http://www.mayoclinic.

org/diseases-conditions/scrotalmasses/basics/definition/con-20022447

Definition
Scrotal masses are abnormalities in the contents of the scrotum, the bag of skin
hanging behind the penis. The scrotum contains the testicles and related structures
that produce, store and transport sperm and male sex hormones.
Scrotal masses might be an accumulation of fluids, the growth of abnormal tissue, or
normal contents of the scrotum that have become swollen, inflamed or hardened.
Scrotal masses need to be examined by a doctor, even if you're not in pain or having
other symptoms. Scrotal masses could be cancerous or caused by another condition
that affects testicular function and health.
Self-examination and regular doctor exams of the scrotum are important for prompt
recognition, diagnosis and treatment of scrotal masses.

Symptoms
Signs and symptoms of scrotal masses vary depending on the abnormality. Signs
and symptoms might include:

An unusual lump

Sudden pain

A dull aching pain or feeling of heaviness in the scrotum

Pain that radiates throughout the groin, abdomen or lower back

Tender, swollen or hardened testicle

Tender, swollen or hardened epididymis (ep-ih-DID-uh-mis), the soft, commashaped tube above and behind the testicle that stores and transports sperm
Swelling in the scrotum

Redness of the skin of the scrotum

Nausea or vomiting

If the cause of a scrotal mass is an infection, signs and symptoms also might include:

Fever

Urinary frequency

Pus or blood in the urine

Male reproductive system

The male reproductive system makes, stores and moves sperm. Testicles produce
sperm. Fluid from the seminal vesicles and prostate gland combine with sperm to
make semen. The penis ejaculates semen during sexual intercourse.

When to see a doctor

Seek emergency medical care if you develop sudden pain in your scrotum. Some
conditions require prompt treatment to avoid permanent damage to a testicle.

See your doctor if you detect a lump in your scrotum, even if it's not painful or tender,
or if you experience other symptoms of a scrotal mass.
Some scrotal masses are more common in children. See your doctor if your son
experiences symptoms of a scrotal mass, if you have any concerns about the
development of his genitals or if he is "missing" a testicle an undescended or
retractile testicle, which might increase the risk of some scrotal masses later in life

Causes
A number of disorders can result in a scrotal mass or an abnormality in the scrotum,
including:

Testicular cancer.Testicular cancer is a tumor containing abnormal testicular

tissue, which can usually be felt as a lump in the scrotum. Although most tumors
don't cause other symptoms, some men experience pain or swelling.

Spermatocele. Also known as a spermatic cyst or epididymal cyst,

spermatocele is a typically painless, noncancerous (benign), fluid-filled sac in the
scrotum, usually above the testicle.

Epididymitis. This is inflammation of the epididymis, the comma-shaped

structure above and behind the testicle that stores and transports sperm.
Epididymitis is often caused by a bacterial infection, including sexually transmitted
bacterial infections, such as chlamydia. Less commonly, epididymitis is caused by
a viral infection or abnormal flow of urine into the epididymis.

Orchitis. This is inflammation of the testicle usually due to a viral infection

most commonly mumps. When orchitis is caused by a bacterial infection, the
epididymis also might be infected.

Hydrocele. Hydrocele occurs when there is excess fluid between the layers of
a sac that surrounds each testicle. A small amount of fluid in this space is normal,
but the excess fluid of a hydrocele usually results in a painless swelling of the
scrotum.
In infants, a hydrocele occurs usually because an opening between the abdomen
and the scrotum hasn't properly sealed during development. In adults, a hydrocele
occurs usually because of an imbalance in the production or absorption of fluid,
often as a result of injury or infection in the scrotum.

Hematocele. Hematocele occurs where there is blood between the layers of a

sac that surrounds each testicle. Traumatic injury, such as a direct blow to the
testicles, is the most likely cause.

Varicocele. This is the enlargement of the veins within the scrotum that carry
oxygen-depleted blood from each testicle and epididymis. Varicocele is more
common on the left side of the scrotum because of differences in how blood
circulates from each side. A varicocele might cause infertility.

Inguinal hernia. This is a condition in which a portion of the small intestine

pushes through an opening or weak spot in the tissue separating the abdomen
and groin. In infants, an inguinal hernia usually occurs because the passageway
from the abdomen to the scrotum has failed to close during development. An
inguinal hernia might appear as a mass in the scrotum or higher in the groin.

Testicular torsion. This is a twisting of the spermatic cord, the bundle of

blood vessels, nerves and the tube that carries semen from the testicle to the
penis. This painful condition cuts off blood to the testicle and can result in the loss
of the testicle if not promptly treated. The affected testicle might be sideways,
enlarged and higher than normal.

Spermatocele

A spermatocele, also known as a spermatic cyst, is a typically painless,

noncancerous (benign), fluid-filled sac that grows near the top of a testicle.

Hydrocele

Hydrocele is the type of scrotal swelling that occurs when fluid collects in the thin
sheath that surrounds the testicle.

Varicocele

A varicocele is enlargement of the veins that transport oxygen-depleted blood away

from the testicle.

Inguinal hernia

Inguinal hernias occur when part of the membrane lining the abdominal cavity
(omentum) or intestine protrudes through a weak spot in the abdomen often along
the inguinal canal, which carries the spermatic cord in men.

Risk Factors
Factors that increase the risk of a scrotal mass vary because of the various causes of
scrotal abnormalities. Significant risk factors include:

Undescended or retractile testicle

An undescended testicle doesn't leave the abdomen and enter the scrotum during
fetal development or early infancy. A retractile testicle descends into the scrotum, but
retreats to the abdomen. Either might increase the risk of:

Inguinal hernia

Testicular torsion

Testicular cancer

Abnormalities present at birth

Abnormalities of the testicles, penis or kidneys present at birth (congenital) might
increase the risk of a scrotal mass and testicular cancer later in life.

