From Big Medical Encyclopedia

SPERMATOZOALNY GRANULOMA (Greek sperma, spermat[os] a seed + zoon the living being, a granuloma) — productive inflammatory process in an epididymis, is more rare in fabric of a small egg or in a wall of a deferent duct, caused by penetration of spermatozoa from a gleam of channels in surrounding fabric.

The SPERMATOZOALNY GRANULOMA meets preferential up to 30 years. More often the appendage of the right small egg (its head and a body), approximately at 14% of patients — both appendages is surprised. Most often This year results from the previous inflammatory process in channels of an epididymis, after damage of seminiferous ways or as a complication after a resection of a seed cord, the plastic surgery undertaken for the purpose of recovery of passability of seminiferous ways at obturatsionny azoospermism (see). Inflammatory changes in an epididymis of a specific or nonspecific etiology usually are the main condition contributing to development This year. Approximately in 50% of patients along with This year in an epididymis find tubercular process, in 30% — nonspecific epididymite (see). Owing to cicatricial narrowing of channels of an epididymis their passability is broken, there is staz contents, and then a focal destruction of an epithelial cover and basal membrane of channels that promotes penetration spermatozoa (see) in surrounding intersticial fabric. Perhaps also development This year owing to aseptic inflammatory process. In fabric of a small egg arises at so-called granulematozny This year orchitis (see).

Morphologically distinguish three stages of development This year. In the first stage spermatozoa and semen get from channels of an epididymis into its fabric. In the second stage in fabric of an appendage around the spermatozoa which were implemented into it and semen there is a granulematozny reaction, edges is expressed in accumulation of leukocytes, epithelial, plasmatic and colossal cells, and also the macrophages englobing spermatozoa. The ripening granulyatsionny fabric (see) it is enriched with collagenic fibers. In the third stage there is a scarring of a granuloma, at the same time on its periphery lymphoid infiltration and fibrosis is observed, degree of manifestation to-rogo depends on prescription of process.

The struck epididymis on a section of white-gray color with the yellowy-brown centers, on the periphery a consistence of an appendage softer, than in the center. Patients are disturbed by the aching pains in a scrotum amplifying during the walking and an ejaculation. The epididymis, seldom small egg gradually increase. At a palpation dense low-painful infiltrate from 3 — 5 mm to 7 cm in size is found. At 1/3 patients the appendage becomes hilly. It is at the same time condensed or chetkoobrazno the seed cord is changed. At most of patients symptoms of a tubercular or nonspecific epididymite are noted.

Diagnosis establish at gistol. a research of the material received by means of a biopsy.

Differential diagnosis carry out with tubercular and nonspecific epididymite (see), malakoplakia (see), new growths of an epididymis and most small egg (see).

Treatment generally operational: make an epididimektomiya (excision of an epididymis). At This year small egg according to indications carry out a resection or removal of a small egg. At This year deferent duct the resection of an affected area of a channel with imposing of an anastomosis the end in the end is necessary.

Forecast for reproductive and sexual functions at hemilesion favorable.

Bibliography: Lysov A. I. and Berezovskaya E. K. To a question about spermatozoal-ache to a granuloma of an epididymis, Urology, No. 1, page 36, 1958; The Multivolume guide to pathological anatomy, under the editorship of A. I. Strukov, t. 7, page 334, M., 1964; Morgenstern 3. To a question about filched-miofagii, Works of 1st Vseros. congress of pathologists, page 415, M., 1925; Shper-l and N of I. D. Kliniko-morfologichesky characteristic of a spermatozoalny granuloma of an epididymis, Urology, No. 1, page 34, 1964; T. N.'s Capers Granulomatous, orchitis with sperm granuloma of epididymis, J. Urol. (Baltimore), v. 87, p. 705, 1962; Holstein A. F. Morphologische Stu-dien am Nebenhoden des Mensclien, S. 54, Stuttgart, 1969; Lyons R. C., Petre J. H. a. L e e Page N. Spermatic granuloma of the epididymis, J. Urol. (Baltimore), v. 97, p. 320, 19G7; Sundarasiva-r an about D. Spermatozoal granuloma of the epididymis, J. Path. Bact., v. 69, p. 324, 1955.

A. Ya. Pytel.