Review Question - QID 103016

The next step in evaluation of scrotal masses after the physical exam and transillumination test is testicular ultrasonography to help determine if the mass is extra-testicular or intra-testicular.

The differential for scrotal masses includes torsion, orchitis, epididymitis, hematocele, hydrocele, varicocele, hernia, and testicular cancer. Testicular cancer is the most common malignancy in males of age 15-35, the vast majority of which are germ cell tumors. It typically presents as a non-acute painless testicular mass, although some patients do report discomfort. Other manifestations may include gynecomastia, paraneoplastic hyperthyroidism, and paraneoplastic limbic encephalitis. Once diagnosed, the first step is radical inguinal orchiectomy with possible retroperitoneal lymph node dissection to evaluate for metastasis. Following surgery and staging, chemotherapy, radiation therapy, or active surveillance are all viable options.

Incorrect Answers:
Answer 1: Needle biopsy is not indicated in the workup of suspected testicular cancer.
Answer 3 and 4: Imaging of the abdomen and pelvis may be necessary once the diagnosis has been established to evaluate for metastasis.
Answer 5: Beta-HCG, AFP, and LDH are some tumor markers seen in patients with testicular cancer and should be ordered once the ultrasound reveals an intra-testicular mass.