A 17 y.o. male presents saying, “I have a lump in my testicle!” He noticed a mass while showering the previous night, and his mother called to have him seen today. He denies any associated pain but says it feels as if he has “grown a third testicle.” He has heard that teens are at heightened risk for testicular cancer and seems concerned for that. He is athletic and is in the midst of the soccer season but does not recall an injury in play or practice nor in other activities. He says he does not know how long it has been present, although he thinks he would have felt it by now if it had been this large for long.
Past Medical/Surgical History
Asthma, uses a long-acting beta agonist and corticosteroid combination inhaler; does well on this regimen, not experiencing increased symptoms
Mild acne
No surgeries
Review of Symptoms
Not obtained yet
Current Meds
Long-acting beta agonist and corticosteroid inhaler
Topical benzoyl peroxide
Physical Examination
Vital signs: T 98, BP 98/68, HR 64, HT 70, WT 150 lbs.
General: Slender, well-developed young male who appears slightly anxious as he describes his complaint but otherwise in no distress.
Genitalia: Exam of his scrotum-skin is moderate pink, dry, and intact. Noticeable area of enlargement on the left. Right testicle is freely mobile, smooth, and rubbery; ovoid in shape and epididymis is palpable. On the left, testicle is isolated from the mass and is mobile with consistency similar to the right, although there is a mass just proximal to the testicle that is approximately 3 cm in diameter, well-defined with smooth surface and cystic (nonsolid) consistency. Mild discomfort voiced with the exam. No visible lesions identified. No palpable inguinal nodes.
Case Study Discussion – Part I:
Answer the following and post your response in the Case Study Part I by creating your own initial thread.
Identify three conditions that you would consider in your differential diagnosis, with the most likely condition listed first. Provide rationale for each differential with supporting evidence from the case study.
What further history, further examination, and diagnostic studies should be considered in order to explore your differential diagnosis and confirm your suspicions?
Answer : aport from the testicular cancer the differential diagnosis conditions are
1 . Epididymal cyst
2. Epidermoid cyst
3. Red Testicular syndrome
Rationale for each condition :
1. Epididymal cyst :
* It is usually pain less noncancerous fluid filled sac in the testicular covering area.
* if it contains sperms it can called sprmatic cyst or spermatocele.
_ further history should asked like any abdominal pressure and tenderness and any sudden pain etc.
_ diagnosis is done by performing computerized tomography, magnetic resonance imaging, and Doppler and ultrasonography.
2. Epidermoid cyst :
* these are unilocular cysts filled with keratin and other disquamated material and linked with sqamous epithelium.
* these cysts are mimic like Testicular tumor or masses.
_further history should ask like is there any sudden pain and feeling of any full ness of testicular area.
_ diagnosis should be performed like CT scan and MRI. To find out exact cyst.
_ Doppler also can perform to know the blood circulation and hematomas.
3. Red testicular syndrome : it also we can suspect as diffential diagnosis because patient is on corticosteroid usage.
* The prolonged corticosteroid usage leads to redness and itching on the tesicles covering area.
* And also patient is complaining about skin is pink, dry and intact at the genital area . And he is also in corticosteroid usage for asthma.
_ further history should be collect like any severe itching, persistant red ness, and is there any sensitivity to pain (hyperalgesia), and is there any infections and fever.
_ diagnostic studies : patch test of the dry skin and culture and sensitivity to find out micro organisms.
* some times due to infections also we can find the enlargement of the lymphatic glands.
These are we can suspect as a differential diagnosis of the testicular tumour.
A 17 y.o. male presents saying, “I have a lump in my testicle!” He noticed a...
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