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Hi,

I am a bit concerned.

A few days ago, after doing an examination for a few minutes, I found a small, relatively hard bump on the top portion of my left testicle. It is quite small, about 2mm in size, or the size/shape of a piece of rice.

It's difficult to tell, but it seems like it is attached to my actual testicle. The reason why it is difficult to discern is because it is so close to the top/end, located right where the testicle meets the epididymis. It feels like it could be an extension of the epididymis, but at the same time, also feels like it's attached to the testicle. Perhaps attached to both? The location and the size make it difficult to tell.

I've read that testicular tumors are almost always located in the middle region or the main body of the teste, and are usually much larger than this. Is that true?

I plan on getting this checked out, but with the holidays right around the corner, timing is really bad that it may need to wait a week or two. While I understand it is something that I should address, I would like to understand if this is something that I should be really concerned about.

Could it be the appendix teste or an epididyimal cyst?

I am not sure if this is new or not. I regularly feel around there, but not at the tips/ends of the testes, so I don't know if this has been there for a long time or not.

I am 29 years old. I exercise often and am in good health.

Thank you.

Answer
Travis, you seem well versed in testicular anatomy.  Testicular tumors can be located anywhere inside of the tunica albuginea (thick covering of the testicle) and not just in the "middle region".  However, they do not often present as a surface nodule until larger.  What you are describing almost certainly is a benign condition.  I suspect that what you are feeling is either the appendix of the testis or epididmyis, a tunica albuginea cyst or a very small spermatocele.  All of these are totally benign conditions. Therefore, I think it is okay to wait until after the holidays to see a urologist.  To follow is a "macro" I have written regarding your problem.  


In evaluating lumps inside the scrotum, it is important to differentiate those that are extra-testicular, (originating from the contents of the scrotum but not actually from the testicle) from those that are originating from the testicle per se.  The former are very common and almost always benign.  Such examples would include hernia, varicocele, epididymal cyst, spermatocele, hydrocele, etc.  Inflammation of the epididymis (epididymitis) typically produces a mass in this structure that gradually recedes as healing occurs.  After a vasectomy, a small, sensitive mass can develop at the site of surgery called a spermatic granuloma. There also exists a small embryonic remnant on the upper pole and the testicle and another on the head of the epididymis.  These are called the appendix testis (also know as the hydatid of Morgagni) and the appendix epididymis respectively.  None of the requires treatment and they are generally painless.  The one exception is that occasionally the appendix can twist (torsion) and shut off its blood supply.  This produces a painful nodule that gradually disappears in a week or so.  Sometimes they are removed surgically if one cannot differentiate them from torsion of the testicle.  

Testicular lesions can also be benign, the most common of these being a tunica albuginea cyst which characteristically is smooth, round, painless and rarely more than 5mm in size.  All other masses of the testicle are to be considered tumor until proven otherwise.  A urologist (as opposed to a family physician) can usually differentiate between the various lesions on physical examination.  An ultrasound of the scrotum will generally be done if the diagnosis is not obvious or there is concern about tumor. 

Since the evaluation of scrotal lumps by a layman can be difficult & inaccurate, it is my advice to consult with a urologist.  Good luck.

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Arthur Goldstein, M.D.

Expertise

Problems or questions related to the field of urology; ie urinary stone disease, urinary cancers (kidney, bladder, prostate, testis, etc.), urinary infections, etc. I no longer answer questions related to erection problems or male sexual dysfunction.

Experience

I am retired from the active practice of urology. My 34 years was totally in the clinical field and involved the entire gamut of genitourinary problems, with special interest in endourology.

Organizations
American Medical Association, American Urological Association, American College of Surgeons

Education/Credentials
College degree - BS Medical degree - MD Master of Science - MS

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