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Case 124: Scrotal lump

This man had noticed a lump in his right hemiscrotum.

1. What is the diagnosis?

There is a hydrocoele and also within this is an epididymal cyst.

A lump seen on examination, that you can 'get above' and is separate to the testis is often an epididymal cyst or spermatocoele.

2. What are the options for treatment?

The options are:

Observation
reassurance

or if symptomatic
aspiration
sclerosant injection
excision


The aetiology of epididymal cysts has not been ellucidated. It is thought to be a congenital abnormality related to hormonal disorders during early development in-utero.

Physical examination is very important in assessing scrotal pathology, but not sufficient for the diagnosis and must be completed by scrotal ultrasonography, which shows an echo-free cystic epididymal structure.

Despite even excellent ultrasonography, the differential diagnosis of other scrotal cystic masses and even some solid epididymal tumours, which may present all of the sonographic characteristics of a cyst, must be considered.

The treatment of symptomatic epididymal cyst should be surgical. For asymptomatic cysts diagnosed by sonography, clinical follow-up to document stability of the mass is justified.