Nonneoplastic Conditions

Epididymitis: primary cause of epididymal obstruction and usually related to cystitis, prostatitis or urethritis that spreads through the vas deferens or lymphatics. It may cause testicular ischaemia and necrosis. Causes include chlamydia trachomatis, neisseria gonorrhoea, E-coli, pseudomonas, other urinary tract infection organisms and rarely tuberculosis and brucellosis.

Cysts of epididymal appendix and epididymal cysts: the former can twist, necrose and present with pain while the latter form an epididymal mass separate from the testis. Treatment is resection of the necrotic appendix and cyst aspiration, respectively, or if persistent epididymectomy.

Spermatic granuloma/epididymitis nodosa: inflammation or trauma damage to the epithelium or basement membrane, causing spillage of spermatozoa into the interstitium (similar to vasiitis nodosa). It consists of a nodule up to 3 cm in the head of the epididymis with histological features of non-caseating granulomas around spermatozoa.

Spermatocele: cystic dilation of efferent ducts lined by ciliated columnar cells with thin connective tissue wall; no smooth muscle. The cysts are usually translucent and contain spermatozoa and proteinaceous fluid.

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