Epididymal sarcoidosis

Sarcoidosis Presenting as a Penile Lesion: A Case Report

Sarcoidosis is a systemic disease of unknown etiology affecting multiple organs and is characterized by the presence of non-caseating granulomas. It is very rare for patients with this condition to present initially with a penile lesion only. We report the case of a 63-year-old man who presented initially with an isolated single penile lesion. He subsequently developed multiple skin nodules over his right arm, chest, and trunk. The diagnosis of sarcoidosis was made based on clinical, radiological, and histopathological reports. The patient responded well to steroids.

Sarcoidosis presenting as penile mass

Sarcoidosis is an inflammatory disease with unknown cause characterized by noncaseating granuloma formations. It may present with bilateral hilar lymphadenopathy, skin lesions, eye, and musculoskeletal system involvement. Rare involvement of the genital organs (prostate, testis, epididymis) has also been reported. However, penile involvement is observed quite rare. In this paper, we report a patient with penile mass who was diagnosed with sarcoidosis on the basis of the laboratory, radiological, and pathological investigations.

Epididymitis

In April 2013, the Centers for Disease Control and Prevention (CDC) convened an advisory group to assist in development of the 2015 CDC sexually transmitted diseases (STDs) treatment guidelines. The advisory group examined recent abstracts and published literature addressing the diagnosis and management of sexually transmitted infections. This article summarizes the key questions, evidence, and recommendations for the diagnosis and management of epididymitis that were considered in preparation of the 2015 CDC STD treatment guidelines.

Corticosteroid therapy improves the outcome of semen analysis in an oligozoospermic patient with epididymal sarcoidosis

Sarcoidosis is a multisystem, inflammatory disorder characterized by the presence of noncaseating epithelioid granulomas. Sarcoidosis can involve the genitourinary system by affecting the kidney and genitals. Most characteristic genital lesions proceed to granuloma and can comprise the epididymis, testis, and vas deferens. Few case reports have been published on this rare entity. We report a case in which a man presented with bilateral epididymal sarcoidosis and severe oligospermia. Corticosteroid treatment, which was applied in gradually decreasing doses for 6 months, dissolved the testicular granuloma. Consequently, semen analysis demonstrated a significant increase in the sperm count to within normal limits.

Testicular Sarcoidosis: Sonographic Findings

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.

Idiopathic granulomatous orchitis

Idiopathic granulomatous orchitis is a rare inflammatory process of the testis of unknown etiology. It is characterized by presence of non-specific granulomatous inflammation and admixed multinucleated giant cells. It usually presents as a testicular mass which is highly suspicious of malignancy. Histologically, there is extensive destruction of seminiferous tubules with tubular or interstitial pattern of granulomatous inflammation and prominent collagen fibrosis. Trauma and possible auto-antibodies against sperms have been postulated to be the underlying mechanism. Differential diagnoses include intratubular germ-cell neoplasia, malignant lymphomas, and malakoplakia. Orchiectomy is currently the most appropriate therapy for this condition.

A diagnostic dilemma: metastatic testicular cancer and systemic sarcoidosis - a review of the literature

Sarcoidosis is a multisystem disease that most commonly involves the lungs and the lymph nodes, but with genitourinary tract involvement, can easily mimic testicular cancer with metastasis to the lungs. We describe the case of a 30-year-old African-American male who presented with complaints of a headache, skin lesions, and a scrotal mass. A computed tomography scan of the head showed lesions in the frontotemporal and pons region, causing obstructive hydrocephalus. An ultrasound of the scrotum showed an enlarged epididymis bilaterally as well as a solid hypoechoic ill-defined mass on the right side, separate from the intact testis. Given the high suspicion for testicular malignancy with brain metastasis, a right orchiectomy was completed. The pathology revealed non-caseating necrotizing granulomas that stained negative for tubercular and fungal organisms, which was consistent with sarcoidosis. Additionally, the patient's skin and central nervous system (CNS) lesions improved on steroids that had been started for cerebral edema. Given the predilection of testicular cancer for CNS metastasis, neurosarcoidosis can also be mistaken for testicular cancer metastasis to the CNS, as seen in our case. Differentiating testicular cancer from genitourinary sarcoidosis is difficult but can be clarified using a combination of clinical presentation, epidemiology, serum markers (ACE, AFP, B-HCG), biopsies from skin/lymph nodes, and sometimes imaging. It is critical to differentiate genitourinary sarcoidosis from malignancy, as a misdiagnosis can lead to unnecessary surgical interventions, which have important implications for future fertility. There can also be a coexistence of as well as an association between testicular cancer and sarcoidosis, which should be recognized by health care providers.

Pseudoneoplastic lesions of the testis and paratesticular structures

Pseudotumors or tumor-like proliferations (non-neoplastic masses) and benign mimickers (non-neoplastic cellular proliferations) are rare in the testis and paratesticular structures. Clinically, these lesions (cysts, ectopic tissues, and vascular, inflammatory, or hyperplastic lesions) are of great interest for the reason that, because of the topography, they may be relevant as differential diagnoses. The purpose of this paper is to present an overview of the pseudoneoplasic entities arising in the testis and paratesticular structures; emphasis is placed on how the practicing pathologist may distinguish benign mimickers and pseudotumors from true neoplasia. These lesions can be classified as macroscopic or microscopic mimickers of neoplasia.

Sarcoidosis presenting as intrascrotal mass: case report and review

Sarcoidosis is a multisystemic disease that usually involves the lungs and lymph nodes, but almost any organ can be involved. Genitourinary involvement with sarcoidosis is extremely rare. We report the case of a 30-year-old African-American male who presented with a right-sided intrascrotal mass and diffuse lymphadenopathy. On further workup, he was found to have sarcoidosis. Two months of corticosteroid treatment resulted in the disappearance of his intrascrotal mass.

