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Vol. 4, No. 1, 2011
Issue release date: January – April
Section title: Published: March 2011

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Case Rep Oncol 2011;4:118–124
(DOI:10.1159/000324184)

A Diagnostic Dilemma: Metastatic Testicular Cancer and Systemic Sarcoidosis – A Review of the Literature

Gupta R. · Senadhi V.
Department of Internal Medicine, Sinai Hospital, Johns Hopkins University/Sinai Hospital Program in Internal Medicine, Baltimore, Md., USA

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Abstract

Sarcoidosis is a multisystem disease that most commonly involves the lungs and the lymph nodes, but with genitourinary tract involvement, can easily mimic testicular cancer with metastasis to the lungs. We describe the case of a 30-year-old African-American male who presented with complaints of a headache, skin lesions, and a scrotal mass. A computed tomography scan of the head showed lesions in the frontotemporal and pons region, causing obstructive hydrocephalus. An ultrasound of the scrotum showed an enlarged epididymis bilaterally as well as a solid hypoechoic ill-defined mass on the right side, separate from the intact testis. Given the high suspicion for testicular malignancy with brain metastasis, a right orchiectomy was completed. The pathology revealed non-caseating necrotizing granulomas that stained negative for tubercular and fungal organisms, which was consistent with sarcoidosis. Additionally, the patient’s skin and central nervous system (CNS) lesions improved on steroids that had been started for cerebral edema. Given the predilection of testicular cancer for CNS metastasis, neurosarcoidosis can also be mistaken for testicular cancer metastasis to the CNS, as seen in our case. Differentiating testicular cancer from genitourinary sarcoidosis is difficult but can be clarified using a combination of clinical presentation, epidemiology, serum markers (ACE, AFP, B-HCG), biopsies from skin/lymph nodes, and sometimes imaging. It is critical to differentiate genitourinary sarcoidosis from malignancy, as a misdiagnosis can lead to unnecessary surgical interventions, which have important implications for future fertility. There can also be a coexistence of as well as an association between testicular cancer and sarcoidosis, which should be recognized by health care providers. Both authors contributed equally to the manuscript.


  

Author Contacts

Viplove Senadhi
Johns Hopkins University/Sinai Hospital Program in Internal Medicine, Sinai Hospital
2401 W. Belvedere Avenue, Baltimore, MD 21215 (USA)
Tel. +1 410 601 8135, E-Mail vsenadhi@hotmail.com

  

Article Information

Published online: March 2, 2011
Number of Print Pages : 7
Number of Figures : 4,

  

Publication Details

Case Reports in Oncology

Vol. 4, No. 1, Year 2011 (Cover Date: January - April)

Journal Editor: Markman M. (Philadelphia, Pa.)
ISSN: NIL (Print), eISSN: 1662-6575 (Online)

For additional information: http://www.karger.com/CRO


Article / Publication Details

First-Page Preview
Abstract of Published: March 2011

Published online: 3/2/2011
Issue release date: January – April

Number of Print Pages: 7
Number of Figures: 4
Number of Tables: 0

ISSN: (Print)
eISSN: 1662-6575 (Online)

For additional information: http://www.karger.com/CRO


Open Access License / Drug Dosage

Open Access License: This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial 3.0 Unported license (CC BY-NC) (www.karger.com/OA-license), applicable to the online version of the article only. Distribution permitted for non-commercial purposes only.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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