Painless Scrotal Lumps: Current Therapeutic Approach and Follow-up

  • Sara Benvenuto
  • Stefano Bucci
  • Carlo Trombetta
  • Paolo Umari
  • Michele Rizzo
Part of the Medical Radiology book series (MEDRAD)


Scrotal lesions can be broadly grouped by anatomical location as intratesticular or extratesticular. The clinician must consider a wide differential diagnosis based on this location, and a reliable and rapid differentiation of harmless from serious conditions such as cancer of the testis, is essential. Solid testicular masses are considered germ cell tumors until proven otherwise, but numerous other possible pathologies exist. The paratesticular region has the broadest differential diagnosis, as it contains numerous distinct structures and it is a common location for ectopic tissue and metastatic disease.


Germ Cell Tumor Malignant Mesothelioma Spermatic Cord Epidermoid Cyst Spermatic Vein 


  1. Albers P, Siener R, Kliesch S et al (2003) Risk factors for relapse in clinical stage I nonseminomatous testicular germ cell tumors: results of the German Testicular Cancer Study Group Trial. J Clin Oncol 21:1505–1512PubMedCrossRefGoogle Scholar
  2. Beccia DJ, Krane RJ, Olsson CA (1976) Clinical management of non-testicular intrascrotal tumors. J Urol 116:476–479PubMedGoogle Scholar
  3. Bercovici JP, Nahoul K, Tater D et al (1984) Hormonal profile of leydig cell tumors with gynecomastia. J Clin Endocrinol Metab 59:625–630PubMedCrossRefGoogle Scholar
  4. Bruno C, Minniti S, Procacci C (2002) Diagnosis of malignant mesothelioma of the tunica vaginalis testis by ultrasound-guided fine-needle aspiration. J Clin Ultrasound 30:181–183PubMedCrossRefGoogle Scholar
  5. Chang B, Borer JG, Tan PE et al (1998) Large-cell calcifying Sertoli cell tumor of the testis: case report and review of the literature. Urology 52:520–522, discussion 522–523PubMedCrossRefGoogle Scholar
  6. Cheville JC, Sebo TJ, Lager DJ et al (1998) Leydig cell tumor of the testis: a clinicopathologic, DNA content, and MIB-1 comparison of nonmetastasizing and metastasizing tumors. Am J Surg Pathol 22:1361–1367PubMedCrossRefGoogle Scholar
  7. Choi SHS, Lee T (1993) Adolescent varicocele. Curr Opin Urol 6:305–311CrossRefGoogle Scholar
  8. Cornud FDD, Bonnel D (1992) Traitement non chirurgical des varicocele spar embolisation des veines spermatiques et interet du Doppler couleur dans le bilan pre et post embolisation. Contracept Fertil Sex 20:1048–1053Google Scholar
  9. Cullen MH, Stenning SP, Parkinson MC et al (1996) Short-course adjuvant chemotherapy in high-risk stage I nonseminomatous germ cell tumors of the testis: a Medical Research Council report. J Clin Oncol 14:1106–1113PubMedGoogle Scholar
  10. Cunningham JJ (1983) Sonographic findings in clinically unsuspected acute and chronic scrotal hematoceles. AJR Am J Roentgenol 140:749–752PubMedGoogle Scholar
  11. Dieckmann KP, Kulejewski M, Pichlmeier U et al (2007) Diagnosis of contralateral testicular intraepithelial neoplasia (TIN) in patients with testicular germ cell cancer: systematic two-site biopsies are more sensitive than a single random biopsy. Eur Urol 51:175–183, discussion 183–175PubMedCrossRefGoogle Scholar
  12. Doherty FJ (1991) Ultrasound of the nonacute scrotum. Semin Ultrasound CT MR 12:131–156PubMedGoogle Scholar
  13. Doll DC, Weiss RB (1986) Malignant lymphoma of the testis. Am J Med 81:515–524PubMedCrossRefGoogle Scholar
