Testicular Cyst

What is a testicular lump?

A testicular lump is an abnormal mass in the testicles. Testicles are present in the scrotum and they are an egg shaped organ. The production of sperm and testosterone is the main function of the testicle. Either in one or in both of the testicles the lump may be there and this condition is quite common. This condition commonly occurs in adults as well as teenagers. An existing problem in the testicular area is indicated if there is a lump in the testicle. Testicular lumps may form due to many causes such as injury and infection; it may even be caused from some underlying reason such as testicular cancer or testicular torsion. Even though a lump may not be testicular cancer, one should seek medical attention if there is a lump on the testicle so that other serious conditions can be ruled out. Also, it has been advised that self-examination should be done in males above the age of 14 in the testicular area to make sure there are no lumps. 

An injury, inflammation or infection may cause a testicular lump. When the tissues swell, or within the testicle there is a cyst, then it can cause a testicular lump. The person may have symptoms of pain, swelling or fever if the injury is accompanied by inflammation. Testicular lumps may even be caused by testicular torsion which causes nausea, lightheadedness and pain. Epididymal infection is another common cause. Also, a cyst in the scrotum and varicose veins are another cause. Very rarely testicular cancer is the cause in which the lump is painless. Testicular lumps may also be caused by viral infection mumps. Other symptoms accompanying a testicular lump would be swollen salivary glands, fever and sore throat. Sometimes a testicular lump may be confused with an inguinal hernia in which abdominal contents enter into the groin. Identifying a testicular lump is the main goal of a clinical evaluation. 

Causes of testicular lump

One of the most common causes of a testicular lump is injury, but it can be caused by many other reasons. Some of the causes are the following:

• Varicocele - testicular lump can be caused by this condition which is one of the most common causes. Enlarged veins in the testicle can cause the lump. Most often after the individual hits puberty the lumps on the testicles are observed.
• Hydrocele - when in the testicle, fluid builds up then this type of testicular lump is observed. This occurs in around 2 in every 100 males.
• Epididymal cyst - when fluid fills the epididymis and the fluid cannot be drained out then it causes this condition which is also known as spermatocele. This condition does not require any treatment since on its own it can get resolved. This is a benign condition.
• Testicular torsion - testicular lump can be caused by this which is a serious concern. In this condition the testicles twist and to correct the condition immediate surgery is needed. If the condition is not treated, then it can even cause further complications such as infertility or tissue necrosis.
• Testicular cancer - this cause of testicular lump is by far the most serious one. A section of the lump is taken so that a biopsy can be done and then one can determine whether the lump is cancerous or not. It is necessary to formulate an appropriate treatment plan if cancer is detected.

Symptoms of testicular lump

Many symptoms may appear depending on the cause of the lump. Swelling and changes in the texture of the testicle are the most common symptoms of testicular lump.

• If testicular lump is caused by varicocele, then the testicle that is affected will feel heavier than the one that is not affected.
• In children there is no pain, if testicular lump is caused by hydrocele, it causes abdominal pressure in the adults. Also, the testicle may swell.
• If spermatocele causes testicular lump, then the testicle that is affected will feel heavier than the unaffected one.
• If testicular torsion causes testicular lump, then it will cause the testicle to swell and severe pain may be experienced. Also, it will cause abdominal pain, fever, scrotal swelling, vomiting, nausea, and frequency of urination will increase.
• If testicular cancer is the cause then it will cause a dull ache in the abdomen, severe pain, scrotal area will feel heavy, and in the scrotum there will be sudden buildup of fluid.

Most often even other body systems are involved when the testicle is affected.

Testicular pain

Symptoms related to the scrotum:

• In the scrotum the blood vessels may get dilated.
• In the scrotum there is a pain or a dull ache.
• The scrotum may swell or may feel heavy.
• The scrotum swells, becomes red or warm.

Symptoms related to other body systems:

• Pain or pressure in the abdomen.
• In semen blood may be present.
• Urination becomes difficult and painful or while urinating there may be burning sensation.
• Changes in the breast area area observed such as the breast area becomes tender or enlarged.
• From the end of the penis pus or some discharge may be present.
• Fever.
• The groin swells and there is pain.
• While ejaculating there is pain.

Symptoms indicating a serious condition:

• When testicular torsion is the cause of testicular lump, then it indicates a serious condition.

