Testicular sarcoidosis with bilateral scrotal swelling

Kimura, Shoichi; Momozono, Kosuke; Shimamatsu, Kazuhide; Noguchi, Masanori

doi:10.1002/iju5.12124

Cited by 7 publications

(8 citation statements)

References 10 publications

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“…Primary sarcoidosis in the genitourinary tract is extremely rare, especially when it comes to the primary detection of the disease in this location. As a consequence, sarcoidosis is rarely considered as a possible cause of pathological findings in these unusual locations, putting patients at risk of unnecessary procedures and surgical interventions that can negatively impact their quality of life ( 3 , 4 , 8 , 10 , 11 ).…”

Section: Discussionmentioning

confidence: 99%

“…Perioperative biopsy with immediate fresh-frozen section evaluation can be performed even if the clinical picture is unclear and the risk of malignancy is intermediate. This will allow, if the malignancy is indeed confirmed, to proceed with the radical procedure immediately while minimizing the risk of spreading of potential malignant cells; on the other hand, this approach will prevent unnecessary orchiectomy if the finding is benign ( 2 , 3 , 6 , 7 , 9 , 10 , 13 , 14 , 16 , 19 , 20 , 28 , 30 , 32 , 35 ). Still, if the clinical picture strongly indicates malignancy, biopsy is unnecessary and a radical solution should be employed.…”

Section: Discussionmentioning

confidence: 99%

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Unnecessary orchiectomy due to atypical sarcoidosis manifesting as a unilateral scrotal mass: a case report and literature review

Skopelidou,

Hurník,

Židlík

et al. 2023

Front. Immunol.

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Sarcoidosis is a disease characterised primarily by lung tissue involvement. Extrapulmonary involvement, particularly in the genitourinary tract, is extremely rare, particularly when it comes to primary disease detection in this location. The gold standard in establishing a definitive diagnosis of sarcoidosis is a combination of the clinical picture, the results of imaging methods, and histopathological examination from the biopsy taken (thus ruling out other causes of granulomatous inflammation). However, it is common for the biopsy to be infeasible or for the patient to refuse such an examination, resulting in the neglect of this critical verification. We introduce the case of a young 29-year-old man of Czech nationality who had been complaining for some time about non-specific pain above the pubic bone and in the lower abdomen, which was combined with a painless enlargement of the right half of the scrotum. Due to suspected malignancy, it was, after considering clinical, imaging, and laboratory findings, decided to perform a radical orchiectomy as a treatment option. The histological examination revealed that it was not cancer, but rather a rare genitourinary form of extrapulmonary sarcoidosis. In this case, radical resection had been, therefore, unnecessary. We also present a review of the literature on published extrapulmonary, genitourinary, and testicular sarcoidosis cases. All the above demonstrates the importance of considering a possible atypical sarcoidosis manifestation and histological confirmation before pursuing radical solutions.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Unnecessary orchiectomy due to atypical sarcoidosis manifesting as a unilateral scrotal mass: a case report and literature review

Skopelidou,

Hurník,

Židlík

et al. 2023

Front. Immunol.

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“…Fibrosis and occlusion associated with granulomatous inflammation in the epididymis can lead to oligospermia or azoospermia. In these cases, corticosteroid therapy can lead to a reduction in the size of the granulomas and, consequently, their obstructive effect on the epididymis, improving sperm counts [ 9 ]. This was not the case for our patient, but for patients who wish to have children, fertility should be investigated through a spermogram, as corticosteroid therapy can significantly improve sperm quality [ 2 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

A Rare Case of Sarcoidosis With Urologic Symptoms As the Presenting Feature

Campos¹,

Costa²,

Gonçalves³

et al. 2022

Cureus

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Sarcoidosis is a multisystem idiopathic disease that can affect virtually any organ of the human body. However, genitourinary tract involvement is rare. We describe the case of a 33-year-old man with post-coital right scrotal pain. Scrotal ultrasound showed two vascularized nodular lesions in the right testicle and one in the left. A thoracic and abdominopelvic computed tomography scan showed micronodular infiltrate in the liver, spleen, lungs, and millimetric retroperitoneal and iliac lymph nodes. Levels of alpha-fetoprotein and human chorionic gonadotropin beta were normal. On positron emission tomography, the previously documented micronodular infiltrate exhibited features suggestive of an inflammatory etiology. The aspiration cytology of an iliac ganglion was described as normal, with no malignant cells. A liver biopsy revealed non-caseating epithelioid granulomas characteristic of granulomatous hepatitis. After exclusion of other causes of granulomatous inflammation, conjugation of clinical and histological features led us to the diagnosis of sarcoidosis with pulmonary, hepatic, splenic, and genitourinary involvement. This clinical report describes one of the rare occasions when the reproductive tract is affected by sarcoidosis and is the first organ to present signs of involvement by the disease, which reinforces the importance of considering sarcoidosis in the differential diagnosis of urologic conditions. The diagnosis of testicular sarcoidosis is challenging and the issue of its impact on fertility is particularly important.

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“…Either by biopsies taken during a conservative approach, recommended when patients have bilateral scrotal masses or there is a strong clinical suspicion of sarcoidosis and the serum testicular tumor markers are negative, or by orchiectomy which is usually performed for the patients presenting with a unilateral testicular mass or those with positive tumor markers [ 10 ] as our patient. Many patients with sarcoidosis show spontaneous resolution over a period of up to three years.…”

Section: Discussionmentioning

confidence: 99%