A scrotal mass may have a wide range of clinical diagnosis which varies form benign congenital conditions to life-threatening malignancies to acute surgical emergencies (1).

Neoplasia, inflammation or anatomical defects may cause scrotal masses (2).

The cardinal sign of a true scrotal mass is this it is possible to get above it.

A cystic mass can usually be transilluminated. Solid masses do not transilluminate.

An acutely painful scrotum should be treated as a torsion of the testis until proven otherwise.

It is important to differentiate whether the scrotal mass is intratesticular or extratesticular and whether it is cystic or solid (2).

• intratesticular solid mass - should be regarded as malignant except on rare occasions
• if extratesticular and cystic - most likely to be benign
• extratesticular solid masses – almost always benign (with 3% being malignant) (3)

Reference:

• (1) Tiemstra JD, Kapoor S. Evaluation of scrotal masses. Am Fam Physician. 2008;78(10):1165-70
• (2) Kaufman DS et al. Case records of the Massachusetts General Hospital. Case 6-2007. A 28-year-old man with a mass in the testis. N Engl J Med. 2007;356(8):842-9
• (3) Woodward PJ, Schwab CM, Sesterhenn IA. From the archives of the AFIP: extratesticular scrotal masses: radiologic-pathologic correlation. Radiographics. 2003;23(1):215-40