Unusual differential diagnosis of testis tumor: intrascrotal sarcoidosis

Intrascrotal and osseous sarcoidosis mimicking intrascrotal organ cancer and bony metastasis

We report a case of sarcoidosis with concomitant epididymis, testes, and phalanxes involvement mimicking intrascrotal organ cancer and metastatic bony disease. A 23-year-old man developed blurred vision and hyperemia of the left eye, and was diagnosed as having left iritis. A chest computed tomography scan detected bilateral hilar lymphadenopathy and lung nodular shadows. A transbronchial lung biopsy revealed a non-caseating granuloma and he was diagnosed with sarcoidosis. One year after the onset of his eye symptoms, he noticed enlargement of his right scrotum. Magnetic resonance imaging detected lesions of the right epididymis, bilateral testes, and bilateral phalanxes. A technetium-99m scintigram revealed a high accumulation in the bilateral bones of extremities. These radiological findings mimicked intrascrotal organ cancer and metastatic bony disease. Pathologic evaluation following the right epididymectomy revealed non-caseating granulomas compatible with sarcoidosis. Three and half years after the appearance of intrascrotal and bony lesions, they improved spontaneously. (Sarcoidosis Vasc Diffuse Lung Dis 2017; 34: 373-376).

Genitourinary sarcoidosis: An essential review for the practicing clinician

INTRODUCTION

Sarcoidosis is a multisystem disease that commonly involves the lungs, but may also present with extrapulmonary manifestations. Genitourinary (GU) tract involvement has been traditionally thought to be rare, but that view may underestimate the true prevalence of the disease due to the often, silent presentation thereof.

METHODS

The literature pertaining to sarcoidosis from the general systemic point of view, etiology and therapy and with regard to specific organs was reviewed by identifying key words in a PubMed search. That material with special relevance to the Indian experience was emphasized.

RESULTS

There are a number of isolated case reports in the literature describing symptomatic and asymptomatic GU tract sarcoidosis. The world literature associated with the generalized syndrome was reviewed and summarized. Specific aspects of GU involvement are presented for each organ of the GU tract.

CONCLUSIONS

It is critical for the practicing clinician to have a working knowledge of the clinical manifestations of this disease as it involves the GU tract, as well as to be able to distinguish it from tuberculosis and the various malignancies that affect this organ system.

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.

A diagnostic algorithm for male genital oedema

Male genital oedema can be defined as swelling or the appearance of swelling of the scrotum and/or the penile shaft and prepuce. Despite the various causes of genital oedema reported in the published work, a concise approach to the evaluation and management has not been sufficiently addressed.

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.

[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.

Multiple indurated papules on penis and scrotum

BACKGROUND

Sarcoidosis is a chronic disease with involvement of multiple organs. Cutaneous lesions may appear as the only manifestation or may be accompanied by systemic disease.

OBJECTIVE

To learn that genital sarcoidosis is a rare entity that should be included in the differential diagnosis of genital papules and nodules.

METHODS AND RESULTS

A 31-year-old African-American man presented with cutaneous lesions on his penis and scrotum existing for 2 years. The genital lesions were so prominent as to interfere with his sexual life. Sarcoidosis was demonstrated on biopsy.

CONCLUSIONS

Sarcoid lesions may affect any skin area, but are rarely described on the genitalia. Dermatologists should be aware that genital sarcoidosis is a rare entity that should be included in the differential diagnosis of genital papules and nodules. Additionally, genital sarcoidosis may cause urinary problems and may represent a therapeutic challenge.

Sonographic findings in testicular sarcoidosis simulating malignant nodule

Testicular involvement by sarcoidosis is rare. We report a case of a patient with known sarcoid who had a unilateral testicular nodule with apparent capsular invasion on sonography. The epididymis was normal on both sides. Despite these atypical features, pathology showed the nodule to be a sarcoid granuloma. In patients with sarcoidosis, the differential diagnosis of an intratesticular mass should include testicular involvement by sarcoid.