—This condition is rare except as an occasional complication of mumps, or, much more rarely, of one of the other exanthems. Why after acute parotiditis there should be a tendency to inflammation of the testis or the ovary has never been fully explained. Nevertheless it is sufficiently frequent to be well known to the laity, and is occasionally so pronounced as to lead to actual atrophy, with loss of function of the testis involved. In any true orchitis there will be considerable pain and tenderness, because the testis proper is so tightly confined within its tunica albuginea, i. e., a firm, inelastic membrane. By proximity there will also be set up more or less involvement of the tunica vaginalis, with effusion, so that some degree of acute hydrocele may be looked for in every such instance.
Treatment.
—The treatment of the condition above described consists essentially in rest, with local soothing applications, of which perhaps nothing will be more satisfactory than guaiacol, which, however, should always be used with caution.
TUMORS OF THE TESTICLE.
Dermoid cysts and tumors and teratomas, i. e., those of mixed type, are frequently met in this region. Their explanation is doubtless afforded by the extreme complexity of the elements which help to make up the part, while in the embryonic condition, and the confusion of tissue elements which may then and there arise. These growths of embryonic origin vary from single cysts to a mass of cystic tumors, which may replace the organ, or constitute neoplasms of large size, while some of the teratomas have features causing them to resemble the mixed growths occasionally found within or about the ovary. In this way is to be explained the occurrence in such masses of hair, teeth, and other epiblastic elements, as well as of cartilage or bone or other mesoblastic elements. Taken together these growths constitute an interesting group for the pathologist to study. For the surgeon, however, they require essentially the same class of treatment, namely, extirpation, or, if this be impossible, complete removal of the organ, i. e., castration. There should be no hesitation in performing this upon any such growth, as no testicle thus affected is likely to be functionable, and the individual suffers no possible deprivation of potency by its removal.
The other benign and simple tumors, especially fibromas and chondromas, are occasionally met, and I have described one rare case of large lipoma within the limits of the testicle proper.
Cancer of the Testicle.
—This includes, usually, sarcoma, developing from the mesoblastic elements, although adenocarcinoma may be met here, but as an extension from some growth occurring first in the skin or in the immediate neighborhood. Deep cancer in this region is difficult to at first distinguish from the induration produced by tuberculosis or syphilis. In doubtful cases the therapeutic test may be tried in order to differentiate it from the latter. From the former it is usually separated by its more consistent and regular (i. e., its less nodular) character. In all three cases the lymphatics of the groin may be early involved, or perhaps not until late. As a rule cancer is met in the later years of life, while the other conditions are more frequently seen in the first half. In the more rapid cases there will be considerable pain, with dilatation of the scrotal veins, and evidences of constitutional involvement. Sarcoma may grow rapidly and metastasis is almost invariably to the lungs.
Of tumors in the testicle, as of those in the breast, it may be said that any new-growth which tends to enlarge, become more dense or adherent, to spread, or to be accompanied by lymphatic involvement should be removed; no mistake will be made in applying this rule in these cases, especially if by the therapeutic test or otherwise syphilis can be excluded. Malignant disease sometimes travels rapidly up the cord, and the main fear is not so much of local recurrence as of deep involvement within the pelvis. Cases of cancerous growth of the testicle should be not only thoroughly extirpated from the scrotum, but the inguinal canal should be opened, and the cord followed as far as possible and completely removed.
Cases may arise where amputation of the scrotum may be justifiable for the purpose of temporary relief, in order to avoid discomfort, hemorrhage, or offensive ulceration.