Case Report: Testicular Sarcoidosis: The Diagnostic Role of Contrast-Enhanced Ultrasound and Review of the Literature

Abstract

Sarcoidosis is a multisystemic disease histologically characterized by non-caseating epithelioid granulomas and multinucleated giant cells; the etiology is still uncertain, and likely related to a complex interplay between environmental and genetic factors. The genitourinary system is affected in fewer than 0.2% of all clinically diagnosed cases of sarcoidosis and in 5% of those identified in autopsy studies. In this report, we describe a case of a 42-year-old male with one hypoechoic lesion per testis on B-mode evaluation; contrast-enhanced ultrasound (CEUS) on both lesions was carried out. During the early phase, the masses showed a hypovascular appearance as compared to the surrounding testicular tissue, maintaining the hypo-enhancement in the late phase. Tissue biopsy for pathological evaluation confirmed testicular sarcoid involvement, showing non-caseating granulomas. Allowing visualization of testicular microvascularisation, CEUS may play an important role in excluding malignancy, avoiding unnecessary aggressive treatment for benign conditions, such as sarcoidosis. A review of the literature of reported cases since 2004 of sarcoidosis involving the testis is also included.

Keywords: andrology; contrast media; sarcoidosis; ultrasonography; urology.

Figure 1

Thoraco-abdominal contrast-enhanced computed tomography (CT) scan showing hilar and mediastinal lymphadenopathies (A), enlarged retroperitoneal lymph nodes, and multiple hepatic and splenic hypodense lesions (B). Positron emission tomography-computed tomography (PET/CT) detecting an increased focal ¹⁸F-Fludeoxyglucose (¹⁸F-FDG) uptake in the mediastinal and abdominal lesions (C) and in the left testis (D).

Figure 2

B-mode ultrasonography showing one hypoechoic lesion in the left testis with ill-defined margins (A) and some Color-Doppler flow (B). Contrast-enhanced ultrasonography showing the hypovascular appearance of the lesions as compared to the surrounding testicular tissue (C).