Testicular pain as the initial presentation of testicular neoplasms

Testicular neoplasms are reported to present with testicular pain in 0.01-10% of patients. The diagnosis of tumour may, therefore, not be considered immediately with this mode of presentation, leading potentially to delays in diagnosis and poorer prognosis or scrotal exploration for suspected torsion. The objective of this study was to assess the incidence of pain as the presentation of testicular neoplasms.

A retrospective case note analysis of all patients undergoing radical orchidectomy over an 11-year period in Hull, UK was performed. Data on presenting symptoms, histology and clinical stage were collected.

It was found that 23.5% of all patients analysed (27 of 115) presented with testicular pain, but that this did not appear to correlate with any particular histological sub-type of neoplasm or stage of disease. However, those presenting with germ cell tumours and testicular pain were more likely to suffer disease relapse than those presenting with painless testicular enlargement (1 6% compared to 2.6%).

Testicular neoplasms should be considered earlier in patients presenting with testicular pain, as this may be more common than previously reported.