SHM Converge Scientific Abstract ePoster Gallery-From Testicular Mass to Pulmonary Sarcoidosis

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A 27-year-old Hispanic man presented with an enlarging right testicular mass, raising concern for testicular cancer. Scrotal ultrasound showed multiple bilateral nodules and a dominant right testicular mass. Tumor markers (LDH, β-hCG, AFP) were negative, but because of suspicion for malignancy, he underwent right orchiectomy. Pathology instead revealed noncaseating granulomatous orchitis, with no fungal or acid-fast organisms identified.<br /><br />After this diagnosis, further evaluation in primary care found no cardiopulmonary symptoms, but chest CT demonstrated perilymphatic pulmonary micronodules and hilar lymphadenopathy, consistent with pulmonary sarcoidosis. Pulmonary function tests and serum calcium were normal, though vitamin D was low. A subsequent left lung biopsy confirmed noncaseating granulomatous inflammation. With evidence of both pulmonary and extrapulmonary disease, the patient was started on oral prednisone.<br /><br />The report emphasizes that sarcoidosis is a systemic granulomatous disease most often affecting the lungs, but testicular involvement is extremely rare. Testicular sarcoidosis can closely mimic testicular cancer, especially because it often occurs in young men, the same group at highest risk for testicular malignancy. This overlap can lead to unnecessary orchiectomy, as happened in this case.<br /><br />The authors stress that clinicians should include sarcoidosis in the differential diagnosis of a testicular mass, alongside cancer. Initial evaluation should include tumor markers, and imaging may sometimes help distinguish the two. If other lesions are present, biopsy can be useful for diagnosis. The case underscores the importance of considering testicular sarcoidosis to avoid misdiagnosis and unnecessary surgery.

Asset Subtitle

Mohammad Alsheikh-Kassim

Meta Tag

Author List Mohammad Alsheikh-Kassim, Robby Wesley

Category Clinical Vignettes

Concept Testicular Sarcoidosis

Concept Testicular Mass

Concept Sarcoidosis

Concept Testicular Cancer

Concept Tumor Marker

Distinguished Non-Finalist

Presenter Organization UT Health Houston Science Center

Presenting Author Mohammad Alsheikh-Kassim

Track Adult

Keywords

testicular sarcoidosis

granulomatous orchitis

noncaseating granulomas

testicular mass

testicular cancer mimic

pulmonary sarcoidosis

hilar lymphadenopathy

orchiectomy

biopsy diagnosis

prednisone treatment

Testicular Sarcoidosis

Testicular Mass

Sarcoidosis

Testicular Cancer

Tumor Marker