An atypical extra testicular mass simulating a testicular malignancy: An interesting case report

BACKGROUND Sperm granuloma is commonly seen after vasectomy or trauma. We present an extremely rare mass of spontaneous sperm granuloma which clinico-radiologically mimicked a testicular tumor. CASE PRESENTATION A 46-year-old married male presented with a spontaneous, painless, hard left testicular mass of three months’ duration. The patient had no prior trauma, surgeries, family history, or any history of drug or smoking use. Ultrasonography followed by MRI revealed a heteroechoic irregular mass measuring approximately 3cm with increased vascularity and no calcification or necrosis likely arising from the left spermatic cord and partially from the left epididymis. Testicular tumor markers were normal. He underwent an excision of mass with left orchiectomy. Histopathological examination was consistent with a “Sperm Granuloma. This was a rare presentation of sperm granuloma as a spontaneous hard testicular mass. Radiologically the mass was heteroechoic and irregular. With the differential diagnosis of a neoplastic lesion, the patient was taken up for High inguinal orchidectomy. In histopathology, it turned out to be a sperm granuloma (SG). SG is a granulomatous lesion resulting from a chronic immune response to extravasated sperm caused by vasectomy. CONCLUSION This first reported case of spontaneous sperm granuloma underscores the potential for this rare condition to present as a hard scrotal mass, which can be easily mistaken for testicular or extra-testicular malignancies.