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Have Painless Pin Head Sized Hard Bump On Testicle. Ultrasound Done. What Does The Report Suggest?

Posted on Mon, 13 Aug 2012

Question: I am a 47 year old maile and had asked a question a few weeks ago about a painless pin head sized hard bump attached to the front of my left testicle and was examined by a urologists and he scheduled me to have an ultrasound. I had the ultrasound last week and I my follow up dr. appt is not until August 6th. I will type exactly what the impression portion of the report says. I requested the report from the facility where it was perfomred. IMPRESSION: 1. Left testicular microcalcifications of indeterminate etiology. These microcalifications could be benign versus malignant process (for example burned-out seminoma) versus vascular calcifications versus previous infection versus history of trauma at that site. Recommend contuied follow up. 2 Subcentimeter left epidymal cyst versus spermataocele. 3. Bilateral hydroceles. 4/ Query left-sided varicocele.

Now I am very worried espescially about impression 1. and what this all means and the contuied follow up. In the FINDINGS portion of the report it says nothing abnormal about the right testicle. Right testicle size 4.51 x 2.60 x 2.9 cm. Left testicle size 4.60 x 1.92 x 2.59 cm. It also says there are multiple rounded anecoic regions noted adjacent to the left testicle. However, this is unknown whether this comminute or not. The microcalcifications are subcentimer and located in a subcentimeter region. Well can you help translate this and please let me know if I should try to move my appt. up with my urologists and exactly how worried I should be, because I am pretty worried after reading all that in the ultrasound report. Thank you so much for your help.

Answered by Dr. Shanthi E (7 hours later)

Hi,

Thanks for posting your query and uploading the ultrasound report. I have read it in detail.

Let us take each testicle separately and discuss.

Firstly, the right testicle:

You need to know the basic difference between hydrocoele and varicocoele to understand your report better.

Hydrocoele is the collection of fluid in the scrotum, where as varicoele is dilatation in the venous plexus of the spermatic vein. Varicoele is much of a concern compared to hydrocoele.

A right sided hydrocoele is seen in the right testicle. There is no varicoele however, in the same testicle.

Your right testicle is normal except for the hydrocoele.

The left testicle:

Subcentimeter microcalcifications are seen here. Microcalcifications are usually seen in Non-seminomatous lesion is seen in the epididymal head.

A small hydrocoele is also seen on the left side.

There are multiple rounded anechoic regions noted adjacent to the left testicle.

There seems to be a problem in the left testicle. There could be two possibilities here. Either it can be seminoma or it could be Non- seminoma. As I said earlier, microcalcification is seen in non-seminomas. However, seminoma is more common.

You need to follow up the ultrasound report with a CT-scan of the Pelvis region to confirm on the cause. In addition, tumor markers like beta HCG (bHCG), alpha foetoprotien (AFP) and lactate dehydrogenase (LDH) needs to be done to come to conclusion on the type of the tumor.

Please try to move up with your appointment with the urologist. Early diagnosis and treatment has high cure rate in testicular cancer.

This is just a probability. It needs further confirmation with CT and MRI.

Hope this helps you.

Please do write back for further discussion on this.

Regards,

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Shanthi E (9 hours later)

I am just wanting clarification. From the report you have read you came to a conclusion that the probablitlity is that it is a malignicy. I am presuming both seminoma's and non-seminoma's are both malignant in nature. I don't know if there are other possiblities or not. I was hoping it might just be a benign cyst of some nature however that does not seem to be your interpretation and you know much more than I.

Answered by Dr. Shanthi E (5 hours later)

Hi,

Thanks for writing back. I am sorry; I was just unable to put it across straight to you in my initial reply. Let me try this time.

Both Seminoma and Non-seminomatous germ cell tumours of the testis are malignant in nature.

About 99% of the testicular tumours are malignant.

The standard protocol goes like this - A painless, hard lump in the testis should be considered testicular cancer and needs to be investigated further until proven otherwise.

The only other tumour which I can think of being benign is interstitial cell tumour. Again, the chances of it being are only 1%.

The broad five year survival rate is anywhere between 86% to 94%.

Lastly, it would be unethical and inappropriate to conclude on this without doing a proper physical examination.

I hope I have been clear in my answer now. Please do write back for further clarifications, if required.

I wish you good health.

Regards,

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Shanthi E (1 hour later)

I was able to immediately get into my urologist this afternoon. He went over the entire report with me. He told me that there was nothing that looked malignant, cancerous or pre-cancerous. He said I had an epididimyl cyst which was what I was feeling as the pin headed lump. He talked about the varicocele and spermicoceles, hydrodoceles etc. He told me the calcifications were fluid filled and extremely small in nature and that they could have been there for who knows how long. He said there was no mass or tumor and that I did not need to worry or even have a follow up, but if i wished we could do another ultrasound in 6 months just to ease my mind if necessary. I am not sure how I am suppose to interrpret what he is telling me and what you are telling me. He also performed another testiculare exam and did not feel any changes, lumps or masses other than the epididyml cyst.

Could you please let me know if I should seek a second opinion. I am somewhat confused at this point. I do appreciated the time you have spent on evaluating what i have sent you and written to you and would certainly appreciate a reply.

Thank you so much for your help. You help many people and should feel proud.

Answered by Dr. Shanthi E (5 hours later)

Hi,

Thanks for writing back.

I am glad that you were able to XXXXXXX your Urologist. I agree with him that there is an epididymal cyst in you.

Also, he has performed another testicular examination on you and has ruled out lumps or masses.

However, the ultrasound report is still concerning me and I would not neglect it, if you were my patient.

There is no need to seek a second opinion, but, please repeat the ultrasound again in a month. You will not lose much in this. You may get it done at a different centre by a different sonologist. Please do write me the report.

I do not think waiting for 6 months is a good idea. Also, I want you to be free without any confusion.

In the meantime, please look for any new symptoms like loss of weight, heaviness in your scrotum, enlarging scrotum - painful or painless.

If these do occur, please get back to your Urologist.

If you can get the tumour markers done as I mentioned in my first reply, it would be great. If they are normal, then we might as well be rest assured that it is nothing but an epididymal cyst.

I would be interested to know about the follow up and your progress. Please do write again.

If you have no queries for now, please close this discussion and write a review.

Please move on in life, as nothing is confirmed in you.

Thanks,

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar