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testicular swelling; testicular mass
Etiology:
- hydrocele
- epididymitis, orchitis
- genitourinary tuberculosis
- varicocele
- inguinal hernia
- testicular cancer
- primary testicular lymphoma (most common in men > 60 years)
- germ-cell tumors (seminoma)
- rhabdomyosarcoma
- stromal tumors
- genitourinary sarcoidosis
- pharmaceuticals (bilateral, may be better labeled macroorchidism)
- tricyclic antidepressants
Clinical manifestations:
- hydocele & testicular cancer may be painless
- epididymitis & orchitis likey associated with some pain
Laboratory:
prior to histologic diagnosis (levels fall after orchiectomy)
- beta-chorionic gonadotropin in serum
- alpha-fetoprotein in serum [2]
* alpha-fetoprotein in serum is never elevated in pure seminomas
* beta-chorionic gonadotropin in serum is elevated in ~20% of pure seminomas [2]
Special laboratory:
- testicular ultrasonography
- heterogenous, hypoechoic testicular mass most likely testicular cancer
Management:
- depends upon etiology
- trial of antibiotics for suspected infectious etiology
- orchiectomy may be necessary for tissue diagnosis
Related
macroorchidism
testis
General
scrotal pain/mass (testicular pain, testicular torsion)
References
- Thompson RW, Yu H, Dahl DM et al
Case 10-2018: An 84-Year-Old Man with Painless Unilateral
Testicular Swelling.
N Engl J Med 2018; 378:1233-1240
PMID: 29590543
http://www.nejm.org/doi/full/10.1056/NEJMcpc1712224
- Medical Knowledge Self Assessment Program (MKSAP) 18,
American College of Physicians, Philadelphia 2018