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.