Left Epididymis Mass: Pain, Diagnosis, and Treatment Options

Left epididymal mass?

Hello Doctor: I have had a hard lump on my left testicle for several years, and it sometimes causes severe pain.
I previously went to a urology clinic for an ultrasound examination, and the doctor explained that it was epididymitis.
After taking medication, the severe pain was alleviated (the doctor also mentioned there was a varicocele), but the hard lump has not completely disappeared, and I can still feel it.
Recently, I have experienced severe pain again, which radiates to my left lower abdomen.
Light contact with the swollen area intensifies the pain.
I visited a local clinic, and the doctor, through visual inspection and palpation, believes it is chronic epididymitis.
After taking pain relievers and antibiotics for three days, the pain has subsided, but I still feel slight discomfort.
Should I go to a larger hospital for a detailed examination? Is there a possibility that it could be cancer? Could the hard lump have undergone fibrosis, making it impossible to resolve with medication? Thank you.

Duo Duo, 30~39 year old female. Ask Date: 2015/09/29

Dr. Xu Weikai reply Urology

Hello, epididymitis.
The lump may not disappear.
Some individuals may experience recurrent acute episodes throughout their lives, and appropriate medication can be administered during these episodes.
If there are any unclear points, feel free to ask again, and we can discuss and research further.
Answers found online should only be used as a reference; if necessary, it is important to seek medical attention at a healthcare facility.
The Ministry of Health and Welfare Taitung Hospital cares about you.

Reply Date: 2015/09/29

More Info

Hello, thank you for your inquiry regarding the left epididymis mass and the associated pain. Based on your description, it seems you have been dealing with a persistent issue that has not fully resolved despite treatment. Let's break down your concerns and provide some guidance on the next steps.

Understanding the Condition
The epididymis is a coiled tube located at the back of the testicle, responsible for storing and maturing sperm. Inflammation of the epididymis, known as epididymitis, can result from various causes, including infections, trauma, or even certain medical conditions like varicocele (enlargement of veins within the scrotum). The presence of a hard mass that persists despite treatment could indicate chronic inflammation or other underlying issues.

Pain and Symptoms
You mentioned experiencing severe pain that radiates to the left lower abdomen, which can be concerning. The fact that the pain intensifies with light touch suggests that there may still be significant inflammation or irritation in the area. Chronic epididymitis can lead to fibrosis, which may explain the hard mass you can feel. However, the possibility of other conditions, including tumors or cysts, should not be overlooked.

Diagnostic Steps
Given your history and the persistence of the mass, it is advisable to seek further evaluation at a larger medical facility, particularly one with a urology department that can provide comprehensive care. Here are some diagnostic steps that may be recommended:
1. Ultrasound: While you have already had an ultrasound, it may be beneficial to repeat this test or have a more detailed imaging study to assess the characteristics of the mass and rule out any malignancy.

2. MRI or CT Scan: If the ultrasound findings are inconclusive, advanced imaging like an MRI or CT scan may provide more detailed information about the mass and surrounding structures.

3. Blood Tests: Tests for infection, inflammation markers, and tumor markers (if indicated) can help in assessing the situation further.

4. Biopsy: In some cases, if there is a suspicion of malignancy, a biopsy may be necessary to obtain a definitive diagnosis.

Treatment Options
If the diagnosis confirms chronic epididymitis, treatment may include:
- Antibiotics: If an infection is present or suspected, a course of antibiotics may be necessary.

- Pain Management: Non-steroidal anti-inflammatory drugs (NSAIDs) can help manage pain and inflammation.

- Surgery: In cases where there is significant fibrosis or if a tumor is found, surgical intervention may be required to remove the affected tissue.

Concerns About Cancer
While the presence of a hard mass can be alarming, it is essential to remember that not all masses are cancerous. Chronic inflammation can lead to changes in tissue that may feel firm or hard. However, it is crucial to rule out malignancy through appropriate diagnostic measures.

Conclusion
In summary, given the persistence of your symptoms and the hard mass, it is highly recommended that you seek further evaluation at a larger medical center. A urologist can provide a thorough assessment and guide you through the necessary tests to determine the exact nature of the mass and the best course of action. Early diagnosis and treatment are key to managing any potential complications effectively. Please do not hesitate to reach out to a healthcare professional for further assistance.

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