PRESENTATION OF THE CASE

A 33-year-old man who had undergone a vasectomy 3 years before, was admitted to the hospital in order to revert his infertility. There was no remarkable previous history. A vasovasostomy was performed. During the surgical procedure a thickening of the ends of both vasa deferentia was observed. Such specimens were resected to perform pathological studies. After 6 months the patient is in good health and has good parameters in spermiogram analysis.

Grossly, both segments resected were thickened (0,9 cm. in diameter in each case). The histologic examination revealed a proliferation of small, intramural ductules lined by cuboidal cells with abundant cytoplasm and nuclei with large nucleoli (fig. 1). Prominent granulomas with abundant spermatozoa (fig. 2) were found as well as few ductules which were intermingled with them. Foci of perineural and endoneural invasion by epithelial cells were readily observed (fig. 3).

Fig. 2.- Abundant spermatozoa

Fig. 3.- Neural invasion by epithelial cells.

Awareness of VN in biopsies of vasa deferentia is important because of the frequent resemblance to invasive adenocarcinoma. Indeed, perineural invasion as well as nuclear atypia can lead to a erroneous diagnosis of malignancy. The existence of a previous history of surgical procedure in the vasa deferentia coupled with the concomitant presence of sperm granulomas will usually lead to the correct diagnosis. The mechanism of this ductular proliferation and nerve invasion is not well know yet although surgical procedures, infection, diverticula and developmental defects have been also considered.