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Sarcoidosis of testis and epididymis
SARCOIDOSIS PETER
S. AMENTA,
PAUL GONICK, SHEILA
OF TESTIS AND EPIDIDYMIS M.D.
M.D.
MORIBER
KATZ, M.D.
From the Department of Pathology and Laboratory Medicine, Hahnemann Medical College and Hospital, Philadelphia, Pennsylvania
- A case of sarcoidosis involving the testes and epididymis is reported. The disease was bilateral, and evolved one year after discontinuation of corticoid therapy and was not accompanied by signs of systemic sarcoidosis.
ABSTRACT
Sarcoidosis is a multisystemic, chronic, granulomatous disease of unknown origin, The genital tract, however, is rarely involved. We present a case of sarcoidosis involving both the testis and epididymis. Case Report A thirty-six-year-old black man presented in 1976 with diffuse polyarthralgias and chest pain, blurred vision, and tearing. A diagnosis of bilateral uveitis was made, and he was admitted for further evaluation. An admission chest roentgenogram demonstrated enlarged medi-
astinal lymph nodes. A diagnosis of sarcoidosis was considered. Pulmonary function tests revealed a reduced diffusing capacity and no other abnormalities. Mediastinal lymph node biopsies contained noncaseating granulomas with giant cells, consistent with sarcoidosis. Since the initial diagnosis, the patient has been well and has been treated periodically with prednisone. He has been without treatment for the last year. One month prior to admission he noticed an enlarged left testicle and a gradually enlarging right testicle. This was not associated with pain, hematuria, frequency, rash, or weight loss. The patient was admitted
FIGURE 1. Granuloma in fibrotic testicle (A) and in epididymis (B). (Hemutoxylin and eosin, original mugnijication x 180.)
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UROLOGY
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for surgical exploration and biopsy of the left testicle and epididymis. Findings on physical examination revealed a well-developed, well-nourished thirty-six-yearold black man. Vital signs were stable and lungs clear to auscultation. The remainder of the physical examination, except for the genitalia, was unremarkable. Both testes were firm. Each measured 6 by 4 by 4 cm., and each had a nodular surface. There was bilateral epididymal enlargement and firmness. The specimens of testicle and epididymis were received in Carson fixative. They consisted of multiple fragments of brown-tan, soft tissue which measured on the average 0.5 by 0.3 by 0.2 cm. Histologically, the tissue of the epididymis contained several normal tubular structures, whereas the testicular tissue exhibited only several atrophic seminiferous tubules. Both tissues contained numerous, discrete, noncaseating granulomas composed of epithelioid and giant cells (Fig. 1). Methenamine silver and acid-fast carbol &chin were done, but no fungi and acid-fast bacilli could be demonstrated. Cultures of the tissue were also negative. Electron microscopic studies confirmed the epithelioid nature of the cells forming the granulomas, and the absence of microorganisms and intercellular foreign materials. Comment The infrequent involvement of the genital tract in sarcoidosis is well documented. In autopsy studies on patients with sarcoidosis, less 1 than 5 per cent had genital involvement.
~IROI,O<:Y
i
JI’NE
1981
/
\‘OLUME
XVII, NUMBER
6
Furthermore, there have been only approximately 20 cases of clinically diagnosed sarcoidosis of the genitalia. The majority of these cases involved the epididymis bilaterally. Sarcoidosis of the testis is even less common than that of the epididymis. There have been only 5 cases of clinically diagnosed testicular sarcoidosis reported in the literature.2-5 In all these cases both the testis and epididymis were involved, except the patient reported by Opal, Pittman, and Hofeldt5 who presented with isolated testicular sarcoidosis. In most cases sarcoidosis of the testis and epididymis was bilateral. The present case of sarcoidosis of the testis and epididymis resembled, in practically all aspects, the other previously reported cases. The disease involved both structures; it was bilateral, and it produced palpable scrotal masses. We are publishing this note as a reminder that genital sarcoidosis, although rare, should be considered in the differential diagnosis of scrotal masses. Philadelphia,
Pennsylvania 19102 (DR. AMENTA)
References 1. Ricker W, and Mardelle C: Sarcoidosis, Am. J. Clin. Pathol. 19: 725 (1979). 2. Longscope WT: Sarcoidosis, or Besnier-Boeck-Schaumann disease, JAMA 117: 1321 (1941). 3. McGowan AJ, and Smith EH: Urological implications of sarcoidosis, J. Ural. 97: 1080 (1967’). 4. Chowdhury SD, and Higgins PM: Sarcoid of the testis, Br. J. Ural. 45: 218 (1973). 5. Opal SM, Pittman DL, and Hofeldt FD: Testicular sarcoidosis, Am. J. Med. 67: 147 (1979).
