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.

What are Scrotal Masses?

The scrotum contains the male testes, the sex organs that produce and store semen as well as the hormone testosterone. A scrotal mass is a lump or bulge that can be felt in the scrotum. There are several kinds of scrotal masses:

  • Hydrocele (non-cancerous): A mass or swelling from a buildup of fluid around the testicle. This swelling can occur after testicular injury or after hernia surgery.
  • Spermatocele (non-cancerous): A cyst-like growth that contains fluid and dead sperm cells, usually located in the epididymis (the coiled duct behind the testicle). It is more common among men who have had vasectomies or testicular injuries.
  • Epididymitis: Inflammation of the coiled tube behind the testicle that carries sperm to the vas deferens. This inflammation can form a tender lump or mass behind the testicle.
  • Varicocele: An enlargement of the veins behind the testicle, almost always on the left side. These distended veins, also known as varicose veins, are only present when standing and can cause a “heavy” sensation in the left testicle. Varicoceles are sometimes associated with infertility.
  • Testicular Cancer: Abnormal cells grown out of control in the testes, usually forming a hard lump in the testicle. Testicular cancer is less common than the other causes of scrotal masses, but it is the most serious.

What causes a Scrotal Mass?

The cause of a scrotal mass depends on the condition, though an infection, injury, or fluid buildup are all culprits.

Regarding testicular cancer, some issues may increase its probability. A family history of testicular cancer; the genetic disorder Klinefelter syndrome, which results in two or more X chromosomes; or an undescended testicle can all increase the probability of scrotal tumors.

What are the symptoms of Scrotal Masses?

The most common symptoms of scrotal masses include:

  • Pain in one or both testicles
  • Changes in the size or shape of one or both testes
  • A heavy feeling in the scrotum
  • A dull pressure or pain in the lower back, belly, groin or in all three places

How are Scrotal Masses diagnosed?

Many men detect scrotal masses during self-examination, though a physician may detect it during a routine physical exam. 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. A testicular tumor is too solid, but light will pass through a mass or swelling caused by a hydrocele, which is fluid. The physician will also examine the other testicle for lumps, masses, or other abnormalities.

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. These tests may include:

  • Blood test: To detect high levels of certain proteins that are often secreted by testicular cancer. These proteins include alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG).
  • Imaging or x-ray tests:
    • CT scan: An imaging scan that screens for and determines the extent of the disease, and if it has reached surrounding tissues or other organs.
    • Ultrasound: Images of the testes taken with a wand-like instrument called a transducer that emits sound waves and picks up the echoes as they bounce off organs.
  • Biopsy: Rarely performed given the risk for the spread of cancer; the affected testicle is almost always removed in its entirety for both diagnosis and treatment.

How are Scrotal Masses treated?

Depending on the condition, different treatments may be necessary:

  • Hydrocele: This fluid buildup generally does not require treatment. Hydrocele that become too large or bulky in the scrotum can be surgically removed.
  • Spermatocele: These growths also generally do not require treatment. If they become too large or tender they can be surgically removed.
  • Testicular cancer: Nearly all men with testicular cancer undergo surgery to remove the affected testicle, a procedure called radical inguinal orchiectomy.
  • Epididymitis: This condition is generally treated with antibiotics and anti-inflammatory medications.
  • Varicocele: Enlarged veins usually do not require treatment unless they are so large that they cause severe symptoms or infertility.