Painless testicular mass

Specialty: Nephrology and urology.

• indurated testicular nodule
• intratesticular lump without pain
• painless testicle mass

Why it occurs

• Primary testicular neoplasia (seminoma or non-seminomatous germ cell tumors, typically presenting in men aged 15 to 35 years as a hard, painless mass)
• Spermatocele or giant epididymal cyst (benign accumulation of fluid with sperm in the head of the epididymis, which can simulate an intratesticular mass if it is large in volume)
• Chronic septate tension hydrocele (accumulation of fluid in the tunica vaginalis that simulates an enlarged and indurated testicle)
• Granulomatous or tuberculous orchitis (fungal or Mycobacterium tuberculosis infection in the genitourinary tract that causes painless chronic inflammatory hard nodules)
• Old organized intratesticular hematoma (long-standing post-traumatic sequelae with fibrin deposition)

Initial workup

Scrotal ultrasound with high-resolution color Doppler (study of choice for urological emergency to differentiate solid intratesticular masses from cystic/extratesticular masses and evaluate central anarchic vascularization); analysis of tumor markers in peripheral blood (Alpha-fetoprotein - AFP, Beta fraction of human chorionic gonadotropin - b-hCG, and Lactate Dehydrogenase - LDH); CT of the chest, abdomen and pelvis with intravenous contrast for complete oncological staging if malignancy is suspected.

Standard management

• They are not treated with primary drugs if the suspicion of testicular neoplasia is high; The definitive treatment of choice is surgery through radical orchiectomy via the inguinal route with high ligation of the spermatic cord.
• Four-drug antituberculous regimen (Rifampicin, Isoniazid, Pyrazinamide, Ethambutol) if origin is proven by genitourinary tuberculosis by PCR of mycobacteria in urine or biopsy of the epididymis.