617
S. AMENTA,
PAUL GONICK, SHEILA
OF TESTIS AND EPIDIDYMIS M.D.
M.D.
MORIBER
KATZ, M.D.
From the Department of Pathology and Laboratory Medicine, Hahnemann Medical College and Hospital, Philadelphia, Pennsylvania
- A case of sarcoidosis involving the testes and epididymis is reported. The disease was bilateral, and evolved one year after discontinuation of corticoid therapy and was not accompanied by signs of systemic sarcoidosis.
ABSTRACT
Sarcoidosis is a multisystemic, chronic, granulomatous disease of unknown origin, The genital tract, however, is rarely involved. We present a case of sarcoidosis involving both the testis and epididymis. Case Report A thirty-six-year-old black man presented in 1976 with diffuse polyarthralgias and chest pain, blurred vision, and tearing. A diagnosis of bilateral uveitis was made, and he was admitted for further evaluation. An admission chest roentgenogram demonstrated enlarged medi-
astinal lymph nodes. A diagnosis of sarcoidosis was considered. Pulmonary function tests revealed a reduced diffusing capacity and no other abnormalities. Mediastinal lymph node biopsies contained noncaseating granulomas with giant cells, consistent with sarcoidosis. Since the initial diagnosis, the patient has been well and has been treated periodically with prednisone. He has been without treatment for the last year. One month prior to admission he noticed an enlarged left testicle and a gradually enlarging right testicle. This was not associated with pain, hematuria, frequency, rash, or weight loss. The patient was admitted
FIGURE 1. Granuloma in fibrotic testicle (A) and in epididymis (B). (Hemutoxylin and eosin, original mugnijication x 180.)
616
UROLOGY
/
JUNE 1981 / VOLUME
Xl’II, NUMBER 6
for surgical exploration and biopsy of the left testicle and epididymis. Findings on physical examination revealed a well-developed, well-nourished thirty-six-yearold black man. Vital signs were stable and lungs clear to auscultation. The remainder of the physical examination, except for the genitalia, was unremarkable. Both testes were firm. Each measured 6 by 4 by 4 cm., and each had a nodular surface. There was bilateral epididymal enlargement and firmness. The specimens of testicle and epididymis were received in Carson fixative. They consisted of multiple fragments of brown-tan, soft tissue which measured on the average 0.5 by 0.3 by 0.2 cm. Histologically, the tissue of the epididymis contained several normal tubular structures, whereas the testicular tissue exhibited only several atrophic seminiferous tubules. Both tissues contained numerous, discrete, noncaseating granulomas composed of epithelioid and giant cells (Fig. 1). Methenamine silver and acid-fast carbol &chin were done, but no fungi and acid-fast bacilli could be demonstrated. Cultures of the tissue were also negative. Electron microscopic studies confirmed the epithelioid nature of the cells forming the granulomas, and the absence of microorganisms and intercellular foreign materials. Comment The infrequent involvement of the genital tract in sarcoidosis is well documented. In autopsy studies on patients with sarcoidosis, less 1 than 5 per cent had genital involvement.
~IROI,O<:Y
i
JI’NE
1981
/
\‘OLUME
XVII, NUMBER
6
Furthermore, there have been only approximately 20 cases of clinically diagnosed sarcoidosis of the genitalia. The majority of these cases involved the epididymis bilaterally. Sarcoidosis of the testis is even less common than that of the epididymis. There have been only 5 cases of clinically diagnosed testicular sarcoidosis reported in the literature.2-5 In all these cases both the testis and epididymis were involved, except the patient reported by Opal, Pittman, and Hofeldt5 who presented with isolated testicular sarcoidosis. In most cases sarcoidosis of the testis and epididymis was bilateral. The present case of sarcoidosis of the testis and epididymis resembled, in practically all aspects, the other previously reported cases. The disease involved both structures; it was bilateral, and it produced palpable scrotal masses. We are publishing this note as a reminder that genital sarcoidosis, although rare, should be considered in the differential diagnosis of scrotal masses. Philadelphia,
Pennsylvania 19102 (DR. AMENTA)
References 1. Ricker W, and Mardelle C: Sarcoidosis, Am. J. Clin. Pathol. 19: 725 (1979). 2. Longscope WT: Sarcoidosis, or Besnier-Boeck-Schaumann disease, JAMA 117: 1321 (1941). 3. McGowan AJ, and Smith EH: Urological implications of sarcoidosis, J. Ural. 97: 1080 (1967’). 4. Chowdhury SD, and Higgins PM: Sarcoid of the testis, Br. J. Ural. 45: 218 (1973). 5. Opal SM, Pittman DL, and Hofeldt FD: Testicular sarcoidosis, Am. J. Med. 67: 147 (1979).
617