  14. Ellis JH, Bies JR, Kopecky KK et al (1984) Comparison of NMR and CT imaging in the evaluation of metastatic retroperitoneal lymphadenopathy from testicular carcinoma. J Comput Assist Tomogr 8:709–719PubMedCrossRefGoogle Scholar
  15. Fields JM, Russell SA, Andrew SM (1992) Case report: ultrasound appearances of a malignant mesothelioma of the tunica vaginalis testis. Clin Radiol 46:128–130PubMedCrossRefGoogle Scholar
  16. Figler TJ, Olson MC, Kinzler GJ (1996) Polyorchidism and rete testis adenoma: ultrasound and MR findings. Abdom Imaging 21:470–472PubMedCrossRefGoogle Scholar
  17. Frates MC, Benson CB, DiSalvo DN et al (1997) Solid extratesticular masses evaluated with sonography: pathologic correlation. Radiology 204:43–46PubMedGoogle Scholar
  18. Fu YT, Wang HH, Yang TH et al (1996) Epidermoid cysts of the testis: diagnosis by ultrasonography and magnetic resonance imaging resulting in organ-preserving surgery. Br J Urol 78:116–118PubMedGoogle Scholar
  19. GM Thomas A (1990) Current management of varicocele. Urol Clin North Am 17:893–907Google Scholar
  20. Gonzalez R, Narayan P, Formanek A et al (1981) Transvenous embolization of internal spermatic veins: nonoperative approach to treatment of varicocele. Urology 17:246–248PubMedCrossRefGoogle Scholar
  21. Gurdal M, Erol A (2001) Malignant mesothelioma of tunica vaginalis testis associated with long-lasting hydrocele: could hydrocele be an etiological factor? Int Urol Nephrol 32:687–689PubMedCrossRefGoogle Scholar
  22. Hamm B, Fobbe F, Loy V (1988) Testicular cysts: differentiation with US and clinical findings. Radiology 168:19–23PubMedGoogle Scholar
  23. Hargreave TB (1993) Varicocele–a clinical enigma. Br J Urol 72:401–408PubMedCrossRefGoogle Scholar
  24. Heidenreich A, Moul JW (2002) Contralateral testicular biopsy procedure in patients with unilateral testis cancer: is it indicated? Semin Urol Oncol 20:234–238PubMedCrossRefGoogle Scholar
  25. Heiken JP (2000) Tumor of the testis and testicular adnexa. In: Pollack HM, McClennan BL (eds) Clinical urography, 2nd edn. Saunders, Philadelphia, pp 1716–1741Google Scholar
  26. Herr HW, Sheinfeld J (1997) Is biopsy of the contralateral testis necessary in patients with germ cell tumors? J Urol 158:1331–1334PubMedCrossRefGoogle Scholar
  27. Iaccarino V (1980) A non surgical treatment of varicocele: transcatheter sclerotherapy of gonadal veins. Ann Radiol 23:369–371PubMedGoogle Scholar
  28. Jones MA, Young RH, Scully RE (1995) Malignant mesothelioma of the tunica vaginalis. A clinicopathologic analysis of 11 cases with review of the literature. Am J Surg Pathol 19:815–825PubMedCrossRefGoogle Scholar
  29. Kakiashvili DA-CL, Sturgeon JF, Warde PR, Chung P, Moore M, Wang L, Azuero J, Jewett MA (2007) Non risk-adapted surveillance management for clinical stage I nonseminomatous testis tumors. J Urol 177:278CrossRefGoogle Scholar
  30. Krone KD, Carroll BA (1985) Scrotal ultrasound. Radiol Clin North Am 23:121–139PubMedGoogle Scholar
  31. Langer JE (1993) Ultrasound of the scrotum. Semin Roentgenol 28:5–18PubMedCrossRefGoogle Scholar
  32. Liguori G, Garaffa G, Trombetta C et al (2007) Inguinal recurrence of malignant mesothelioma of the tunica vaginalis: one case report with delayed recurrence and review of the literature. Asian J Androl 9:859–860PubMedCrossRefGoogle Scholar
  33. Luker GD, Siegel MJ (1994) Pediatric testicular tumors: evaluation with gray-scale and color Doppler US. Radiology 191:561–564PubMedGoogle Scholar
  34. Petersen PM, Giwercman A, Skakkebaek NE et al (1998) Gonadal function in men with testicular cancer. Semin Oncol 25:224–233PubMedGoogle Scholar
