Background:The incidence of non neoplastic lesions are much more common in epididymis. Clinically, epididymal nodules are easily accessible to fine needle aspiration cytology (FNAC) procedure. There are very few literature reports documenting the role of cytology in evaluation of epididymal nodules. Thus, we studied patients presenting with palpable epididymis nodules in the out patient department (OPD) from a tertiary care general hospital.Aim:This study is aimed to put forth the diagnostic utility of FNAC in palpable lesions of epididymis.Materials and Methods:A total of 40 palpable epididymal nodules were aspirated as a routine OPD procedure as part of this study. Smears were fixed in isopropyl alcohol and air dried. In all the cases, wet fixed papanicoloau stained and air dried giemsa stained smears were studied. Zeihl Neelsen stain was performed in cases which yielded caseous aspirate.Results:Except for two cases of adenomatoid tumor of epididymis all other lesions were nonneoplastic and included 14 cases (35%) of tuberculous granulomatous inflammation, 10 (25%) cystic nodules (9 spermatoceles and 1 encysted hydrocele), 5 (12.5%) of nonspecific inflammations, 3 (7.5%) filarial infection, 3 (7.5%) sperm granulomas and 3 (7.5%) adenomatous hyperplasia of rete testes. Except for the two tumors, one adenomatous hyperplasia and one tuberculous lesion, no other lesion was excised. Follow up and response to therapy was available in 78% patients and resolution indicated appropriateness of the diagnosisConclusions:Thus, as most of the lesions in epididymis are non neoplastic responding to medical line of treatment and FNAC served to aid diagnosis of non specific inflammation and avoid surgical excision in most cases.

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In the present communication, an unusual combination of scalp soft tissue and underlying brain involvement with intact skull bone coupled with bilateral renal involvement from a mediastinal diffuse large B cell lymphoma (DLBL) is presented. A 45-year-old man, a diagnosed case of mediastinal DLBL with bilateral lung involvement, was treated with conventional 6 cycles of chemotherapy and local external radiotherapy with initial good treatment response evidenced by considerable regression in mass size and regression in pulmonary lesions. Three months later, he returned with complaints of soft tissue swelling over the scalp; one of them in the high parietal bone and the other over the occipital region. A whole body FDG-PET at this time showed 2 moderate-sized foci in the scalp (with preservation of both tables of skull bone) and corresponding large foci in the brain parenchyma beneath, a superior mediastinal focus, a few foci in the apical and lower zone of left lung, extensive irregular uptake in the right pleura and the right lung parenchyma coupled with a loculated effusion in its lower zone and studded foci of hypermetabolism throughout the bilaterally enlarged kidneys. CT of the head confirmed the FDG-PET findings and histopathology of the biopsy from the scalp swelling was suggestive of DLBL. Ultrasound imaging of the abdomen showed lobulated bilaterally enlarged kidneys with multiple hypoechoic areas within them. The patient underwent palliative local external radiotherapy to the brain and systemic chemotherapy with poor clinical results with raised serum beta-2 microglobulin and serum LDH levels and deranged renal function. The patient died within a month after the FDG-PET study. The event of scalp and bilateral renal involvement from DLBL is rare in lymphoma literature and this report highlights that such unusual events can occur as part of widespread dissemination and underscores the importance of whole-body imaging with FDG-PET.