Testicular sarcoidosis

Testicular Sarcoidosis is a rare manifestation of sarcoidosis, a systemic granulomatous disease that predominantly affects the lungs and lymph nodes but can involve any organ, including the testes. Testicular sarcoidosis is characterized by the presence of non-caseating granulomas in the testicular tissue, without evidence of infection or malignancy. This condition can present with testicular pain, swelling, or as an incidental finding during the investigation of infertility or other medical conditions.

Etiology and Pathogenesis

The exact cause of sarcoidosis, including testicular involvement, remains unknown. However, it is believed to result from a complex interplay between genetic predisposition and environmental factors, leading to an exaggerated immune response in genetically susceptible individuals. The formation of non-caseating granulomas, which are clusters of inflammatory cells, is a hallmark of the disease.

Clinical Presentation

Men with testicular sarcoidosis may present with a variety of symptoms, including:

• Testicular pain or discomfort
• Swelling or a palpable mass in one or both testes
• Asymptomatic testicular lesions found incidentally during ultrasound examination
• Symptoms related to systemic sarcoidosis, such as fatigue, weight loss, fever, or respiratory symptoms

Diagnosis

The diagnosis of testicular sarcoidosis is challenging and often requires a combination of clinical evaluation, imaging studies, and histopathological examination. Key diagnostic steps include:

• Ultrasound of the testes, which may show hypoechoic lesions
• Serum markers, such as lactate dehydrogenase (LDH), alpha-fetoprotein (AFP), and human chorionic gonadotropin (hCG), to rule out testicular cancer
• Magnetic resonance imaging (MRI) of the testes for further characterization of lesions
• Biopsy of testicular tissue, demonstrating non-caseating granulomas without evidence of infection or malignancy

Treatment

Treatment of testicular sarcoidosis is tailored to the individual's symptoms and the extent of systemic involvement. Options may include:

• Observation and monitoring for asymptomatic cases
• Corticosteroids for reducing inflammation and granuloma size
• Immunosuppressive medications for patients who do not respond to steroids or have significant side effects
• Surgical intervention, such as orchiectomy, is rarely required unless there is suspicion of malignancy or intractable pain

Prognosis

The prognosis for men with testicular sarcoidosis is generally good, especially if the condition is diagnosed early and managed appropriately. Fertility can be affected, so men who wish to father children should discuss fertility preservation options with their healthcare provider.

Epidemiology

Testicular sarcoidosis is a rare condition, and its exact prevalence is unknown. It can occur at any age but is most commonly diagnosed in men aged 20-40 years. Sarcoidosis has a higher prevalence in certain ethnic groups, such as African Americans and Northern Europeans.

Conclusion

Testicular sarcoidosis is an uncommon manifestation of sarcoidosis that requires a high index of suspicion for diagnosis. Due to its rarity and the nonspecific nature of its symptoms, it is essential for healthcare providers to consider this condition in the differential diagnosis of testicular masses and unexplained testicular symptoms. Early diagnosis and appropriate management can lead to favorable outcomes for affected individuals.