Testicular Pain: Epididymitis or Testicular Cancer?

Q: Testicular Pain: Epididymitis or Testicular Cancer?

Hello： Based on what you said, the conclusion is that there is a tumor in the left testicle, and it needs to be distinguished as benign or malignant. <br>The physician will likely arrange for further examinations. <br>National Taiwan University Hospital has extensive experience a

Epididymitis or testicular cancer? I'm feeling very down?

Hello Doctor, at the beginning of this year, I felt a dull pain in the area of blood vessels in my left testicle, so I went to a urology clinic in Taipei.
The doctor there only did a brief examination and diagnosed me with a varicocele, prescribing painkillers without further investigation.
He mentioned that I likely had this varicocele since childhood, as my left testicle appeared to be about 40% smaller than the right one.
After finishing the medication, the pain persisted, so on April 18, 2019, I visited National Taiwan University Hospital for a more thorough examination.
The doctor there also performed a brief physical examination and diagnosed me with moderate varicocele, ordering a semen analysis, ultrasound, and ibuprofen.
At that time, my left testicle felt somewhat firm, similar to a lychee seed (though not as exaggerated), and there was a harder, smooth area on top that was mildly painful when pressed.
However, since I would be out of Taiwan in May, I postponed the follow-up and tests.
The semen analysis was scheduled for April 25, and the ultrasound for June 3.
In May, I had a severe cold, and upon returning to Taiwan in June, I inadvertently infected a housemate with the same cold.
On June 6, during my follow-up appointment, the doctor mentioned that the ultrasound findings were less concerning than what the technician had indicated, stating that there were no major issues (the ultrasound technician had suggested that the varicocele situation was manageable and that infection or tumor needed to be ruled out).
The doctor prescribed a 28-day course of Augmentin, but from that day onward, my testicle began to change and swell.
I thought this was normal since I was on medication.
By the time of my next appointment, the situation remained similar.
On July 18, 2019, I explained my condition to the doctor (without mentioning the cold).
The doctor performed another physical examination and ordered an immediate ultrasound, suggesting that it might not be a good sign and that there was a possibility of needing a testicular removal surgery, but he couldn't determine whether it was due to inflammation or a tumor at that moment (that was the gist of his message).
He mentioned that typically, with medication, recovery should be expected, but given the rapid changes in my condition, he hesitated and prescribed two weeks of Augmentin and painkillers.
I am feeling very low and confused about my situation; my left testicle is noticeably larger than the right (I remember it being smaller during childhood, and it seems to be smaller than normal).
I regret not seeking treatment from a major hospital sooner.
Therefore, I am here to seek your opinion.
Thank you.
Below are the reports from the two ultrasounds:
2019/6/3
Right Testicle (3.74 x 1.74 cm) - homogeneous, blood flow normal
Epididymis (3.41 x 1.58 cm) - heterogeneous, blood flow increased
Impression: No varicocele noted on either side; increased blood flow in the right testis, rule out orchitis.
2019/7/4
Right Testicle (3.6 x 1.8 cm) - homogeneous, blood flow normal
Epididymis (3.8 x 2.2 cm) - hypo-echoic, blood flow normal
Impression: bilateral varicocele; left testicular tumor.

Wei, 20~29 year old female. Ask Date: 2019/07/06

Dr. Du Shixi reply Urology

Hello: Based on what you said, the conclusion is that there is a tumor in the left testicle, and it needs to be distinguished as benign or malignant.
The physician will likely arrange for further examinations.
National Taiwan University Hospital has extensive experience and will certainly be able to handle it.
If there have been any unsafe sexual practices, it is important to inform the physician (you should also mention if you have a cold) for their reference.
If there is inflammation, medication should help reduce the swelling.
Wishing you good health.

Reply Date: 2019/07/06

More Info

When it comes to testicular pain, distinguishing between conditions like epididymitis and testicular cancer is crucial for appropriate management. Based on your description, it seems you have been experiencing persistent discomfort in your left testicle, which has led to a series of medical evaluations and imaging studies.

Understanding Your Symptoms
1. Initial Diagnosis: The initial assessment by the doctor suggested that you had a varicocele, which is an enlargement of the veins within the scrotum. This condition can cause discomfort and is often benign. However, it is important to note that varicoceles can sometimes be associated with testicular atrophy, which may explain why your left testicle appears smaller than the right.

