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Skopelidou V, Hurník P, Židlík V, Tulinský L, Lenz J, Balner T, Žiak D, Delongová P, Karas R, Škripková M, Jendřejek M. Unnecessary orchiectomy due to atypical sarcoidosis manifesting as a unilateral scrotal mass: a case report and literature review. Front Immunol 2023; 14:1253120. [PMID: 38090555 PMCID: PMC10711076 DOI: 10.3389/fimmu.2023.1253120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 11/13/2023] [Indexed: 12/18/2023] Open
Abstract
Sarcoidosis is a disease characterised primarily by lung tissue involvement. Extrapulmonary involvement, particularly in the genitourinary tract, is extremely rare, particularly when it comes to primary disease detection in this location. The gold standard in establishing a definitive diagnosis of sarcoidosis is a combination of the clinical picture, the results of imaging methods, and histopathological examination from the biopsy taken (thus ruling out other causes of granulomatous inflammation). However, it is common for the biopsy to be infeasible or for the patient to refuse such an examination, resulting in the neglect of this critical verification. We introduce the case of a young 29-year-old man of Czech nationality who had been complaining for some time about non-specific pain above the pubic bone and in the lower abdomen, which was combined with a painless enlargement of the right half of the scrotum. Due to suspected malignancy, it was, after considering clinical, imaging, and laboratory findings, decided to perform a radical orchiectomy as a treatment option. The histological examination revealed that it was not cancer, but rather a rare genitourinary form of extrapulmonary sarcoidosis. In this case, radical resection had been, therefore, unnecessary. We also present a review of the literature on published extrapulmonary, genitourinary, and testicular sarcoidosis cases. All the above demonstrates the importance of considering a possible atypical sarcoidosis manifestation and histological confirmation before pursuing radical solutions.
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Affiliation(s)
- Valeria Skopelidou
- Institute of Molecular and Clinical Pathology and Medical Genetics, University Hospital Ostrava, Ostrava, Czechia
- Institute of Molecular and Clinical Pathology and Medical Genetics, Faculty of Medicine, University of Ostrava, Ostrava, Czechia
| | - Pavel Hurník
- Institute of Molecular and Clinical Pathology and Medical Genetics, University Hospital Ostrava, Ostrava, Czechia
- Institute of Molecular and Clinical Pathology and Medical Genetics, Faculty of Medicine, University of Ostrava, Ostrava, Czechia
- Department of Pathology, EUC Laboratoře CGB a.s., Ostrava, Czechia
| | - Vladimir Židlík
- Institute of Molecular and Clinical Pathology and Medical Genetics, University Hospital Ostrava, Ostrava, Czechia
- Institute of Molecular and Clinical Pathology and Medical Genetics, Faculty of Medicine, University of Ostrava, Ostrava, Czechia
- Department of Pathology, EUC Laboratoře CGB a.s., Ostrava, Czechia
| | - Lubomír Tulinský
- Department of Surgery, University Hospital Ostrava, Ostrava, Czechia
- Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Ostrava, Czechia
| | - Jiří Lenz
- Department of Pathology, Znojmo Hospital, Znojmo, Czechia
| | - Tomáš Balner
- Department of Allergology and Clinical Immunology, University Hospital Ostrava, Ostrava, Czechia
| | - Dušan Žiak
- Institute of Molecular and Clinical Pathology and Medical Genetics, University Hospital Ostrava, Ostrava, Czechia
- Institute of Molecular and Clinical Pathology and Medical Genetics, Faculty of Medicine, University of Ostrava, Ostrava, Czechia
- Department of Pathology, EUC Laboratoře CGB a.s., Ostrava, Czechia
| | - Patricie Delongová
- Institute of Molecular and Clinical Pathology and Medical Genetics, University Hospital Ostrava, Ostrava, Czechia
- Institute of Molecular and Clinical Pathology and Medical Genetics, Faculty of Medicine, University of Ostrava, Ostrava, Czechia
- Department of Pathology, EUC Laboratoře CGB a.s., Ostrava, Czechia
| | - Rudolf Karas
- Department of Radiology, Faculty of Medicine, University of Ostrava, Ostrava, Czechia
- Department of Imaging Methods, Faculty of Medicine, University of Ostrava, Ostrava, Czechia
- Department of Radiology, Palacký University Olomouc, Olomouc, Czechia
| | - Miroslava Škripková
- Department of Pulmonary Diseases and Tuberculosis, University of Ostrava, Ostrava, Czechia
| | - Matěj Jendřejek
- Department of Surgery, University Hospital Ostrava, Ostrava, Czechia
