Paratesticular Tumors

Overview

Paratesticular tumors are growths that arise in the tissues surrounding the testicle rather than in the testicle itself. This area includes the epididymis (a coiled tube behind the testicle that stores sperm), the spermatic cord (which carries blood vessels and the sperm-carrying tube), and the supporting coverings and connective tissues.

The great majority of paratesticular tumors are benign, meaning non-cancerous, and many cause few problems beyond a noticeable lump. A smaller number are cancerous. Because it is not possible to tell for certain from feel alone, and because the symptoms can overlap with testicular cancer and other scrotal conditions, any new lump or swelling in the scrotum should be examined by a doctor promptly. Most paratesticular tumors are diagnosed and treated successfully.

Symptoms

The most common feature is a lump or swelling near, but separate from, the testicle. Symptoms may include:

• A painless lump in the scrotum, alongside or above the testicle
• A feeling of heaviness or fullness in the scrotum
• Swelling that may grow slowly over time
• Occasional discomfort or aching, though many are painless
• A lump that feels separate from the testicle itself on examination

Because a lump cannot be assumed to be harmless, it is important to have any new scrotal lump checked rather than waiting to see if it changes.

Causes

The cause of most paratesticular tumors is not known, and they generally develop without any clear trigger. They can arise from any of the various tissues in the area, which is why there are several different types:

• Benign tumors: such as those arising from connective tissue or the epididymis, which make up the majority.
• Cancerous tumors: less common, and arising from tissues such as muscle, fat, or connective tissue of the cord and surroundings.
• Other growths and cysts: some scrotal lumps in this area are fluid-filled or inflammatory rather than true tumors and are distinguished during assessment.

Risk Factors

There are no well-established lifestyle risk factors for most paratesticular tumors, and they often occur in otherwise healthy people. Relevant points include:

• Most arise spontaneously without an identifiable cause
• They can occur across a wide age range, including in children for certain types
• A history of other scrotal conditions may prompt examination that uncovers a lump

Because risk factors are limited, awareness and prompt evaluation of any new lump are the most important steps.

Diagnosis

Diagnosis focuses on locating the lump, determining whether it is in the testicle or the surrounding structures, and assessing whether it could be cancerous.

• Physical examination: feeling the lump and its relationship to the testicle.
• Scrotal ultrasound: the key test, which shows whether a lump is solid or fluid-filled and whether it lies inside or outside the testicle.
• Blood tests: tumor markers may be checked to help assess for cancer.
• Further imaging: such as MRI or CT in selected cases.
• Surgical removal and examination: often the definitive way to confirm the exact type, as the tissue is examined under a microscope.

Treatment

Treatment depends on whether the tumor is benign or cancerous and on its type and size.

• Surgical removal: the main treatment; many benign tumors can be removed while sparing the testicle.
• Examination of the tissue: the removed growth is examined to confirm whether it is benign or cancerous.
• Wider surgery: for cancerous tumors, more extensive removal may be needed.
• Additional treatment: chemotherapy or radiotherapy may be used for certain cancerous types, guided by a specialist.
• Follow-up: monitoring after treatment, particularly for cancerous tumors.

Outcomes are generally very good, especially for the benign tumors that make up most cases.

Prevention

There is no known way to prevent most paratesticular tumors, so the emphasis is on early detection of any scrotal lump:

• Get to know what is normal for you and perform regular testicular self-examination
• Check for any new lumps, swelling, or changes in the scrotum
• See a doctor promptly about any new lump rather than waiting
• Attend any recommended follow-up after treatment of a previous tumor

When to See a Doctor

See a doctor promptly if you notice any new lump, swelling, or change in your scrotum or near a testicle, even if it is painless. While most paratesticular lumps are benign, they cannot be reliably distinguished from cancer by feel alone, so evaluation is important. Seek emergency care if you experience sudden, severe testicular or scrotal pain, especially with swelling, nausea, or a testicle that appears to have changed position, as this can indicate a twisted testicle (testicular torsion), which is a surgical emergency.

Related Topics

Frequently Asked Questions

References

1. American Cancer Society. Testicular cancer.
2. Mayo Clinic. Testicular and scrotal lumps.
3. MedlinePlus, U.S. National Library of Medicine.
4. National Cancer Institute (NCI).