epididymis

[goodeaster]

I have had pain in my left testicle for a while now.I had an undescended left testicle when I was 11  which was operated on ( I am 40 now) and its the epididymis of that testicle that has always felt slightly tender and rather large compared to the one on the right. . Three weeks ago I discovered a pea sized lump . I went to the specialist who first said it was a cyst and gave me antibiotics for epidiymitus. I had a scan there and the guy who did the scan ( not the speciailist) said it was not a cyst as it was not fluid filled. I went back after the course of antibiotics with the pain no better and the specialist feeling 3-4 - what he keeps calling- cysts. He has now decided to book me in for surgery in three weeks to remove the 'infected' epididymis. I am a little concerned -even though he keeps telling me its definately not cancer. Having read a few medical studies it seems that the incidence of malignant tumours in 'paratesticular masses' is 10-20% and the 'is it a cyst or not a cyst' is making me think the specialist is just trying to calm my fears.
As it is not water filled-does this mean it is not a cyst?...and therefore would be unable to prove its malignancy until its removed and had a biopsy done on it?....or is he right in saying that there is 'no chance' of this being cancer?

[Stephen Liroff, MD]

You certainly did the sensible thing in getting your scrotum evaluated, and I understand your anxiety now with the findings and disparate views as to what is going on. First, a little defining. A cyst is a fluid filled structure. If not fluid filled, it is not a cyst. The ultrasound technitian my have missed the area with the scan head (needs to use a special head on the machine for scanning small parts). I have sent patients for scrotal ultrasounds and then found out the testis was evaluated but not the epididymus. Also, the size of the lumps that you are feeling may be too small to be accurately evaluated by the ultrasound machine being used.
You are correct in being concerned about a cancer. Most tumors of the epididymus are benign, but a tumor (growth that is not a cyst) and is causing pain and is of recent onset, does have a greater potential to be a cancer than a non-tender one. With all that being said, you need to discuss your concerns with your urologist. His expertice in evaluating scrotal masses has to be respected. You also need to know that removing the mass or your whole epididymus will likely make you sterile from that testicle. You only need one testicle with intact tubing to be fertile, so if there is no problem with the other  side, this surgery should not affect your overall fertility. Not incidentally, the whole approach to an intrascrotal structure that may have a malignancy is different than approaching a benign mass.
It sounds as if you need to sit and discuss all of this with your urologist.
Good luck.
S.A.Liroff, M.D.

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