Differential Diagnosis for Scrotal Mass

The patient presents with a 2-cm, hard, nontender mass in the right testicle following trauma. The mass does not transilluminate and does not change in size with position. Here is the differential diagnosis categorized for clarity:

• Single Most Likely Diagnosis

  • D) Germinal cell tumor: This is the most likely diagnosis given the description of the mass as hard and non-tender, which does not transilluminate. Testicular cancer, including germinal cell tumors, can present as a painless testicular mass and is a significant concern in young men, especially after trauma which might draw attention to the area but is not typically a cause of testicular cancer.

• Other Likely Diagnoses

  • E) Vascular trauma: Given the history of trauma to the scrotum, vascular trauma could potentially lead to the formation of a hematoma or other vascular abnormalities that might present as a mass. However, the description of the mass as hard and non-tender, without mention of significant swelling or discoloration, makes this less likely.
  • B) Dilated pampiniform venous plexus (Varicocele): While varicoceles are more common on the left side and can be tender, they typically are described as feeling like a "bag of worms" and increase in size with standing and decrease or disappear with recumbency, which does not match the patient's presentation.

• Do Not Miss Diagnoses

  • Testicular torsion or other acute conditions: Although the patient's symptoms have been present for 2 months, any condition that could lead to testicular loss or other severe outcomes should be considered, even if the timeline does not perfectly match. However, the chronic nature and specific characteristics of the mass make this less likely.
  • Epididymitis or orchitis: These conditions are typically associated with pain, swelling, and possibly fever, which does not align with the patient's presentation of a dull ache and a hard, non-tender mass.

• Rare Diagnoses

  • A) Cystic dilations of the efferent ductules (Spermatocele or epididymal cyst): These would typically transilluminate, which contradicts the patient's presentation.
  • C) Fluid accumulation within the tunica vaginalis testis (Hydrocele): Hydroceles do transilluminate and can vary in size with position, which does not match the description provided.
  • Other rare tumors or conditions could also be considered but are less likely given the information provided.