Sperm granulomas, also known as epididymitis nodosa, are benign lesions that can occur in the scrotum; particularly, in those with a prior vasectomy.
On this page:
Epidemiology
They occur after vasectomy in ~40% (range 35-42%) of patients and in ~2.5% of the general population 2,5,6.
Clinical presentation
These are mostly asymptomatic but when symptomatic present as a painful nodule 5.
Pathology
Sperm granulomas are considered a form of chronic epididymitis, which occurs secondary to inflammation, trauma, and/or a vasectomy 6. A giant cell reaction occurs secondary to extravasated sperm cells forming a granuloma, which is usually <1 cm in size 5. Calcification is uncommon (<10%) 6.
Radiographic features
Ultrasound
Sperm granulomas may appear as a well-circumscribed heterogeneous hypoechoic nodule and is commonly found at the epididymis (typically the tail) or the ends of the divided ductus deferens 5,6. Color Doppler signal may or may not be present 6. The testis will appear normal 6.
Differential diagnosis
adenomatoid tumor: similar sonographic appearance 6
papillary cystadenoma: can be cystic, usually occur in the epididymal head 6
other granulomatous conditions, e.g. sarcoidosis, tuberculosis 6
Unable to process the form. Check for errors and try again.