Emergency Ultrasound > Top 10 Pathology > Palpable Mass/Tumor

Palpable Mass/Tumor

Palpable masses typically present as non-tender palpable structures that the patient has felt himself during bathing or self-examination. The differential diagnosis for an extra testicular mass or lump include hydrocele, a spermatocele or epididymal cyst (Fig 5a, 5c), a tunica albuginea cyst (Fig 5b), an inguinal hernia (Fig 8), the rare solid epididymal mass, sperm granulomas and findings of chronic epididymitis.

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Fig 6 a. Spermatocele, b. Tunica albuginea cyst, c Epidydimal cyst.

As established before, the differential diagnosis for a palpable intratesticular mass mostly includes malignancy such as primary malignant tumors and metastasis. Primary testicular neoplasia is a very common malignancy in males 25 years of age to 35 years of age. Most of these tumors are germ cell in histology with seminoma being the most common. Mixed histology tumors are being more commonly found. Primary testicular malignancies metastasize to the lungs, mediastinum and brain. Seminoma commonly presents as a homogenous low-level echo within the testicular parenchyma and frequently has fairly well defined borders (Fig 7a, 7b).

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Fig 7 a. Seminoma transverse, b. Seminoma sagittal.

Alternatively, an irregular mass with calcifications, cystic areas or significantly heterogeneous echos suggests a nonseminomatous or a mixed histology neoplasm. Other cell types include embryonal cell, teratoma (Fig 7c) and choriocarcinoma. In a patient above 45 years of age, a solid intratesticular mass most likely represents a metastasis. Most common primary malignancies metastasizing to the testicle include prostate, renal, lung, gastrointestinal and melanoma. Lymphoma and leukemia are also common malignancies that spread to the testicles as these organs can act as a sanctuary for these two latter entities (Fig 7d). Some chemotherapeutic agents do not cross the testicular barrier and recurrence can manifest first in the gonads in a patient with recurrent lymphoma or leukemia. Secondary malignancies tend to be bilateral but can also be unilateral. Classically, imaging shows multiple masses and diffuse increase in size of the testes (Fig 7e).

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Fig 7 c. Teratoma, d. Leukemia/Lymphoma, e. Metastasis.

Testicular cancer, although representing 1% of all malignancies in men, is the most common neoplasm in boys and young adults from 15 to 34 years old. The estimated number of new cases of testicular carcinoma in the United States during 2006 was 8,250, and cancer deaths due to this disease were estimated to occur in 370 patients. Testicular cancer most commonly presents as a painless scrotal mass.

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