EpistemisUnilateral painless testicular mass of slow progression
Specialty: Nephrology and urology.
Why it occurs
- Classic testicular seminoma (it is the most common germ cell tumor, with slow and asymptomatic progression, typically debuting as a unilateral painless mass)
- Non-seminomatous germ cell tumor (such as embryonal carcinoma, choriocarcinoma or yolk sac tumor, which progresses more aggressively but can debut painlessly)
- Giant chronic hydrocele or calcified spermatocele (benign lesions that slowly accumulate fluid or cystic material with debris simulating a mass)
- Genitourinary tuberculosis (slow granulomatous involvement of the testicle and epididymis with the formation of painless nodules of hard consistency)
Initial workup
Urgent high-resolution scrotal Doppler ultrasound (initial key study, classifies the mass as solid and intratesticular); blood tumor markers (Alpha-fetoprotein, b-hCG, LDH); CT of the chest, abdomen and pelvis with intravenous contrast for oncological staging; urgent referral to urology for scheduled inguinal orchiectomy surgery (transscrotal biopsy is never performed due to risk of lymphatic tumor seeding).
red flags
Unilateral hard, asymmetrical, stony, fixed intratesticular mass that cannot be separated from the testicle upon palpation, with loss of normal testicular elasticity, accompanied by palpable inguinal or retroperitoneal lymphadenopathy, unexplained gynecomastia, or dull chronic low back pain (suspected retroperitoneal metastasis of testicular cancer).
Standard management
- They are not treated with drugs initially; The standard definitive treatment for suspected solid testicular tumor is radical inguinal orchiectomy.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Nephrology and urology
- Listed causes
- 4
- Treatment options
- 1