  35. Petersen PM, Giwercman A, Daugaard G et al (2002) Effect of graded testicular doses of radiotherapy in patients treated for carcinoma-in situ in the testis. J Clin Oncol 20:1537–1543PubMedCrossRefGoogle Scholar
  36. Plas E, Riedl CR, Pfluger H (1998) Malignant mesothelioma of the tunica vaginalis testis: review of the literature and assessment of prognostic parameters. Cancer 83:2437–2446PubMedCrossRefGoogle Scholar
  37. Richie JP (1997) Neoplasms of the testis. In: Walsh PC (ed) Campbell’s Urology, 7th edn. Saunders, Philadelphia, pp 2411–2452Google Scholar
  38. Rifkin MD, Kurtz AB, Pasto ME et al (1985) Diagnostic capabilities of high-resolution scrotal ultrasonography: prospective evaluation. J Ultrasound Med 4:13–19PubMedGoogle Scholar
  39. Rushton HG, Belman AB, Sesterhenn I et al (1990) Testicular sparing surgery for prepubertal teratoma of the testis: a clinical and pathological study. J Urol 144:726–730PubMedGoogle Scholar
  40. Sandlow JI (2007) Surgery of the scrotum and seminal vesicles. In: Wein AJ (ed) Campbell-Walsh urology, 9th edn. Saunders Elsevier, PhiladelphiaGoogle Scholar
  41. Sobin LH, Wittekind C (2002) TNM classification of malignant tumours. John Wiley and Sons, New YorkGoogle Scholar
  42. Subramanyam BR, Balthazar EJ, Raghavendra BN et al (1982) Sonographic diagnosis of scrotal hernia. AJR Am J Roentgenol 139:535–538PubMedGoogle Scholar
  43. Trabucco EETA (1998) Flat plugs and mesh hernioplasty in the inguinal box: description of the surgical technique. Hernia 2:133–138CrossRefGoogle Scholar
  44. Trabucco EE AFT, Rollino R (1998) Ernioplastlca inguinale tension-free con rete presagomata senza suture secondo trabucco. Chirurgia Minerva Medica, TorinoGoogle Scholar
  45. Tyagi G, Munn CS, Kiser LC et al (1989) Malignant mesothelioma of tunica vaginalis testis. Urology 34:102–104PubMedCrossRefGoogle Scholar
  46. Ulbright TM, Amin MB, Young RH (1999) Tumors of the testis, adnexa spermatic cord, and scrotumAtlas of tumor pathology. Armed Forced Institute of Pathology, Washington, pp 1–290Google Scholar
  47. Verhagen P, Blom JM, van Rijk PP et al (1992) Pulmonary embolism after percutaneous embolization of left spermatic vein. Eur J Radiol 15:190–192PubMedCrossRefGoogle Scholar
  48. Verma N, Lazarchick J, Gudena V et al (2008) Testicular lymphoma: an update for clinicians. Am J Med Sci 336:336–341PubMedCrossRefGoogle Scholar
  49. Walsh TJ, Seeger KT, Turek PJ (2007) Spermatoceles in adults: when does size matter? Arch Androl 53:345–348PubMedCrossRefGoogle Scholar
  50. Weiss RM, George NJR, O’Reilly PH (2001) Comprehensive urology. Mosby, LondonGoogle Scholar
  51. Wells I (1995) Embolization of varicoceles. Curr Opin Urol 5:82–84CrossRefGoogle Scholar
  52. White R (1994) Radiologic management of varicoceles using embolotherapy. In: Whitehead E, Nagler H (eds) Management of impotence and infertility. Lippincott, Philadelphia, pp 228–240Google Scholar
  53. Zagars GK (1999) Management of stage I seminoma: radiotherapy. In: Horwich AH (ed) Testicular cancer: investigation and management. Chapman and Hall Medical, London, p 99Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2011

Authors and Affiliations

  • Sara Benvenuto
    • 1
  • Stefano Bucci
    • 1
  • Carlo Trombetta
    • 1
  • Paolo Umari
    • 1
  • Michele Rizzo
    • 1
  1. 1.Department of UrologyUniversity of TriesteTriesteItaly

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