epididymal granulomatous ischemic lesion

 Usually affects head of epididymis
 May be due to ischemia with secondary granulomatous reaction and scarring

In a histologic review of adult epididymides obtained at autopsy (both epididymides of 408 men) or during surgery (261 men with testicular or epididymal nontumoral pathology), a peculiar granulomatous lesion was observed in two autopsy specimens (unilateral) and three surgical specimens. (9255259)

The lesion is located in the caput epididymidis and consists of a zone of necrosis that involved efferent ducts and interstitial connective tissue and was not associated with an acute inflammatory response.

Immunohistochemical study with anticytokeratin antibodies showed the presence of some epithelial cells in the damaged efferent ducts.

At the periphery of the lesion, where damage was less severe, the efferent ducts only showed partial necrosis of their wall through which the necrotic material was released to the ductal lumen.

Inflammatory infiltrates were scanty and consisted of lymphocytes and CD68-positive macrophages. Lymphocytes were mainly located around the necrotic zone or surrounding the adjacent, well-preserved efferent ducts, whereas macrophages formed large clusters in the ductal lumen. In these clusters, cholesterol crystals and giant cells of foreign body type were frequent. Intratubular epithelial regeneration as well as proliferation of small ducts showing epithelial regeneration and numerous spermatozoa in their lumen were observed.

Ceroid granulomata, spermatic granulomata, and epidermoid metaplasia of the efferent ducts were observed in some cases.

On the basis of the histologic study, the following developmental stages of the lesion are suggested: ischemic necrosis, granulomatous reaction, cicatrization, and sequelae. The term "granulomatous ischemic lesion" has been proposed to designate this reactive lesion.

Synopsis

 Zone of necrosis involving efferent ducts and interstitial connective tissue
 adjacent lymphocytes and macrophages
 Macrophages form large clusters with cholesterol crystals and foreign body type giant cells in duct lumen
 Also intratubular epithelial regeneration and proliferation of small ducts showing epithelial regeneration and numerous spermatozoa in their lumen
 Associated with :

• ceroid granuloma,
• spermatic granuloma
• epidermoid metaplasia of the efferent ducts

References

 Granulomatous epididymal lesion of possible ischemic origin. Nistal M, Mate A, Paniagua R. Am J Surg Pathol. 1997 Aug;21(8):951-6. PMID: 9255259