicle. […] Most cases of early testicular cancer can be cured. And even if the disease spreads beyond the testicle, it still may be curable. But you’ll need follow-up care to watch for signs that the cancer has come back.

• #4 Evaluation of Scrotal Masses | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0501/p723.html

  Any patient presenting with acute scrotal pain and a mass or swelling should be evaluated for testicular torsion by scrotal ultrasonography or surgical exploration within six hours of symptom onset. […] Testicular torsion should be suspected in patients with rapid onset of acute unilateral scrotal pain and swelling, nausea or vomiting, high position of the testicle, and an abnormal cremasteric reflex. […] Ultrasonography can reliably differentiate extratesticular masses from intratesticular masses. […] In one study, experienced pediatric radiologists using high-resolution ultrasonography detected the twist of the spermatic cord in testicular torsion 96% of the time and reliably diagnosed other scrotal disorders. […] A study showed a C-reactive protein level of more than 24 mg per L (228.6 nmol per L) to be 96% sensitive and 85% specific for epididymitis/orchitis.

• #4 Evaluation of scrotal masses – PubMed

  https://pubmed.ncbi.nlm.nih.gov/24784335/

  Scrotal masses are caused by a variety of disorders, ranging from benign conditions to those requiring emergent surgical intervention. Painful scrotal masses require urgent evaluation. Characteristics that suggest testicular torsion include rapid symptom onset, nausea and vomiting, high position of the testicle, and abnormal cremasteric reflex. Doppler ultrasonography or surgical exploration is required to confirm the diagnosis. Surgical repair must occur within six hours of symptom onset to reliably salvage the testicle. […] Epididymitis/orchitis have a slower onset and are associated with a C-reactive protein level greater than 24 mg per L (228.6 nmol per L) and increased blood flow on ultrasonography. Acute onset of pain with near normal physical examination and ultrasound findings is consistent with torsion of the testicular appendage. Testicular malignancies cause pain in 15% of cases. If ultrasonography shows an intratesticular mass, timely urology referral is indicated. Inguinal hernias are palpated separate to the testicle and can cause pain. Emergent surgery is indicated for a strangulated hernia. Hydrocele, varicocele, and scrotal skin lesions may be managed in nonurgent settings. A biopsy should be performed to rule out cancer in patients with scrotal skin lesions that are erosive, vascular, hyperkeratotic, or nonhealing, or that change color or have irregular borders.

• #4 Testicular tumours in children: an approach to diagnosis and management with pathologic correlation | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1186/s13244-020-00867-6

  Testicular tumours are rare in children. Painless scrotal mass is the most frequent clinical presentation. Tumoural markers (alpha-fetoprotein, beta-human gonadotropin chorionic) and hormone levels (testosterone) contribute to the diagnosis and management of a testicular mass in boys. Ultrasonography is the best imaging modality to study testicular tumours. A benign tumour is suggested when ultrasonography shows a mainly cystic component, well-defined borders, echogenic rim or normal to increased echogenicity lesion when compared to the healthy testicular parenchyma. Malignant tumour is suspected when ultrasonography shows inhomogeneous, hypoechoic, not well-circumscribed or diffuse infiltration lesion. […] Ultrasonography is the best imaging modality to diagnose testicular tumours. MR can be necessary as an adjunct method when scrotal US findings are uncertain.

• #4 How We Diagnose Testicular Cancer | Dana-Farber Cancer Institute

  https://www.dana-farber.org/cancer-care/types/testicular-cancer/diagnosis

  Removing the entire testicle out of the scrotum is the only safe way to diagnose for testicular cancer. […] The removed testicle will be sent to our pathology laboratory for a thorough examination under a microscope. […] A pathologist is a specially trained doctor who identifies cancerous cells and tumors. […] Most testicular cancers are classified as germ cell tumors. […] In order to decide what treatment is best for you, it is important to know whether or not your testicular cancer has spread beyond the testicle. […] Testicular cancer is divided or staged into groups based on how far the cancer has spread to other parts of the body. […] Stage 1 means that the X-rays/CT scans do not show any evidence of cancer beyond the testicle. […] Stage 2 means that the CT scan has identified cancer that has spread beyond the testicle to the lymph nodes in the abdomen.

