An Unusual Presentation of Sarcoidosis: A Case of Testicular Sarcoidosis Presenting with Bilateral Testicular Masses and Acute Anterior Uveitis

Program: Abstracts - Orals, Poster Previews, and Posters
Session: SUN 176-202-Male Reproductive Endocrinology and Male Reproductive Tract (posters)
Bench to Bedside
Sunday, April 3, 2016: 1:15 PM-3:15 PM
Exhibit/Poster Hall (BCEC)

Poster Board SUN 184
Enver Simsek*, Tulay Simsek, Meliha Demiral, Nuran Cetin, Cigdem Binay, Baran Tokar, Mustafa F Acikalin and Ilknur A.Sivrikoz
Eskisehir Osmangazi University School of Medicine, Eskisehir, Turkey
Backround: Sarcoidosis is an idiopathic and systemic inflammatory disease that usually involves the lungs and lymph nodes, bur almost any organ can be involved. Genitourinary involvement with sarcoidosis is extremely rare. Because the testicular sarcoidosis is extremely rare, there has not been consensus on the diagnostic and treatment options. Herein, we report an unusual form of testicular sarcoidosis, mimicking malignancy at initial presentation.

Material and Methods: We present here a case of bilateral testicular sarcoidosis accompanied by acute anterior uveitis and without radiographic evidence of intrathoracic involvement. An 8-year-old Turkish boy presented with a six-month history of photophobia, blurred vision, lacrimation and redness in his both eyes, and painless symmetrical scrotal swelling. Physical revealed lacrimation, conjunctival hyperemia bilaterally, and bilateral nontender, irregularly shaped, and very hard consistency testes. Laboratory investigations were consisted of CBC differential count, erythrocyte sedimentation rate, serum calcium, liver and renal function tests, C-reactive protein and fibrinogen levels, spot urine calcium/creatinine, serum angiotensin converting enzyme activity, serologic tests for brucellosis, Treponema pallidum, and Chlamydia trachomatis,  and serum tumour markers (lactate dehydrogenase, α-fetoprotein, and β-human chorionic gonadotropin ). He underwent scrotal ultrasound, chest and abdominal computed tomography, F-18 PET/CT and inguinal exploratory incisional wedge biopsy from testicular masses for frozen section assessment, and special stains for acid-fast mycobacterium and fungi infections.

Results: Serum tumor markers were negative.  Serum angiotensin converting enzyme (ACE) was of 115 U/l (normal range 15-70 U/l). Scrotal ultrasound revealed multiple hypoechoic areas scattered throughout both testicles. Histopathological examination of biopsy specimens showed epitheloid noncaseating granulomas without any evidence of malignancy.  Ziehl-Nelsen and periodic acid shift (PAS) staining for tuberculosis and fungi infections were negative. The final diagnosis was consistent with sarcoidosis. The PET/CT scan showed the intense F-18 FDG accumulation on bilateral testis. The chest roentgenogram, computed tomography of the thorax and abdomen were normal.

Conclusion:  To our knowledge, this is the first case of testicular sarcoidosis in a child from Turkey. Sarcoidosis should be considered in the differentials of testicular mass and intraoperative frozen section assessment is the best method for differentials of testicular masses. The diagnosis of testicular sarcoidosis should be based on the exclusions of other inflammatory diseases characterized by epitheloid noncaseating granulomas

Nothing to Disclose: ES, TS, MD, NC, CB, BT, MFA, IA

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