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JE Sramek MD
JE Sramek MD, Doctor (MD)
Category: Health
Satisfied Customers: 207
Experience:  Specializing in Pathology, I excel at making test results and cancer understandable.
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Lump under scrotum. What could it be?

Resolved Question:

I have a lump under my scrotum (sorry this is gross) that feels like a cyst. It is not large, maybe the size of my thumbnail and is not growing. I can't tell if it is a skin issue or something that is part of my "urinary/prostate" system. From looking at anatomy pictures, it seems to be just under my prostate, so it is not testicular.
Submitted: 9 years ago.
Category: Health
Expert:  JE Sramek MD replied 9 years ago.

If it is truly a cyst, then it is likely either a hydrocele or an epididymal cyst (larger ones are called "spermatoceles"). Since it sounds like it is high in the scrotum, it's more likely an epididymal cyst. Hydroceles are fluid collections in a space around the testicle called the tunica vaginalis. Epididymal cysts are located above the testicle and feel separate from the testicle (whereas hydrocoeles will be around or directly adjacent to the testicle). Both of these are benign and treatment is usually conservative if they're not causing symptoms. The other possibility is an inguinal hernia which is an outpouching of the abdominal cavity into the scrotum. These are made larger by bearing down (like you're having a bowel movement) and can be painful. Hope this helps.

Customer: replied 9 years ago.

Hi Doc. I like your response, but I wish I had the chance to improve my question. Could I please be more specific about the lump and see if this changes your response.

The lump is really NOT on my scrotum, but more on where the back of the scrotum joins with my body. (In college we called this the "taint", but I don't know the real name.)

It is small, but it feels like it is in the skin. It is a little sensitive, but that may because since I noticed it, I monitor/touch it more than I would normally do. And, somewhat contradictory from the last statement, it feels like it is on a tube (urinary tract or something" as it feels more attached to a place than just floating in the skin.

Not sure if this changes anything, but let me know. I am seeing a Urologist next week because my GP did not know what it was and figured we should get a specialist involved.

Expert:  JE Sramek MD replied 9 years ago.

Ok, that does change things. So it's behind the scrotum. Does it feel like it's fixed to the skin or to the "tube" or neither? Is it directly in the middle or off to one side? Does it compress or is it more solid?

Customer: replied 9 years ago.

It is hard to tell, but maybe more on the tube. It is on the left side but almost in the middle. It is squishy, so not hard. But, it is firm enough that it does not change shape if I put pressure on it.

Anything else I can do to better describe it?

Expert:  JE Sramek MD replied 9 years ago.

Have you had any problems with urination? Specifically blood in your urine or dribbling?

Customer: replied 9 years ago.

No blood or severe trouble. Sometimes I feel I cant get the stream going and/or can't finish. But, that is usually at night if I get up and have to go. During the day orr when I am awake and active, I dont notice anything or sense any trouble.

I have had a colonoscopy (2 years ago) and a DRE every year. All came back normal, including last physical 3-4 months ago. Also, my PSAs are low and steady. Physical also revealed no testicular abnormalities.

I guess course of action is to see a Urologist rather than dermatologist, right?

Expert:  JE Sramek MD replied 9 years ago.

It sounds like a urologist is what you need. The fact that it is not attached to the skin makes an epidermal inclusion cyst (or sebaceous cyst) less likely. It sounds like it may be arising from the urethra or the adjacent glands. There are a few possibilities: It could be a syringocele, which is a cyst that forms as a result of blockage of the duct of your Cowper's gland (sometimes called the bulbourethral gland). This is fairly uncommon but seems to fit your description. The other options are downright rare: A urethral diverticulum is possible, though rare in men. That is an outpouching of the urethra that can often get infected or cause bleeding. It could also be a tumor of the Cowper's gland but those are very rare. I'm not sure if this information is helpful, but in the end, it doesn't sound like anything serious.

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Customer: replied 9 years ago.

Hi Doc. Not sure you remember me and my question. I went to a great Urologist and she said she was 99.x% sure the lump was a sebaceous cyst, esp because I have had several of these removed and it runs in my family. She did recommend removing it and doing a biopsy. She said there is a tiny, tiny % chance that it could be a "scrotal liposarcoma" and that removing it would eliminate the cancer.

So, I plan to do that. Do you have any info on scrotal liposarcomas?


Expert:  JE Sramek MD replied 9 years ago.

Sarcomas are malignant tumors of soft tissues (muscle, fat, fibrous tissue, etc). Liposarcomas are malignant tumors of fat cells. Liposarcomas in the skin do very well compared with liposarcomas in other locations. So if you find grim information online, realize that the poor prognosis associated with liposarcomas is limited to deep tissue or intraabdominal locations. If completely excised, the recurrence rate for liposarcs in the skin is very low. The other possibility (which is more likely than a liposarc) is a lipoma, which is the benign equivalent of liposarcoma. I can't quote you any probabilities because liposarcomas are so rare in this location, but your urologist is correct in that excision is usually curative. Hope this helps.