Presentation
Left-sided painless scrotal swelling.
Patient Data
The left testis is enlarged and almost replaced by a heterogenous mainly hypoechoic lesion showing internal vascularity with area of necrosis measuring about 5.7 x 5.7 x 8 cm (155 mL in volume) suggesting testicular malignancy.
Complimentary abdominal ultrasound shows a left para-aortic, irregular, hypoechoic mass suggesting metastatic lymph nodes measuring about 5.6 x 5.7 cm.
The right testis, epididymal head, and the visualized part of the left epididymal head appear of normal size, shape and echogenicity without focal lesion.
Mild left-sided hydrocele is noted measuring about 4.6 x 3.8 x 6.1 cm (54 mL in volume).
Minimal non-significant right-sided hydrocele is noted.
Case Discussion
Testicular cancers are divided into seminomas and non-seminomas. The exact etiology of testicular cancer is unknown, but studies show that if the patient has undescended testis, he is at increased risk of testicular cancer.
Testicular cancers are initially evaluated by clinical exam and ultrasonography, and there are multiple treatment methods that available for this certain type of testicular cancers.
The following non-painful causes of testicular swelling should be considered in the workup of a scrotal mass:
- spermatocele
- varicocele
- hematocele
- inguinal hernia (bowel)
- testicular tumors