Bilateral epididymal sarcoidosis presenting without radiographic evidence of intrathoracic lesion: Review of sarcoidosis involving the male reproductive tract

Abstract

Sarcoidosis is a multisystem disorder that rarely involves the genitourinary tract. To date, only 59 cases of histologically proven sarcoidosis involving the male reproductive tract have been reported in the literature. We present here a case of bilateral epididymal sarcoidosis without radiographic evidence of intrathoracic lesion. A 46-year-old man presented with a one-week history of painless bilateral scrotal swellings. Physical examination detected multiple elastic firm nodules on both sides of the scrotum which showed no tenderness. The nodules seemed to involve the entire bilateral epididymides. Some irregularly shaped hypoechoic masses in the bilateral epididymides were identified on gray scale ultrasonography. On magnetic resonance images, the bilateral epididymides were seen to be enlarged, heterogeneous and nodular without any signs of testicular involvement. The lesion showed a slightly high signal intensity on the T2-weighted image. Pathological evaluation following bilateral epididymectomy found non-caseating epithelioid cell granulomas with giant cells in epididymal tissue, thus confirming a diagnosis of sarcoidosis. Gallium-67 scanning showed additional small hot spots in the anterior chest wall and extremities. Open biopsy of a superficial papular lesion in the dermis of the right upper arm was performed and pathological findings indicated sarcoid granulomas. This report also includes a review of the literature pertaining to sarcoidosis of the male reproductive tract.

Systemic sarcoidosis mimicking advanced testicular cancer

“…6,7 Clinical features suggesting a benign diagnosis of GUS include bilateral lesions and AfroCaribbean ethnicity (three-fold higher incidence of GUS; just 3.5% of total testicular cancer cases). 1,2,8 Sarcoidosis is not known to cause false-positive results for AFP or beta-HCG serum levels and should be baseline investigations. 9 Conversely, as in our case, sarcoidosis can cause a raised LDH and is not a reliable diagnostic test for testicular malignancy.…”

“…Extrapulmonary granulomata occur in over 75% of cases, but genitourinary sarcoidosis (GUS) is very rare with just over 60 cases reported. 1,2 We discuss an unusual presentation of GUS in a patient with known sarcoidosis who developed a testicular mass, and discrete liver and splenic lesions mimicking metastatic testicular cancer.…”

Sarcoidose na infância com manifestações raras: vasculite, acometimento do sistema nervoso central, ósseo e genital

“…Encontramos na literatura poucos relatos de caso (9)(10)(11)(12)(13)(14) nos quais, em pacientes submetidos à propedêutica de massa paratesticular, foi diagnosticado sarcoidose. Kodama K et al (13) relatam somente 59 casos descritos na literatura de sarcoidose com acometimento do trato genital comprovado histologicamente. Nosso paciente cursou com envolvimento epididimal bilateral.…”

A case of epididymal sarcoidosis

“…In this study, 21 men underwent unnecessary orchidectomy or epididymectomy; 7 however, we managed our patient conservatively.…”