Encyclopedia of Pathology

Living Edition
| Editors: J.H.J.M. van Krieken

Idiopathic Granulomatous Epididymitis

  • Maurizio ColecchiaEmail author
  • Alessia Bertolotti
Living reference work entry
DOI: https://doi.org/10.1007/978-3-319-28845-1_4828-1


Idiopathic granulomatous epididymitis (IGE) refers to a lesion of the epididymis requiring a period of ≥6 weeks for the duration of symptoms, while others accept a period of 3 months, with no identifiable etiology (Çek et al. 2017).

Clinical Feature

  • Incidence

    Idiopathic granulomatous epididymitis is rare.

  • Age

    It affects the adult male usually 40–59 years old.

  • Sex


  • Site

    Typically unilateral swelling and tenderness of epididymis, usually beginning in the tail and spreading to involve the whole of the epididymis.

  • Treatment

    Some patients who were only medically treated for granulomatous orchitis have recovered, but orchidectomy in cases without a preoperatory diagnosis is the treatment of choice (Morozumi et al. 2018).

  • Outcome

    Patients with a 6 weeks or longer history of discomfort or pain in the epididymis may experience testicular pain generally without any signs of infection; induration involving the spermatic cord could be another symptom.


A mass with small white yellow nodules occurs without necrotic areas. It occurs generally as solid and unilateral nodular enlargement of the testis.


Granulomatous lesions display predominantly histiocytic infiltrates and typically involve tubular walls. IGE typically lacks necrotizing granulomatous inflammation with palisading histocytes and Langhans giant cells observed in tuberculous epididymitis. Giant cells and plasma cells, lymphocytes, and neutrophils are frequently present (Fig. 1).
Fig. 1

Idiopathic granulomatous epididymitis. Presence of giant cells and plasma cell infiltrate, lack of necrosis, or well-formed granulomas

Differential Diagnosis

Ischemic granulomatous epididymitis at early stage presents necrosis affecting both the efferent ductules and the intertubular connective tissue. As the lesion progresses, efferent ductules are full of cholesterol crystals and giant cells with epididymal fibrosis at final stages (Nistal et al. 1997). Infectious nontubercular epididymitis is generally associated with brucella and blastomycosis: epididymal tubules have necrotic walls, and there is histiocytic infiltrate associated with squamous metaplasia. Other infective agents are fungal organisms and Gram-negative bacteria.

References and Further Reading

  1. Çek, M., Sturdza, L., & Pilatz, A. (2017). Acute and chronic epididymitis. European Urology Supplements, 16, 124–131.CrossRefGoogle Scholar
  2. Morozumi, K., Ozawa, M., Kuromoto, A., Sato, M., Hoshi, S., & Numahata, K. (2018). High orchidectomy and histopathology to differentiate granulomatous orchitis from testicular malignancy: Case report and literature review. Hinyokika Kiyo, 64(2), 75–78.PubMedGoogle Scholar
  3. Nistal, M., Mate, A., & Paniagua, R. (1997). Granulomatous epididymal lesion of possible ischemic origin. American Journal of Surgical Pathology, 21(8), 951–956.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Uropathology Unit, Department of PathologyFondazione IRCCS Istituto Nazionale dei Tumori di MilanoMilanItaly
  2. 2.Department of PathologyFondazione IRCCS Istituto Nazionale dei Tumori di MilanoMilanItaly