British Journal of Urology (1998), 82, 769–770

CASE RE PORT

Sarcoidosis presenting as a testicular massM.S. METCAL FE, Y. REES*, P. MORGAN†, K. O’REIL LY* and D.P.S. SANDHU*Surgical Directorate, Leicester Royal Infirmary, *Leicester General Hospital and †Glenfield Hospital, Leicester, UK

were elevated, but AFP, bhCG and calcium levels wereCase report

normal. Heaf testing was negative, despite BCG vacci-nation in childhood. The rapid growth of the mass inA 30-year-old Afro-Caribbean man presented with a

painless lump in his right scrotum. He also complained his right testis and epididymis necessitated a rightorchidectomy, because of concern that the underlyingof a dry cough and night sweats. His medical history

was otherwise unremarkable. Examination revealed a pathology might have been neoplastic. Histologyshowed diCuse granulomatous epididymitis and orchitis.firm mass attached to his right epididymis and multiple

skin lipomata. Testicular ultrasonography detected mul- The granulomata were non-caeseating and no myco-bacteria were identified by appropriate staining (Fig. 2).tiple hypo-echoic areas in both epididymes and testes,

with a palpable nodule measuring 17 mm across. These The conjunction of histological, ultrasonographic andchest radiographic findings were strongly supportive ofwere reported as consistent with granulomatous

inflammation or lymphomatous infiltration (Fig. 1). a diagnosis of sarcoidosis, although tuberculosis wasnot absolutely excluded. The patient is responding toBilateral hilar lymphadenopathy was noted on his chest

X-ray. Serum angiotensin-converting enzyme levels steroid treatment for sarcoidosis and triple therapy tocover tuberculosis.

Comment

Sarcoidosis is an idiopathic granulomatous disease whichmay aCect any organ system. However, intrascrotalsarcoidosis is rare, particularly so as a presenting featureof the disease [1].

Langerhans giant cell

Granuloma

Seminiferoustubules

Fig. 1. Ultrasonogram of the right testis, showing hypoechoic Fig. 2. Section through the right testis. Haematoxylin and eosin.×240.areas (arrows).

769© 1998 British Journal of Urology

770 CASE REPORTS

Reference Authors

M.S. Metcalfe, MB, BChir, Senior House OBcer.1 Haas GP, Badalement RA, Wonnell DM, Miles BJ. Testicularsarcoidosis: case report and a review of the literature. J Urol Y. Rees, MRCRad, Consultant Radiologist.

P. Morgan, MRCP, Consultant Physician.1986; 135: 1254–6K. O’Reilly, MRCPath, Consultant Pathologist.D.P.S. Sandhu, MD, FRCS(Ed.Urol), FRCS (Glas), Consultant

Urologist.Correspondence: Dr M.S. Metcalfe, Leicester Royal Infirmary,Infirmary Square, Leicester, UK.

© 1998 British Journal of Urology 82, 769–770