Sperm granuloma is a granulomatous inflammatory reaction to extravasated spermatozoa following injury or inflammation of vas deferens or epididymis. Vasectomy, trauma, or epididymitis are the usual predisposing factors. This orchiectomy specimen is from a patient who presented with right testicular pain and discomfort. Ultrasound examination revealed a solid and cystic mass within the tail of the epididymis. The specimen shows a 1.5 cm lesion with a soft, necrotic-appearing center filled with hemorrhagic material. The testis proper is unremarkable. The sections showed extravasated spermatozoa surrounded by chronic inflammation and fibrosis.