Scrotal mass classification

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Niloofarsadaat Eshaghhosseiny, MD[2]Sujit Routray, M.D. [3]

Scrotal massdeponds on intra testicular or extra testicular may be classified into 6 subtypes based on their anatomical origion.Based on the exictance of pain, scrotal mass may be classified as either painfull or non painfull. The staging of testicular cancer is based on the TNMS.

Scrotal mass(intratesticular or extratesticular) may be classified according to their anatomical origin into 6 groups:

• Skin
• Tunica vaginalis testis
• Processus vaginalis testis
• Panpiniform plexus
• Epididymis
• Testis^[1]

Based on the pain existant , scrotal mass may be classified as either painfull or non painfull .^[2] The staging of testicular cancer is based on the TNMS.^[3] According table adapted from Department of Am Fam Physician. 2008 Nov 15;78(10):1165-1170.^[4]

Classification of Scrotal mass by Anatomical place

Anatomical place	Disease	Natural history	Pain	Other symptoms
Skin	Sebaceuse cyst Squamouse cell carcinoma	Acute/chronic,stable Chronic,progressive	No No	__ __
Tunica vaginalis	Hydrocele ,Hematocele	Acute /chronic,stable Acute,caused by trauma	No Yes	Transillumination Does not transilluminate well
Processus vaginalis	Indirect inguinal hernia ,Hydrocele	Acute/chronic,stable or progressive Chronic ,stable	No,Yes if strangulated No	By valsalva maneuvers may enlarge Different sizes
Panpiniform plexus	Varicocele	Chronic ,stable	No	“Bag of worms”
Epididimysis	Epididimysis ,Spermatocele	Acute ,progressive Chroic,stable	Yes No	May have UTI symptoms __
Testis	Testicular tortion, Apendix testis tortion Orchitis Testicular cancer	Acute,progressive, Acute,stable Acute,self -limitted Chronic,progressive	Yes Yes Yes No	Increase pain by elevation of testis,cremastic reflex usually abcent Blue dot sign Decrease pain by elevation of testis __

According table adapted from Am Fam Physician. 2014 May 1;89(9):723-727.^[2]

Pin full	With or without pain	Non painfull
Testicular tortion	Testicular cancer	Hydrocele
Testicular appendage tortion	Inguinal hernias	Varicocele
Epididimytis		Scrotal wall mass(skin cancer)
Orchitis
Hematocele or testicular rupture