• #4 Diagnosis and Treatment of Early-Stage Testicular Cancer: AUA Guideline – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/testicular-cancer-guideline

  1. A solid mass in the testis identified by physical exam or imaging should be managed as a malignant neoplasm until proven otherwise. (Clinical Principle) […] […] 2. In a man with a solid mass in the testis suspicious for malignant neoplasm, serum tumor markers (AFP, hCG, and LDH) should be drawn and measured prior to any treatment, including orchiectomy. (Moderate Recommendation; Evidence Level: Grade C) […] […] 3. Scrotal ultrasound with Doppler should be obtained in patients with a unilateral or bilateral scrotal mass suspicious for neoplasm. (Strong Recommendation; Evidence Level: Grade B) […] […] 4. Testicular microlithiasis in the absence of solid mass and risk factors for developing a germ cell tumor (GCT) does not confer an increased risk of malignant neoplasm and does not require further evaluation. (Moderate Recommendation; Evidence Level: Grade C) […]

• #4 Scrotal masses – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/scrotal-masses/diagnosis-treatment/drc-20352609

  Radical inguinal orchiectomy. This is the main treatment for testicular cancer. It’s surgery to remove the affected testicle and the spermatic cord through a cut in the groin. Lymph nodes in your stomach area also might be removed if the cancer has spread to them. […] Chemotherapy. This uses powerful chemicals to kill cancer cells. Most often, you receive chemo through a needle in a vein. It’s often used to cure testicular cancer that has spread beyond the testicle. It also is used to lower the chances of the cancer coming back after a testicle is removed with surgery. Chemo isn’t a treatment for cancer that’s only in the testicle. […] Radiation therapy also may be used. It sends high-dose X-rays or other high-energy radiation to specific parts of the body. This can kill cancer cells or slow them from growing. With testicular cancer, the main use for radiation is to destroy cancer cells that have spread to the lymph nodes. Your provider may recommend this treatment after surgery to remove an affected testicle. […] Most cases of early testicular cancer can be cured. And even if the disease spreads beyond the testicle, it still may be curable. But you’ll need follow-up care to watch for signs that the cancer has come back.

• #5 Evaluation of scrotal masses – PubMed

  https://pubmed.ncbi.nlm.nih.gov/24784335/

  Scrotal masses are caused by a variety of disorders, ranging from benign conditions to those requiring emergent surgical intervention. Painful scrotal masses require urgent evaluation. Characteristics that suggest testicular torsion include rapid symptom onset, nausea and vomiting, high position of the testicle, and abnormal cremasteric reflex. Doppler ultrasonography or surgical exploration is required to confirm the diagnosis. Surgical repair must occur within six hours of symptom onset to reliably salvage the testicle. […] Epididymitis/orchitis have a slower onset and are associated with a C-reactive protein level greater than 24 mg per L (228.6 nmol per L) and increased blood flow on ultrasonography. Acute onset of pain with near normal physical examination and ultrasound findings is consistent with torsion of the testicular appendage. Testicular malignancies cause pain in 15% of cases. If ultrasonography shows an intratesticular mass, timely urology referral is indicated. Inguinal hernias are palpated separate to the testicle and can cause pain. Emergent surgery is indicated for a strangulated hernia. Hydrocele, varicocele, and scrotal skin lesions may be managed in nonurgent settings. A biopsy should be performed to rule out cancer in patients with scrotal skin lesions that are erosive, vascular, hyperkeratotic, or nonhealing, or that change color or have irregular borders.

• #6 Evaluation of scrotal masses – PubMed

  https://pubmed.ncbi.nlm.nih.gov/24784335/

  Scrotal masses are caused by a variety of disorders, ranging from benign conditions to those requiring emergent surgical intervention. Painful scrotal masses require urgent evaluation. Characteristics that suggest testicular torsion include rapid symptom onset, nausea and vomiting, high position of the testicle, and abnormal cremasteric reflex. Doppler ultrasonography or surgical exploration is required to confirm the diagnosis. Surgical repair must occur within six hours of symptom onset to reliably salvage the testicle. […] Epididymitis/orchitis have a slower onset and are associated with a C-reactive protein level greater than 24 mg per L (228.6 nmol per L) and increased blood flow on ultrasonography. Acute onset of pain with near normal physical examination and ultrasound findings is consistent with torsion of the testicular appendage. Testicular malignancies cause pain in 15% of cases. If ultrasonography shows an intratesticular mass, timely urology referral is indicated. Inguinal hernias are palpated separate to the testicle and can cause pain. Emergent surgery is indicated for a strangulated hernia. Hydrocele, varicocele, and scrotal skin lesions may be managed in nonurgent settings. A biopsy should be performed to rule out cancer in patients with scrotal skin lesions that are erosive, vascular, hyperkeratotic, or nonhealing, or that change color or have irregular borders.

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