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De Cinque A, Corcioni B, Rossi MS, Franceschelli A, Colombo F, Golfieri R, Renzulli M, Gaudiano C. Case Report: Testicular Sarcoidosis: The Diagnostic Role of Contrast-Enhanced Ultrasound and Review of the Literature. Front Med (Lausanne) 2021; 7:610384. [PMID: 33585510 PMCID: PMC7873883 DOI: 10.3389/fmed.2020.610384] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 12/18/2020] [Indexed: 01/22/2023] Open
Abstract
Sarcoidosis is a multisystemic disease histologically characterized by non-caseating epithelioid granulomas and multinucleated giant cells; the etiology is still uncertain, and likely related to a complex interplay between environmental and genetic factors. The genitourinary system is affected in fewer than 0.2% of all clinically diagnosed cases of sarcoidosis and in 5% of those identified in autopsy studies. In this report, we describe a case of a 42–year-old male with one hypoechoic lesion per testis on B-mode evaluation; contrast-enhanced ultrasound (CEUS) on both lesions was carried out. During the early phase, the masses showed a hypovascular appearance as compared to the surrounding testicular tissue, maintaining the hypo-enhancement in the late phase. Tissue biopsy for pathological evaluation confirmed testicular sarcoid involvement, showing non-caseating granulomas. Allowing visualization of testicular microvascularisation, CEUS may play an important role in excluding malignancy, avoiding unnecessary aggressive treatment for benign conditions, such as sarcoidosis. A review of the literature of reported cases since 2004 of sarcoidosis involving the testis is also included.
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Affiliation(s)
- Antonio De Cinque
- Department of Radiology, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Beniamino Corcioni
- Department of Radiology, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Martina Sofia Rossi
- Department of Urology, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alessandro Franceschelli
- Department of Urology, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Andrology-Unit, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Fulvio Colombo
- Department of Urology, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Andrology-Unit, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Rita Golfieri
- Department of Radiology, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Matteo Renzulli
- Department of Radiology, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Caterina Gaudiano
- Department of Radiology, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Abstract
Testicular sarcoidosis is a rare but benign entity. It is often mistaken for testicular neoplasm, leading to orchiectomy. It is, therefore, extremely important to identify and correctly diagnose testicular sarcoidosis on sonography to avoid unnecessary orchiectomy. This case study reports a young patient who had a prior history of unilateral orchiectomy for cryporchidism and presented with testicular lesions on the contralateral testis. He was later found to have skin lesions and chest symptoms that led to a diagnosis of sarcoidosis.
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Affiliation(s)
- Hamad H. Ghazle
- Rochester Institute of Technology, Diagnostic Medical Sonography Program, Rochester, NY, USA,
| | - Shweta Bhatt
- Rochester Institute of Technology, Diagnostic Medical Sonography Program, Rochester, NY, USA
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Abstract
The diverse embryological origins of the contents of the scrotum create an environment that fosters a wide variety of unusual pathologies. Most scrotal pathologies are discovered by the patient and are initially evaluated by a thorough physical examination and scrotal ultrasonography. Scrotal lesions can be broadly grouped by the anatomical location in which they develop; the clinician must consider a wide differential diagnosis based on this location. Solid testicular masses are considered germ cell tumors until proven otherwise, but numerous other possible pathologies exist, including ectopic tissue, metastasis, and other neoplastic growths. Rete testis lesions are classified as developmental, benign or malignant. Cystic lesions of the epididymis are most commonly benign, but malignant neoplasms can also be present. The paratesticular region has the broadest differential diagnosis, as it contains numerous distinct structures and is a common location for ectopic tissue and metastatic disease; a narrower range of lesions develop in the scrotal wall because of its simpler anatomy. Treatment options range from conservative observation to wide surgical excision and should be considered carefully; the aim of therapy is to remove malignant or potentially malignant tissue while minimizing effects on fertility and function.
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