Differential Diagnosis for a Stable Testicular Bump with Intermittent Pain

Given the description of a small, stable bump on a testicle present since the age of 17, with periodic intermittent dull achy pain, the following differential diagnoses are considered:

• Single Most Likely Diagnosis

  • Epididymal Cyst: This is a common, benign condition that can cause a lump on the testicle. The fact that it has been stable for many years and is associated with intermittent pain supports this diagnosis, as epididymal cysts can sometimes cause discomfort.

• Other Likely Diagnoses

  • Varicocele: A varicocele is an enlargement of the veins within the scrotum, similar to varicose veins. It can cause a feeling of heaviness or aching in the testicle and is a common finding in men.
  • Hydrocele: A hydrocele is an accumulation of fluid around a testicle, leading to swelling. While it's more commonly associated with swelling rather than a discrete bump, it could potentially cause intermittent discomfort.
  • Spermatocele: A spermatocele is a cystic structure that forms at the head of the epididymis and can cause a palpable lump. It's usually benign and might cause intermittent pain.

• Do Not Miss Diagnoses

  • Testicular Cancer: Although the long-standing nature of the bump and the absence of significant changes over time make cancer less likely, testicular cancer cannot be ruled out without further evaluation. It's crucial to consider this diagnosis due to its potential severity and the importance of early detection.
  • Epididymitis or Orchitis: Inflammation of the epididymis (epididymitis) or testis (orchitis) can cause pain and swelling. These conditions can be acute or chronic and might present with intermittent symptoms.

• Rare Diagnoses

  • Adrenal Rest Tumor: These are rare, benign tumors that can occur in the testicles in individuals with congenital adrenal hyperplasia. They might cause testicular enlargement or masses.
  • Testicular Microlithiasis: This condition involves the presence of small calcium deposits within the testicle. While it's often asymptomatic and found incidentally, there's a debated association with an increased risk of testicular cancer.

It's essential to consult a healthcare provider for a thorough examination and potentially further diagnostic tests, such as ultrasound, to determine the cause of the bump and intermittent pain. The likelihood of cancer, given the long history of the bump without significant change, is relatively low, but it's always better to have a professional evaluation to rule out any serious conditions.