History of testicular cancer

If you have had cancer in one testicle, you're at increased risk of cancer affecting the
other testicle. Having a father or brother who has had testicular cancer also increases
your risk.

Complications
Not all scrotal masses result in long-term complications. However, any mass that
affects the health or function of the testicle can lead to:

Delayed or poor development during puberty

Infertility

Preparing for your appointment

If you're having pain, seek emergency care. If you detect a scrotal mass, you'll
probably start by seeing your family doctor. You might be referred to a specialist in
urinary tract and male genital disorders (urologist).
Preparing for your or your child's appointment with your doctor or a urologist will help
you make the most of your time with the doctor.

What you can do

Write down information to share with your doctor, including:

Symptoms you're experiencing, including any that may seem unrelated to a

scrotal mass

Key personal information, including major stresses or recent life changes

Medications, vitamins and supplements you're taking

Family history of testicular cancer or other disorders of the scrotum

Personal medical history, including previous scrotal masses, undescended

testicle or congenital defects related to the genitals
Questions to ask your doctor

Questions about scrotal masses might include:

What tests will I need?

How long will it take to get the test results?

If the scrotal mass is cancerous (malignant), what are the next steps?

If the scrotal mass isn't cancerous, will I need treatment?

Are there brochures or other printed material that I can take with me? What
websites do you recommend?

Don't hesitate to ask any other questions.

What to expect from your doctor

Your doctor is likely to ask you a number of questions, including:

When did you discover a lump or experience other symptoms associated with
a scrotal mass?

Are you having or have you had pain in or near your scrotum?

Have you had fever or blood or pus in your urine?

Have you had a recent injury to the groin?

Does anything, such as pain medication, improve your symptoms?

Does anything worsen symptoms, such as exercise or exertion that puts a

strain on the groin?

Did you have an undescended or retractile testicle that was corrected with
surgery?

Have you ever had a sexually transmitted disease?

Do you have multiple sex partners or a new sex partner?

Test and Diagnosis

Your doctor will rely on a number of factors to diagnose a scrotal mass. These may
include:

A physical exam. Your doctor will feel your scrotum, its contents and nearby
areas of the groin while you're standing and lying down.

Transillumination. Shining a bright light through the scrotum might provide

information about the size, location and makeup of a scrotal mass.

Ultrasound. Using sound waves to create an image of internal organs, this

test can provide detailed information about the size, location and makeup of a
scrotal mass, as well as the condition of the testicles. An ultrasound usually is
necessary to diagnose a scrotal mass.

Urine test. Laboratory tests of a sample of urine might detect a bacterial or

viral infection or the presence of blood or pus in the urine.

Blood test. Laboratory tests of a blood sample might detect a bacterial or viral
infection or elevated levels of certain proteins that are associated with testicular
cancer.

Computerized tomography (CT) scan. If other tests indicate testicular

cancer, you'll likely undergo a specialized X-ray exam (CT scan) of your chest,
abdomen and groin to see if cancer has spread to other tissues or organs.

Treatments and drugs

Most scrotal masses require minimally invasive or no treatment, but some require
medicine or more-serious procedures.

Infections
Scrotal masses caused by a bacterial infection, as is usually the case with
epididymitis, are treated with antibiotics. Viral infections causing epididymitis or
orchitis are usually treated with rest, ice and pain relief medication.

Noncancerous (benign) scrotal masses

Benign scrotal masses might be left untreated or surgically removed, repaired or
drained. These treatment decisions depend on factors such as whether the scrotal
mass:

Causes discomfort or pain

Contributes to or increases the risk of infertility

Becomes infected

Testicular cancer
A specialist in cancer treatment (oncologist) will recommend treatments based on
whether the cancer is isolated to a testicle or has spread to other tissues in the body.
Your age and overall health also are factors in choosing treatment options for
testicular cancer.

Radical inguinal orchiectomy. This is the primary treatment for testicular

cancer. It's a surgical procedure to remove the affected testicle and spermatic
cord through an incision in the groin. Lymph nodes in your abdomen also might be
removed if the cancer has spread to them.

Radiation therapy. This type of therapy uses high-dose X-rays or other highenergy radiation to kill cancer cells that may remain after removal of the affected
testicle.

Chemotherapy. This is a drug treatment that uses powerful chemicals to kill

cancer cells.

Most cases of testicular cancer can be cured, but follow-up care is necessary to
watch for possible recurrences.

Lifestyle and home remedies

Testicular self-exams might help you find a scrotal mass early, allowing you to get
prompt medical care. If you perform this exam regularly, you'll understand what
"normal" feels like and be better prepared to detect abnormality. To do a testicular
self-exam, follow these steps:

Examine your testicles once a month, especially if you've had testicular cancer
or you have a family history of testicular cancer.

Perform the exam after a warm bath or shower. The heat from the water
relaxes your scrotum, making it easier for you to check.

Stand in front of a mirror. Look for swelling on the skin of the scrotum.

Cup your scrotum with one hand to see if it feels different from normal.

Examine one testicle at a time using both hands. Place the index and middle
fingers under the testicle; place your thumbs on top.

Gently roll the testicle between the thumbs and fingers to feel for lumps. The
testicles are usually smooth, oval shaped and somewhat firm. It's normal for one
testicle to be slightly larger than the other.

Feel along the soft, comma-shaped structure that runs above and behind the
testicle (epididymis) to check for swelling.

If you find a lump or other abnormality, call your doctor as soon as possible.

Testicular self-examination

To perform a testicular self-examination, grasp and roll the testicle between your
thumbs and forefingers, feeling for lumps, swelling, hardness or other changes.