FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

SPERMATOCELE A NON-CANCEROUS SCROTAL LUMP

Question: My 21-year-old son found a lump on his testicle. His doctor examined him and said that the lump is a cyst filled with sperm that he called a spermatocele. He said that it was nothing to worry about, and that it should be left alone. Should other tests be done to be sure the lump is really a spermatocele, and should it be removed or just left alone?

Answer: When a patient comes in with a lump on one of his testicles, the first thing I think about is the possibility of cancer, and I'm sure that was your son's major concern, too. Cancer of the testicles is a serious problem for men. Fortunately, this type of cancer can often be cured. That is, it can be eliminated instead of simply treated only to have it return later by a process doctors call metastasis. But testicular cancer must be found early to be cured. I'm pleased that your son has been examining his testicles, because that is the best way to detect testicular cancer early.

I'm sure that your son was initially concerned that the lump he found could be a cancer. Fortunately it wasn't, and a spermatocele is much less serious than cancer. But for the benefit of others, I'll briefly review the steps of a testicular self-exam.

The testicles are normally very smooth "egg-shaped" structures located within the scrotum. A cancer begins as a hard growth in the testicle. It is often as hard and small as a grain of rice that feels like it is stuck on the surface or within the organ. The best way to check for the hard lump of cancer is to gently grasp the testicle and slide it around so that the fingers pass over every part of the organ. It should feel smooth without any disturbance in the contour or firmness accept for a soft sack-like structure, called the epididymis, that is attached to the lower back surface. Every man should check his testicles for cancer at least once each month.

Now, to discuss your son's condition. The epididymis attaches to the testicle, as I mentioned earlier. It serves as a reservoir to hold sperm after they leave the testicle, and it provides the correct conditions for their continued maturation. A spermatocele is a cyst or sack-like growth originating from the epididymis, usually near the top of the testicle. A spermatocele may become as large as the testicle itself.

As you would guess, the cyst that is a spermatocele is filled with sperm from the epididymis. The pressure within the cyst is great enough to make it feel quite firm, just as a balloon that is quite full feels firm. Actually, it may look and feel a great deal like a third testicle.

The location, feel and other physical examination findings make the diagnosis of a spermatocele fairly easy. Occasionally it is necessary to insert a small needle to remove fluid to confirm that sperm are present. This distinguishes the "lump" of a spermatocele from a more common and also non-serious mass within the scrotum, a hydrocele. More elaborate diagnostic studies are not needed for this condition.

A spermatocele is usually treated by just letting it alone. This is just what your son's doctor has recommended for him. On occasion, however, the cyst may grow large enough to become uncomfortable. If this occurs, a simple surgery can remove it.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.