Granulomatous epididymal lesion of possible ischemic origin

Department of Morphology, School of Medicine, Autonomous University, Madrid, Spain.
American Journal of Surgical Pathology (Impact Factor: 5.15). 09/1997; 21(8):951-6. DOI: 10.1097/00000478-199708000-00010
Source: PubMed


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. The lesion was located in the caput epididymidis and consisted 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" is proposed to designate this reactive lesion.

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    • "In an analogous manner, syngeneic testicular spermatogenic cells or epididymal spermatozoa caused spermatic granuloma formation when injected into the epididymides , but not when injected into the testes, of adult mice (Itoh et al, 1999c). In fact, spermatic granulomata are rarely seen in the human testis but are common in the epididymis and vas deferens (Nistal et al, 1997). Furthermore, detailed studies in mice have established that the immunogenetics underlying susceptibility to autoimmune orchitis and epididymitis are quite distinct (Roper et al, 1998). "
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    ABSTRACT: The ability of spermatogenic cells to evade the host immune system and the ability of systemic inflammation to inhibit male reproductive function represent two of the most intriguing conundrums of male reproduction. Clearly, an understanding of the underlying immunology of the male reproductive tract is crucial to resolving these superficially incompatible observations. One important consideration must be the very different immunological environments of the testis, where sperm develop, and the epididymis, where sperm mature and are stored. Compared with the elaborate blood-testis barrier, the tight junctions of the epididymis are much less effective. Unlike the seminiferous epithelium, immune cells are commonly observed within the epithelium, and can even be found within the lumen, of the epididymis. Crucially, there is little evidence for extended allograft survival (immune privilege) in the epididymis, as it exists in the testis, and the epididymis is much more susceptible to loss of immune tolerance. Moreover, the incidence of epididymitis is considerably greater than that of orchitis in humans, and susceptibility to sperm antibody formation after damage to the epididymis or vas deferens increases with increasing distance of the damage from the testis. Although we still know relatively little about testicular immunity, we know less about the interactions between the epididymis and the immune system. Given that the epididymis appears to be more susceptible to inflammation and immune reactions than the testis, and thereby represents the weaker link in protecting developing sperm from the immune system, it is probably time this imbalance in knowledge was addressed.
    Preview · Article · Jul 2011 · Journal of Andrology
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    ABSTRACT: Cholesterol granulomas are proposed as being a non-specific inflammatory reaction to the presence of a foreign body such as cholesterol crystals. They are rare testicular and epididymal lesions. We report a case of an epididymal cholesterol granuloma with an equivocal ultrasonographic appearance that mimicked a paratesticular tumor. (JTUA 20:89-91, 2009)
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    ABSTRACT: The diverse non-neoplastic lesions that occur in the paratesticular region and may potentially mimic neoplasms are considered. These include some aspects of normal histology such as a cribriform pattern of the epididymis, bizarre nuclear atypia within epididymal epithelial cells and the presence of Leydig cells outside the testicular parenchyma. Inflammatory changes associated with a hydrocele and a variety of granulomatous and nongranulomatous infectious disorders may mimic a neoplasm on gross evaluation, but should be readily distinguished from them microscopically. This is also the case with malakoplakia and sarcoidosis, which rarely form a paratesticular mass. Other lesions considered are changes associated with vasculitis, the recently described entities inflammatory pseudotumor and fibromuscular hyperplasia and the well-known processes sperm granuloma, spermatocele, vasitis nodosa, fibrous pseudotumor, meconium periorchitis, mesothelial hyperplasia, the testicular tumor of the adrenogenital syndrome, sclerosing lipogranuloma, and splenic-gonadal fusion. Features that aid in the microscopic distinction of these lesions from neoplasms are emphasized.
    No preview · Article · Dec 2000 · Seminars in Diagnostic Pathology
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