Testicular sarcoidosis

Case contributed by Cecile Swift

Presentation

Increasing abdominal pain, polyuria, and bilateral leg pain. Outpatient bloodwork revealed severe hypercalcemia.

Patient Data

Age: 45 years
Gender: Male

Scrotal ultrasound

ultrasound

Ultrasound of the right hemiscrotum

1. transverse (left) and longitudinal (right) views demonstrate a small mixed cystic and solid intratesticular lesion with internal calcifications and internal vascularity

2. epididymis is enlarged at 1.6 cm and appears hypoechoic with normal internal color doppler flow

3. inguinofemoral lymph node that is abnormally round, enlarged at 1.2 cm, and lacks a normal fatty hilum

CT Chest

ct

Non-contrast CT scan of the chest demonstrates bilateral diffuse pulmonary nodules which are peribroncovascular in distribution. Several nodules are triangular in shape and are adherent to the minor fissure of the right lung. There are also mediastinal lymph nodes and a calcified left hilar lymph node.

CT Abdomen and Pelvis

ct

Non-contrast CT of the abdomen and pelvis demonstrates hepatosplenomegaly as well as mildly enlarged and abnormally round lymph nodes throughout the retroperitoneum and bilateral iliac chains, with several more enlarged lymph nodes in the inguinofemoral chains.

Histology

Enlarged lymph node with fibrosis and giant cells; no evidence of malignancy

Immunohistochemical/special stain(s) is/are performed. Medical necessity for performing stain(s): To rule out metastatic carcinoma, as well as fungal and tuberculous disease.

The stain(s) is/are evaluated following validation of appropriate control reactivity, with the following result(s): 
     AE1/AE3 - Negative
     GMS-fungus - Negative
     AFB - Negative

Case Discussion

The diagnosis of sarcoidosis is commonly based on clinical and radiologic findings and supported by histology 1. In this patient, once the diagnosis of sarcoidosis was confirmed, inguinal node biopsy and negative tumor markers ruled out malignancy. 

Case contributors: 

  • Cecile Swift
  • Roger Rozzi, DO
  • Kathleen Dumford, MD
  • Dave Gabbert, DO

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