Testicular sarcoidosis

Sarcoidosis is a systemic disease of unknown aetiology that results in the formation of non-caseating granulomas in multiple organs. The prevalence is higher among blacks than whites by a ratio of 20:1. Usually the disease is localized to the chest, but urogenital involvement is found in 0.2% of clinically diagnosed cases and 5% of those diagnosed at necropsy.1,2 The kidney is the most frequently affected urogenital organ, followed in men by the epididymis. Testicular sarcoidosis can present as a diffuse painless scrotal mass or can mimic acute epididymo-orchitis. Usually it appears with systemic manifestations of the disease.3 Since it causes occlusion and fibrosis of the ductus epididymis, fertility may be affected.4 On ultrasound, the hypoechogenicity and ‘infiltrative’ pattern seen in the present case are recognized features.5 Opinions differ on the need for histological proof, with reports of limited biopsy and frozen section, radical orchidectomy in unilateral disease and unilateral orchidectomy in bilateral disease. The peak incidence of sarcoidosis and testicular neoplasia coincide at 20–40 years and this is why most patients end up having an orchidectomy. However, testicular tumours are much more common in white men, less than 3.5% of all testicular tumours being found in black men.6 These racial variations justify a more conservative approach in patients of Afro-Caribbean descent with proven sarcoidosis elsewhere. Careful follow-up and ultrasonic surveillance may be preferable in certain clinical settings to biopsy and surgery—especially in patients with bilateral testicular disease

References:some photos in: http://www.gfmer.ch/selected_images_v2/detail_list.php?cat1=15&cat3=516&stype=dhttp://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=10796201.Turk CO, Schacht M, Ross L. Diagnosis and management of testicular sarcoidosis. J Urol 1986;135: 380–1 [PubMed] .2.Gross AJ, Heinzer H, Loy V, Dieckmann KP. Unusual differential diagnosis of testis tumour: intrascrotal sarcoidosis. J Urol 1992;147: 111–14.3.Geller RA, Kuremsky DA, Copeland JS, Stept R. Sarcoidosis and testicular neoplasm: an unusual association. J Urol 1977;118: 487–8 [PubMed] .4.Svetec D, Waguespack RL, Sabanegh ES Jr. Intermittent azoospermia associated with epididymal sarcoidosis. Fertil Steril 1998;70: 777–9 [PubMed] .5.Eraso CE, Vrachliotis TG, Cunningham JJ. Sonographic findings in testicular sarcoidosis simulating malignant nodule. J Clin Ultrasound 1999;27: 81–3 [PubMed] .6.Daniels JL Jr, Stutzman RE, McLeod DG. A comparison of testicular tumors in black and white patients. J Urol 1981;125: 341–2 [PubMed] .