Right Testicular Mass in a 28-yo Man

Painless scrotal masses can range from entirely benign cysts to life-threatening cancers with highly malignant potential. A lot of information regarding the etiology of the mass can be obtained from careful detailed history taking and physical exam findings. In any adult patient with a firm palpable mass confined to the testis, testicular cancer must be at the top of the differential. This is especially true in patients age 14 to 35 yr, as testicular cancer is the most common solid tumor diagnosed in this age group. If scrotal ultrasound confirms a solid mass, tumor markers should be obtained. Prompt referral to a urologist is necessary for urgent radical inguinal orchiectomy to obtain the pathology that will guide future treatment needs along with repeat tumor markers and staging imaging studies. Urologists perform radical orchiectomies only via an inguinal approach as there is a very high risk of local recurrence if the testis is surgically removed through a scrotal incision.