A large majority of patients who develop sperm granuloma give history of vasectomy. This young man presented with a painful nodular lesion in the spermatic cord region 4 months after undergoing vasectomy. The nodule was resected. The image shows bulbous expansion of the vas deferens caused by chronic inflammation and fibrosis. There are several intensely basophilic aggregates of extravasated spermatozoa. The lumen of vas deferens can be seen near the bottom of the image.