Testicular presentation of sarcoidosis and organ preservation: case report and review of management strategies

We report the case of a 24-year-old Cuban-American man initially presenting with a 1-year history of bilateral testicular pain, subsequently diagnosed as sarcoidosis. The diagnosis was histologically confirmed intraoperatively with excisional biopsy of the right tunica. Genitourinary complaints are a rare initial presentation of this disease. Although therapeutic approaches have varied in published reports, no definitive protocol for treatment has been established. We suggest confirmation of the diagnosis, followed by symptomatic treatment, reserving orchiectomy and steroid therapy for severe, refractory, or disseminated cases.

Hypoechoic testicular mass: a case of testicular and epididymal sarcoidosis

We present a case of testicular and epididymal sarcoidosis in a man with a hypoechoic testicular mass. Radical orchiectomy was averted by use of intraoperative frozen section analysis.

[Sarcoidosis presenting as an intrascrotal mass]

INTRODUCTION

Sarcoidosis is a multisystem disorder that rarely involves the genitourinary tract.

CASE

A 35-year-old man had intrascrotal extratesticular mass. Surgical exploration found noncaseating granulomatous inflammation. After the CT scan revealed mediastinal lymphadenopathy and splenomegaly, we diagnosed sarcoidosis. The patient responded rapidly to corticosteroids.

DISCUSSION

Intrascrotal sarcoidosis is an unusual differential diagnosis for an intrascrotal mass. Histological testing is necessary to diagnose noncaseating granulomas. Other granulomatous diseases must be ruled out. Corticosteroid treatment is indicated only for symptomatic sarcoidosis with diffusion of granulomatous lesions and involvement of vital organs.

Sarcoidosis Mimicking Disseminated Testicular Cancer

Sarcoidosis rarely involves the genitourinary system or the spinal cord. This report describes a case of sarcoidosis with a scrotal mass, a mass compressing the spinal cord, and lesions in the liver and spleen. This case illustrates an uncommon manifestation of sarcoidosis, which may mimic disseminated testicular cancer.

Azoospermia in testicular sarcoidosis is an indication for corticosteroid therapy

OBJECTIVE

To report improvement of azoospermia and hypogonadism after high-dose corticosteroid therapy in a patient with testicular sarcoidosis.

DESIGN

Case report.

SETTING

University hospital.

PATIENT(S)

A 27-year-old man with testicular sarcoidosis and azoospermia.

INTERVENTION(S)

High-dose corticosteroid therapy was commenced in an attempt to improve sperm count and restore gonadal function.

MAIN OUTCOME MEASURE(S)

Analysis of sperm count, T, and gonadotropin response to steroid therapy.

RESULT(S)

FSH and LH concentrations decreased and T levels increased in parallel with control of disease activity with steroid therapy. Repeat semen analysis demonstrated a significant increase in sperm count, allowing sperm banking to take place.

CONCLUSION(S)

High-dose corticosteroid therapy may be indicated in testicular sarcoidosis, not only for control of systemic disease activity but also for recovery of gonadal function and spermatogenesis.

Intermittent azoospermia associated with epididymal sarcoidosis

OBJECTIVE

To report an unusual case of intermittent azoospermia associated with epididymal sarcoidosis.

DESIGN

Retrospective case analysis.

SETTING

Wilford Hall Medical Center.

PATIENT(S)

A 36-year-old male with secondary infertility and epididymal sarcoidosis.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURES(S)

An analysis of sperm count in relation to steroid courses.

RESULTS(S)

Epididymalgia, and to a lesser extent, sperm counts were noted to fluctuate temporally around steroid courses given for pulmonary flares of sarcoidosis. Epididymal sarcoidosis can be associated with intermittent azoospermia. Presumably, epididymal granulomas undergo exacerbations and remissions and cause intermittent ductal obstruction.

CONCLUSIONS(S)

Because of the unpredictable effect of sarcoidosis on the male genital tract, all patients interested in paternity should obtain a semen analysis at the time of disease diagnosis. If oligospermia is noted or if there is clinical evidence of epididymal involvement, the patient should be offered sperm banking for possible future assisted reproductive techniques.

Granulomatous epididymal lesion of possible ischemic origin

In a histologic review of adult epididymides obtained at autopsy (both epididymides of 408 men) or during surgery (261 men with testicular or epididymal nontumoral pathology), a peculiar granulomatous lesion was observed in two autopsy specimens (unilateral) and three surgical specimens. The lesion was located in the caput epididymidis and consisted of a zone of necrosis that involved efferent ducts and interstitial connective tissue and was not associated with an acute inflammatory response. Immunohistochemical study with anticytokeratin antibodies showed the presence of some epithelial cells in the damaged efferent ducts. At the periphery of the lesion, where damage was less severe, the efferent ducts only showed partial necrosis of their wall through which the necrotic material was released to the ductal lumen. Inflammatory infiltrates were scanty and consisted of lymphocytes and CD68-positive macrophages. Lymphocytes were mainly located around the necrotic zone or surrounding the adjacent, well-preserved efferent ducts, whereas macrophages formed large clusters in the ductal lumen. In these clusters, cholesterol crystals and giant cells of foreign body type were frequent. Intratubular epithelial regeneration as well as proliferation of small ducts showing epithelial regeneration and numerous spermatozoa in their lumen were observed. Ceroid granulomata, spermatic granulomata, and epidermoid metaplasia of the efferent ducts were observed in some cases. On the basis of the histologic study, the following developmental stages of the lesion are suggested: ischemic necrosis, granulomatous reaction, cicatrization, and sequelae. The term "granulomatous ischemic lesion" is proposed to designate this reactive lesion.