Sarcoid-Like Granulomatosis and Testicular Germ Cell Tumor: The ‘Great Imitator’

Abstract

Objectives: Only a few case reports and small case series of patients with sarcoidosis or sarcoid-like reaction and testicular germ cell tumors (GCT) have been reported in the literature. We performed a retrospective study of patients with testicular GCT managed at the Centre Léon-Bérard, who presented granulomatosis. Methods: We performed a computerized search to identify all male patients with both a diagnosis of sarcoidosis or granuloma and testicular tumors seen at the Centre Léon-Bérard between 1992 and 2008. Results: A total of 13 patients were identified among the 1,182 patients with testicular tumors. The median age at diagnosis of testicular GCT was 25.5 years. Six patients had stage I disease, 2 patients had stage IIb and 5 patients had stage III. Sarcoid-like granulomatosis was found in 9 patients at the time of initial diagnosis and in 4 patients during follow-up. Sarcoidosis presented mainly as pulmonary disease without severe organ involvement, with a benign evolution. Conclusion: We advise caution in the interpretation of clinical and histological findings in these patients. Sarcoid-like granulomatosis, a condition that can be combined with testicular cancer, should always be considered in the differential diagnosis of metastatic testicular tumors.

Paraneoplastic Sarcoid-Like Reactions and the Eye

“…6,8,9,13-15,21,23,33,45-56 , 5,7,10-12,16-20,22,24,25,27-32,34-44,59 Most often, these reactions are observed in lymph nodes draining the malignancy but can also occur in distant organs or the tumor-affected organ itself. [5][6][7][10][11][12][16][17][18][19][20]22,24,25,[27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44]46,47,59 The mechanism for sarcoidlike reactions remains unknown. 46 Some authors have suggested a T-cell-mediated host response to soluble tumor antigens and others a reaction to tumor cell metabolites.…”

Mediastinal Seminoma with an Elevated Level of Serum Angiotensin-converting Enzyme

“…Furthermore, germ cell tumors in which ACE has been detected by immunohistochemistry has been previously reported (14)(15)(16). Although the serum levels of ACE are within the normal range in most cases of germ cell tumors (12,16), there are a few reported cases of ACE elevation (16,17). In addition, the serum ACE level decreased after surgery in the case reported by Rohmer et al (16) Routine measurement of the serum ACE level is, therefore, of little use for making a diagnosis in patients with germ cell tumors.…”

Sarcoidosis and Cancer: A Complex Relationship

“…Some authors have suggested that the presence of a cancer-associated SLR could be a marker of good prognosis, indicating a strong immune response to tumor cells (59)(60)(61)(62). This type of reaction is mainly seen in lymphoma and testicular cancer (6,63,64). Other authors have provided conflicting data regarding other types of cancers, especially non-small lung carcinoma in which the presence of granulomas was not associated with better prognosis (65,66).…”