Spermatic granulomas result from an intense inflammatory response to sperm that enter into the interstitial tissue of epididymis.
The cause of extravasation of the sperm is not clear but trauma or infection may play a role.
Clinically, patients present with scrotal pain and swelling of weeks or months duration.
Microscopically, a mixed inflammatory cell infiltrate is associated with numerous extravasated sperm fragments and phagocytosis of sperm by histiocytes. Ultimately the inflammatory process results in interstitial fibrosis and ductal obstruction.