ConditionMen's health
Paratesticular Tumors
Paratesticular tumors are growths in the tissues around the testicle rather than in the testicle itself, including the epididymis, spermatic cord and the coverings of the testis. Most are benign, such as lipomas of the spermatic cord and adenomatoid tumors of the epididymis. A minority are cancers, mainly sarcomas such as liposarcoma in adults and rhabdomyosarcoma in children and teenagers. They usually appear as a painless lump in the scrotum or groin. Scrotal ultrasound is the key first test, and surgical removal is the main treatment.
Also called: Paratesticular masses, extratesticular tumors, spermatic cord tumors, epididymal tumors
At a glance
- What they are
- Growths in the structures beside the testicle: epididymis, spermatic cord, tunica layers.
- Most common benign types
- Spermatic cord lipoma, adenomatoid tumor, fibrous pseudotumor, leiomyoma.
- Malignant types
- Liposarcoma, leiomyosarcoma, rhabdomyosarcoma, mesothelioma.
- Symptoms
- A painless scrotal or groin lump, sometimes with a hydrocele.
- Diagnosis and treatment
- Scrotal ultrasound, MRI, then surgical removal; added treatment for cancers.
When to get help
Call 911 or go to the ER
- Sudden, severe testicle pain with swelling, nausea or vomiting (possible testicular torsion)
See a doctor within a day or two
- A new firm or hard lump in the scrotum or along the cord, especially one that is growing
- A scrotal lump in a child or teenager
- A lump with groin or belly swelling, back pain or weight loss
Book a routine appointment
- Any new scrotal lump, even if painless, for examination and ultrasound
- A lump that has been present for a while but has changed in size or feel
Where paratesticular tumors arise
The scrotum contains the testicles and several surrounding structures:
- epididymis: a coiled tube behind each testicle that stores sperm
- spermatic cord: the bundle of vas deferens, blood vessels, nerves and fat running up to the groin
- tunica vaginalis and albuginea: coverings of the testicle
Tumors in these structures are much less common than lumps such as cysts and hydroceles, and less common than testicular cancer itself.
Types
Benign
| Tumor | Features |
|---|---|
| Spermatic cord lipoma | Most common; soft, fatty lump along the cord, may mimic a hernia |
| Adenomatoid tumor | Most common epididymal tumor; small, firm, painless |
| Fibrous pseudotumor | Firm nodules on the testicular coverings, often after inflammation or injury |
| Leiomyoma | Smooth muscle tumor |
| Papillary cystadenoma | Associated with von Hippel-Lindau disease |
Malignant
| Tumor | Features |
|---|---|
| Liposarcoma | Most common paratesticular cancer in adults; often large, fatty, may look like a hernia |
| Leiomyosarcoma | Firm, growing mass, usually older adults |
| Rhabdomyosarcoma | Mostly children and young men; can spread to lymph nodes |
| Malignant mesothelioma of the tunica vaginalis | Rare; often presents with a hydrocele; linked to asbestos exposure |
| Lymphoma and metastases | Rare |
Symptoms
- a painless lump in the scrotum, separate from the testicle, or in the groin
- a heavy or dragging feeling
- swelling from fluid around the testicle (hydrocele)
- occasionally discomfort or pain
- in cancers: rapid growth, and sometimes symptoms of spread such as back pain or swollen lymph nodes
Common non-tumor scrotal lumps
Most scrotal lumps are not tumors. Common causes include:
- epididymal cysts and spermatoceles
- hydrocele: fluid around the testicle
- varicocele: enlarged veins
- inguinal hernia
- epididymitis: tender, swollen epididymis from infection
See mass in scrotum for a full guide.
Diagnosis
- physical exam to determine whether the lump is inside or outside the testicle
- scrotal ultrasound: confirms the location, whether it is solid or cystic, and its blood flow; solid extratesticular masses are more often benign, but solid, growing or complex ones need further evaluation
- MRI for large or uncertain masses and to plan surgery
- tumor markers (AFP, beta-hCG, LDH) if testicular cancer is possible
- CT scans of the chest, abdomen and pelvis for staging if a cancer is suspected
Treatment
- benign tumors: surgical removal of the lump, often sparing the testicle when the diagnosis is clear
- suspected malignant tumors: radical inguinal orchiectomy, removing the testicle and spermatic cord through a groin incision, with wide margins; avoiding a cut through the scrotum to reduce local spread
- sarcomas: may require further surgery for clear margins, plus radiation therapy
- rhabdomyosarcoma: surgery plus chemotherapy, sometimes radiation and lymph node surgery, managed by pediatric or sarcoma oncology teams
- mesothelioma: surgery, sometimes with additional treatment
Outlook
Benign paratesticular tumors are cured by removal. Outcomes for sarcomas depend on type, grade, size and clear margins; local recurrence is a known risk, so long-term follow-up imaging is important. Paratesticular rhabdomyosarcoma in children has a good prognosis with combined treatment.
Frequently asked questions
What is a paratesticular tumor?
It is a growth in the tissues around the testicle, such as the epididymis or spermatic cord, rather than in the testicle itself. Most are benign, but some, especially sarcomas, are cancerous.
Are paratesticular tumors usually cancer?
Most are benign, such as spermatic cord lipomas and adenomatoid tumors. However, a significant minority are malignant, mostly sarcomas, so any solid paratesticular mass needs careful evaluation with imaging and usually surgical removal.
How are paratesticular tumors diagnosed?
A scrotal ultrasound is the first test and shows whether the lump is inside or outside the testicle and whether it is solid. MRI may give more detail. The final diagnosis is made by examining the tissue after surgical removal.
Should I worry about a lump next to my testicle?
Most lumps beside the testicle are harmless cysts or fluid collections, but you should have any new scrotal lump checked by a doctor and an ultrasound. Lumps that are firm, growing, or in children and teenagers need prompt assessment.
Sources
This guide was written from current patient and clinical guidance, including:
- American Urological Association: Diagnosis and treatment of early stage testicular cancer guideline
- European Association of Urology: Guidelines on testicular cancer
- American Cancer Society: Rhabdomyosarcoma; Soft tissue sarcoma
- MedlinePlus: Scrotal masses
- Radiological Society of North America (RadioGraphics): Extratesticular scrotal masses