Testicular Lump: Differential Diagnosis & Urgent Evaluation Pathway

Any testicular lump requires prompt clinical evaluation. Testicular cancer is the #1 solid malignancy in men 15–35; 99% curable if localized.

Differential Diagnosis

• Intratesticular (cancer until proven otherwise):
  • Germ cell tumor (seminoma, non-seminoma) — 95%.
  • Leydig/Sertoli cell tumors (rare).
  • Lymphoma (most common >50 yrs).
• Extratesticular (usually benign):
  • Epididymal cyst / spermatocele — fluid-filled, transilluminate.
  • Varicocele — "bag of worms," left > right, Valsalva ↑.
  • Hydrocele — fluid in tunica vaginalis, fluctuant.
  • Epididymitis/orchitis — painful, inflammatory signs.
  • Inguinal hernia — reduces supine, cough impulse.
  • Lipoma, nerve sheath tumor — rare.

Standard Workup

1. History + scrotal exam (standing & supine).
2. Scrotal ultrasound with Doppler — 100% sensitive for intratesticular mass.
3. Tumor markers: AFP, hCG, LDH (baseline for staging/monitoring).
4. CXR/CT chest/abdomen/pelvis if cancer confirmed (staging).

Management Principles

• Intratesticular mass → radical inguinal orchiectomy (diagnostic + therapeutic). No transscrotal biopsy.
• Benign extratesticular → observe or treat symptomatically.
• Multidisciplinary tumor board for cancer.

Self-Exam

Monthly after warm shower. Any new lump = doctor within 1 week.