Sarcoidosis and testicular germ cell tumor. Case report

Impaired spermatogenesis by testicular sarcoidosis

Testicular involvement by sarcoidosis is a rare condition. A 23-year-old Japanese man had asymptomatic bilateral testicular lesions, which were detected by gallium scintigram, together with lesions located bilaterally in the uvea, lungs and hilar, and mediastinal lymph nodes and unilateral supraclavicular lymph nodes. Semen analysis demonstrated severely impaired spermatogenesis. Treatment with corticosteroid dramatically improved these lesions and restored spermatogenesis. This case report suggests that testicular sarcoidosis may cause male infertility.

Intrascrotal involvement of sarcoidosis presenting like testicular appendices

A 31-year-old male visited our clinic with a complaint of painless intrascrotal mass in the left side. He had been diagnosed with pulmonary sarcoidosis 6 years prior. Scrotal ultrasound revealed a distinct mass measuring 18 mm x 16 mm at the left epididymal tail. An epididymectomy was performed for treatment and pathological diagnosis. Four nodules shaped like testicular appendices were also found on the testicular surface and subsequently removed. Histopathological examination established that both the epididymal and appendix-like lesions consisted of non-caseating epithelioid granulomas with giant cells, and were diagnosed as sarcoidosis. The patient has no recurrence of intrascrotal lesions after 6-month follow up. This is the first report of intrascrotal involvement of sarcoidosis presenting like testicular appendices.

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

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.

Sarcoidosis and testicular carcinoma

BACKGROUND

Case reports and small case series have described patients with sarcoidosis and testicular carcinoma. The goals of this study were to determine the incidence of sarcoidosis in patients with testicular carcinoma seen at the Mayo Clinic between 1950 and 1996 and to examine the relation between these two diseases, particularly in regard to the therapy and follow-up of patients with testicular carcinoma.

METHODS

A computerized search of the patient data base at the Mayo Clinic was conducted to identify all patients seen between 1950 and 1996 who had a diagnosis of a malignant testicular tumor and sarcoidosis.

RESULTS

A total of 14 patients were identified. The median age at diagnosis of testicular carcinoma was 31.5 years. Eleven patients presented with Stage I disease and 3 with Stage II disease. Twelve patients had carcinoma diagnosed before sarcoidosis. The median age at the time of diagnosis of sarcoidosis was 36.5 years. Nine patients presented with radiographic Stage I disease, four with radiographic Stage II disease, and one with extrapulmonary disease. The estimated cumulative incidence of sarcoidosis in patients with testicular carcinoma seen at the Mayo Clinic between 1976 and 1995 was 617.3 per 100,000.

CONCLUSIONS

These data suggest that, compared with other solid tumors, testicular carcinoma has the strongest association with sarcoidosis. The observed incidence represents an approximate 100-fold increase compared with a general population of young white men. Although an etiologic relation is possible, the problems of access and surveillance bias should be addressed in prospective studies.

Coincidence of seminoma and sarcoidosis: a myth or fact?

A patient with a stage II seminoma of the testis was treated with a routine orchidectomy and irradiation. One and a half years later enlarged mediastinal lymph nodes were noted. Additional staging showed no other abnormalities and a mediastinoscopy was performed. The initial histologic examination confirmed the clinically suspected diagnosis of sarcoidosis. However, additional immunohistochemical analysis unexpectedly demonstrated that there was also a microscopic relapse of the testis tumor. The literature concerning the co-incidence of non-caseating granulomas and testis tumors is reviewed. It is not clear, whether the granulomas indicate the presence of genuine idiopathic sarcoidosis or whether they reflect a sarcoid-like reaction against tumor antigens. The immunopathogenesis of sarcoid formation and its possible biologic significance in obtaining a spontaneous tumor remission is discussed.

Prostatic sarcoidosis. Review of genitourinary sarcoidosis

Sarcoidosis is seen by the urologist only rarely but it may present a diagnostic and therapeutic dilemma. We describe a rare case of prostatic sarcoidosis. The literature relating to sarcoidosis throughout the genitourinary system is reviewed.

Unusual differential diagnosis of testis tumor: intrascrotal sarcoidosis

We report 2 cases of sarcoidosis with extrapulmonary manifestations in the testis, epididymis and spermatic cord. Each patient presented with an intrascrotal mass of unknown origin that suggested a testicular tumor. Sarcoidosis was confirmed in case 1 by radical orchiectomy and further small sarcoid foci were detected in 1 of the lacrimal glands. In case 2 sarcoidosis was confirmed by biopsy and there were no further extrapulmonary indications. Both cases were stage II disease so no specific therapy was applied. The patients were without signs of progression at 2 and 10 years, respectively, after initial diagnosis.