Xanthogranuloma of the epididymis

Solid epididymal masses can be broadly classified into three categories: inflammatory mass, benign neoplasm, and malignant neoplasm. Examples of inflammatory processes include infectious epididymitis, fibrosis, sperm granuloma, and autoimmune disease. Benign neoplasms include adenomatoid tumor or leiomyoma. Malignant neoplasms include adenocarcinoma, embryonic rhabdomyosarcoma, and seminoma. While ultrasonography has shown promise in differentiating epididymal masses [1], a definitive diagnosis cannot be made without biopsy and histologic analysis. Reported worrisome signs suggestive of malignancy and indicating further exploration include large size and high vascularity on Doppler. [1] We describe a case of a 66 year old man with a history of HIV and latent tuberculosis (TB) who presented with chronic bilateral scrotal swelling.