Diagnosis

• A full history - a full history must be taken by the doctor. The doctor will pay attention to any details such as whether the testicles have been infected or any trauma has been experienced. If any operation has been done on the testicles, then one should mention it to the doctor. Particularly for undecended testicles if operation has been performed then it should be notified to the doctor. If in the past a vasectomy has been performed, tell your doctor.
• Physical examination - the doctor will perform a full examination. The doctor will examine the scrotum, abdomen and the lymph glands. As a part of this examination the doctor will measure the blood pressure too.
• Additional tests - the following additional tests may be suggested.
• General blood tests - the doctor will decide which test to perform. Usually, the doctor will order tests to measure the function of the kidney, liver and also to look for anemia or other problems by checking the blood cells.
• Tumor markers - specific blood tests may be arranged if testicular cancer is suspected. By doing this a tumor marker may be measured.
• Other specific tests - to assess where exactly the swelling is occurring, the doctor will arrange for an ultrasound. The doctor may also suggest a CT scan of the abdomen and chest. Normally through the urology unit this is fixed.

It is important to consult with a doctor if a testicular lump is found. This will help to determine the cause. Also, it is imperative to go to the nearest emergency room if the symptoms of testicular torsion are observed. Infertility and tissue necrosis will result if this condition is left untreated.

Make a list of all the symptoms and the duration of symptoms before going to a physician. The testicle area will be examined by the physician so that the diagnosis can be confirmed and also the doctor will look for any swelling or tenderness in that area. The testicular lump is diagnosed through a visual inspection and the following test may be ordered by the doctor so that the cause can be identified:

• Ultrasound - to observe the flow of blood in the testicle.
• Blood test - to rule out any possibilities of infection that could be the cause.
• Biopsy - a specimen of the lump will be first taken and then sent to the lab. By doing this any chances of testicular cancer can be ruled out.

Treatment of testicular lump

No specific treatment is needed if the testicular lump is caused by varicocele since this condition will resolve on its own. For pain relief and to reduce the inflammation over the counter medications can be given. If the varicocele recurs, then to decongest the veins surgery may be needed.

No specific treatment is needed if hydrocele is the cause. But if the condition recurs then to drain the fluid, surgery may be needed. No specific treatment is needed if spermatocele is the cause. If one is experiencing discomfort or pain then in order to drain the cyst, surgery may be needed. Immediate surgery is needed if a testicular lump is caused by testicular torsion. By doing the surgery it is possible to restore the blood flow and prevent any damage to the tissues.

If testicular cancer causes testicular lump then for treating cancer the regular protocol is followed which includes surgery, radiation and chemotherapy. If the cancer is detected at an early stage, there are more chances of treatment. To prevent the cancer from spreading, the doctor may perform surgery and remove the testicle.

Facts based on testicular lump

• Most of the time the swelling in the scrotum is benign and hence should not be a cause of worry for the person.
• Until and unless the significant symptoms are not caused by the benign swelling, then surgery may not be needed.
• To differentiate between the swellings that are benign and cancerous a simple ultrasound scan will be needed.
• The testicular lump is likely benign if lump is attached to the testicular surface.
• There is a 90 percent chance that the testicular lump is cancerous if the lump is present within the body.
• In men between the ages of 20 and 50, a tumor could be testicular cancer.
• In men over the age of 50, testicular cancer is rare. You should always seek medical attention if cancer is found.
• In abnormal testicles testicular cancer is very common, such as in undescended testicles, injured or infected testicles, and soft atrophic testicles.
• In more than 95 percent of men testicular cancer can be cured if the condition is diagnosed early and early treatment is done. The chances of recovery is possible even though the condition is spread beyond the testicle.

Treatment based on causes

• Cystic swellings - for significant symptoms they can be treated by repairing the hydrocele, epididymal cyst may be excised, open surgery, laparoscopic surgery or radiological embolization may be performed. If there is no significant swelling, then there is no need for surgery.

• Inflammatory swellings - if the epididymis is infected then antibiotics are used. No specific treatment is needed if testicular lump is associated with mumps. Emergency treatment and surgery is required if the cause is testicular torsion.

• Testicular cancer - you will be referred to a urologist if this is the cause of the lump. After doing tests the doctor will order to remove the testicle. The doctor may insert an artificial testicle.

• Other solid swellings - if tuberculosis and syphilis are observed, appropriate antibiotic treatment is needed. If there is sperm granuloma in the epididymis and it is causing discomfort, then one may need to remove it. 

Complications of testicular lump

Serious complications may arise which will lead to permanent damage if a serious disease is causing the testicular lump and medical attention is not received. Also, to reduce the potential complications, a treatment plan will need to be created by the doctor. Testicular lump causes complications such as infertility, infarction of testicular tissue, scrotal abscess, cancer may spread, infection may spread, testis may need to be removed, and treatment may lead to adverse effects.

Article resources:

https://www.baus.org.uk/patients/conditions/12/testicular_lump

https://www.nhs.uk/conditions/testicle-lumps-and-swellings/

https://www.stdcheck.com/std-symptoms-testicle-lump.php

https://medlineplus.gov/ency/article/003162.htm