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Benign neural invasion in vasitis nodosa

1982; Wiley; Volume: 6; Issue: 3 Linguagem: Inglês

10.1111/j.1365-2559.1982.tb02725.x

1365-2559

Richard L. Goldman, J. G. Azzopardi,

Sperm and Testicular Function

Three instances of invasion of nerves of the spermatic cord by benign proliferative ductules of the vas deferens following vasectomy are reported. This phenomenon occurred in association with the histopathological features of vasitis nodosa and was noted in tissue removed during vasovasostomy in two cases and from a painful lower inguinal nodule at the site of vasectomy in a third example. Such neural invasion deserves attention because, especially in association with a proliferative ductular pattern, it may be mistaken for adenocarcinoma. The lesion is also of intrinsic interest in the light of benign neural invasion at other sites.3 cases of vasitis nodosa with benign neural invasion diagnosed in 1975-80 are presented. Vasitis nodosa is characterized by the development of nodular, often painful, lesions at the site of a previous vasectomy procedure. Topographic changes in these 3 men included a haphazard ramifying proliferation of doctules, associated in some areas with cicatricial connective tissue and a mild nonspecific inflammatory infiltrate. Spermatozoa were identifiable within the lumina of some of the newly formed doctules. In all 3 cases, distinct perineural and intraneural benign ductular invasion was present, with no appreciable histologic or cytologic difference between the invasive epithelial structures and their extraneural counterparts. Vasitis nodosa is considered to result from vasal obstruction with retroobstructive ductal extravasation of spermatozoa, the formation of histiocytic spermatic granulomas, and secondary regenerative ductular proliferation. There is concern that the florid ductal proliferation in this condition, especially when accompanied by epithelial invasion of nerves, could be mistaken for adenocarcinoma. The bland histocytologic appearance of the ductules and their lining epithelial cells, and the presence of spermatozoa with some of the ductular lumina, should enable differentiation of vasitis nodosa from a malignancy. The mechanism by which benign epithelial tissue assumes the capacity to invade nerves and perineural spaces is unknown.