副睪丸壞死性肉芽腫性炎症：一例病例報告

楊治豪、黃英哲

高雄長庚紀念醫院 外科部 泌尿科

Necrotizing Granulomatous Inflammation of the Epididymis: A Case Report

Zhi-Hao Yang, Ying-Zhe Huang

Department of Urology, Kaohsiung Chang Gung Memorial Hospital

Purpose: To present a rare case of Necrotizing granulomatous inflammation of the epididymis and emphasize its diagnostic challenge.

Materials and methods: A 40-year-old man with no significant past medical history presented with chronic left epididymal swelling and a palpable mass for several years since 2017. His symptoms had progressively worsened since February 2026, accompanied by intermittent pain and local swelling. He denied urethral discharge or scrotal ulceration. Scrotal ultrasonography performed on February 24, 2026, revealed bilateral varicocele, left hydrocele, and a 1.45 cm heterogeneous hypoechoic lesion over the left epididymis. Laboratory studies, including tumor markers, were within normal limits. The patient subsequently underwent left epididymectomy for both diagnostic and therapeutic purposes. Histopathological examination demonstrated necrotizing granulomatous inflammation, suggestive of tuberculosis.

Results: Postoperatively, the patient had an uneventful recovery, with complete resolution of scrotal pain and swelling. Both acid-fast staining and Tuberculosis polymerase chain reaction were negative, and anti-tuberculous therapy was therefore withheld because of the absence of a confirmed diagnosis of Tuberculosis. Even after integrating clinical, serological, and microbiological findings, the etiology of certain necrotizing granulomas remains obscure. Notably, patients with these idiopathic lesions typically achieve favorable outcomes without the need for supplemental intervention.

Conclusions: Necrotizing granulomatous inflammation of the epididymis is an uncommon pathological finding with a broad differential diagnosis, in which infectious causes, particularly Tuberculosis, should be considered. This case highlights the diagnostic value of histopathological examination in chronic or refractory epididymal lesions. Surgical excision may serve both diagnostic and therapeutic purposes, with close follow-up recommended when the etiology remains undetermined.