2. Changes Over Time: You mentioned that the left testicle has become enlarged and has a different texture, described as being hard and resembling a lychee seed. This change is significant and warrants further investigation. The fact that it has become larger and harder could indicate a potential tumor or other pathological process.

3. Imaging Results: The ultrasound reports you provided indicate that there is a hypoechoic area in the left testicle, which is concerning for a testicular tumor. The presence of increased blood flow to the right testis could suggest inflammation, such as orchitis, but the findings in the left testicle are more alarming.

Possible Conditions
1. Epididymitis: This is an inflammation of the epididymis, often caused by infections. It typically presents with pain and swelling, and it can be treated with antibiotics. However, the presence of a hard mass and significant changes in size may not align with typical epididymitis.

2. Testicular Cancer: The characteristics of the left testicle, particularly the hard texture and the hypoechoic area, raise suspicion for a testicular tumor. Testicular cancer is more common in younger males and can present with a painless lump, although pain can occur. Early detection is key to successful treatment.

Next Steps
Given your symptoms and the ultrasound findings, it is essential to follow up with a urologist who specializes in male reproductive health. Here are some recommended steps:
1. Further Imaging: A more detailed imaging study, such as a Doppler ultrasound or MRI, may be necessary to assess the blood flow and characteristics of the mass more accurately.

2. Tumor Markers: Blood tests for tumor markers such as alpha-fetoprotein (AFP), beta-human chorionic gonadotropin (β-hCG), and lactate dehydrogenase (LDH) can help in diagnosing testicular cancer.

3. Surgical Evaluation: If there is a strong suspicion of a testicular tumor, a surgical procedure called an orchiectomy (removal of the affected testicle) may be necessary for both diagnosis and treatment.

4. Emotional Support: It is understandable to feel anxious and low during this time. Seeking support from friends, family, or a mental health professional can be beneficial as you navigate this challenging situation.

Conclusion
In summary, while epididymitis is a possibility, the changes in your left testicle, particularly the hardness and enlargement, are concerning for a testicular tumor. It is crucial to pursue further evaluation promptly to determine the exact cause of your symptoms and to initiate appropriate treatment. Early intervention can significantly improve outcomes, especially in cases of testicular cancer. Please consult with a urologist as soon as possible to discuss your symptoms and the next steps in your evaluation and management.

Similar Q&A

Understanding Painful Testicular Lumps: Epididymitis vs. Cancer

Hello, Dr. Hsu! I have discovered a small, rice-sized hard lump located just above the left testicle, presumably at the head of the epididymis, which is extremely painful to touch. Could this possibly be epididymitis? I did some research online, and it seems that testicular cance...

Dr. Xu Weikai reply Urology
OTTO: Hello, if you can be 100% certain that the lesion is in the epididymis, then the chances of it being malignant are very low. Testicular cancer typically does not cause pain; however, if it compresses nearby nerves or blood vessels, it can lead to discomfort. Additionally, i...

Understanding Epididymitis: Symptoms and Concerns for Teens

Doctor, last time I was playing on the computer and halfway through, I started to feel pain in my lower back. When I went to the bathroom to check, I found a small hard lump on the left side of my right testicle, and when I touch it, it causes pain in my lower back. I'm worr...

Dr. Sun Hongshun reply Urology
Hello, the chances of testicular cancer are low, but it is still recommended to consult a urologist.

Understanding Testicular Pain: Causes and Concerns for Patients

Hello doctor, I was previously diagnosed with left-sided varicocele at the hospital, and a week ago I experienced hematospermia due to epididymitis. The color of my semen has returned to normal, but I occasionally feel pain in the "right" testicle, accompanied by sorene...

Dr. Du Shixi reply Urology
Hello: It is uncommon for both testicles to have the same issue. It is recommended that you avoid prolonged sitting and maintain good blood circulation. Please refrain from engaging in intense physical activities for the time being. If there are any changes regarding the left epi...

Understanding Epididymitis: Chronic Symptoms and Concerns Explained

About three years ago, after having sexual intercourse, my testicle became swollen and extremely painful. At that time, my right testicle was completely swollen, and it hurt to touch it. I also felt a hard lump below the other testicle. There was blood in my ejaculate, which made...

Dr. Xu Wencang reply Urology
After inflammation, the lump does not resolve quickly, and there is currently no fever or pain. Follow-up at the outpatient clinic is recommended.