Question Title: Lump, left testicle

Hi, I'm 30 years old, I have a painless small lump in my left testicle, it has been there for 4 years, 2 years ago I went to an urologist because it was growing slowly, he performed a US, physical exam and infection study, the diagnostic at that opportunity was an infection due to Ureaplasma Urealyticum, so I took antibiotics for one month and the infection disappeared. In this 4 years the lump has been growing slowly, so I decided last month to go to another urologist, he performed a physical exam and US and said the lump is a epidydimal cyst of about 4mm. The questions are:
1.- I understand that internally the cyst is about 4 mm in size, but externally, when the scrotum is "fully retracted", I can see like a slowly growing bag of a size close to 15 mm in diameter at the top of the testicle, (this was the initial reason for the doctor's visit). Is this likely to be a consequence of the epidydimal cyst?
2.- Is there any possibility of misdiagnostic, in the sense that I could have testicular cancer from the begining, and I have lost these 4 years?
3.- I have been doing the self testicular exam like 3 times each day for a week and now it seems that the testicle is a little bit bigger and I feel little pain, could be this an inflammation due to the manipulation of the testicle?

Thanks for your response,
Joe

Dear Joe,
You have a three part question. First, in regards to the discrepancy between the 4mm epididymal cyst on ultrasound and the 15mm area felt on self examination, you may be feeling the entire epididymus. The wall of the epididymal cyst is usually 1-2 mm. Second, of course the ultrasound is not 100% accurate; however, it is thought to be excellent at determining if a lesion is in the testicle or outside the testicle. Lesions inside the testicle are likely to be cancerous whereas extratesticular lesions are not. The fact that the lesion has grown very little over a 4 year time period makes the diagnosis of testicular cancer highly unlikely. Finally, it is possible that manipulating scrotal contents several times a day may cause swelling and bruising. Testicular self examination is recommended once a month.
This information is provided for general medical information purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available through our department at the Henry Ford Hospital and its suburban locations (I-800-653-6568).

Sincerely HFHS M.D.-CK
*Keyword: testicular cancer

Thanks for your response, regarding my question of the external appearence of the 4 mm lump, you said that I could be feeling the entire epidydimis, but I refer to the external appearence, when I am standing up in front of a mirror I see like a bag that is at the top of the testicle, and it is of a size close to 15 mm.(approx. one third of the entire testicle) , this bag has been growing slowly during this 4 years and that was the cause of my first visit to the urologist. The bag appears and disappears depending on the position of the testicle (if the scrotum is retracted I can see it, if the scrotum is relaxed, so the testicle is down, I can't). Do you think this bag could be related to the only thing my urologist found, that is, the 4 mm cyst at the top of the epidydimis?. When I touch the bag I can feel the epidydimis about 3 mm under the scrotum and what I think are veins and the supportive tissue that is at the top of the testicle. I'm sorry about asking this part again, but I'm a little bit nervous after reading so much medical information about testicular cancer on the internet (I'm not a M.D.), and I'm afraid of asking to my urologist because he assured me that there is nothing to worry about, by the way, if after 4 years I don't have any other symptom related to testicular cancer, other than this slowly growing bag at the top of my left testicle, should I still be worried about this to be cancer?

Thanks a lot, (and sorry about the length)
Joe

Dear Joe,
It sound like your urologist ordered an ultrasound of the scrotum and can assure you that this area above the testicle you describe as a bag, is a cyst(spermatocele). A spermatocele can fluctuate in size and at times even be painful. AN ULTRASOUND IS ABOUT 95% ACCURATE. The cyst is outside the testis which is less likely to be a cancer and because it is outside the testicle, it would not be a testicular cancer anyway. I would not worry yourself about this lesion unless your Urologist has a concern on physical exam. You should continue with your self examinations, but you may do them once a week or so. According to your ultrasound and your doctor’s assessment, you most likely don’t have testicular cancer.
This information is provided for general medical educational purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653-6568).

Sincerely,
HFHS M.D.-AK
*keyword:Testis Cancer

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