HYPOECHOIC TESTICULAR MASS: A CASE OF TESTICULAR AND EPIDIDYMAL SARCOIDOSIS JAMIL REHMAN, EMAD R. RIZKALA, BILAL CHUGHTAI, AND SARDAR ALI KHAN ABSTRACT We present a case of testicular and epididymal sarcoidosis in a man with a hypoechoic testicular mass. Radical orchiectomy was averted by use of intraoperative frozen section analysis. UROLOGY 66: 657.e9–657.e10, 2005. © 2005 Elsevier Inc. M anagement of a hypoechoic testicular mass presents a therapeutic challenge because of the vast array of diagnoses it may represent. Use of a high inguinal incision and intraoperative frozen section analysis provides the needed information to guide and tailor the therapy. CASE REPORT A 29-year-old man presented with a 2-month history of right testicular pain and pleuritic chest pain. The patient complained of night sweats and weight loss. He denied fever and hemoptysis, had no history of human immunodeficiency virus or recent travel, and had had a negative purified pro- tein derivative of tuberculin test 1 year before this admission. His scrotal examination was remark- able for right testicular tenderness and a nontender enlarged left epididymis. Scrotal ultrasonography revealed a 2-cm right testicular hypoechoic mass, several small bilateral testicular hypoechoic masses, and a hypoechoic mass of the left epididy- mis (Fig. 1). Chest x-ray demonstrated bilateral pulmonary infiltrates, and chest computed tomog- raphy revealed bilateral hilar adenopathy, innu- merable lung nodules, and a right apical cavitary lesion. The differential diagnosis included testicular malignancy and genitourinary tuberculosis. His se- rum beta-human chorionic gonadotropin and al- pha-fetoprotein levels, urinalysis, urinary and spu- tum acid-fast bacillus stains, and purified protein derivative of tuberculin test were negative. Because of diffuse bilateral involvement of the testes and epididymis, as well as significant pulmonary pathologic features, we were skeptical of a testicu- lar malignancy. A high inguinal exploration and incisional biopsy of the testicular mass confirmed granulomatous disease and excluded testicular malignancy. Histopathologic examination of the testicular mass and pulmonary nodule confirmed sarcoidosis (Fig. 2). Tuberculosis and fungal cul- ture were negative. COMMENT Sarcoidosis is a multisystemic disease of un- known etiology characterized by noncaseating granulomas. Sarcoidosis may appear at any age, From the Department of Urology, State University of New York School of Medicine, Stony Brook University Medical Center, Stony Brook, New York Address for correspondence: Jamil Rehman, M.D., Department of Urology, Division of Laparoscopic Urologic Surgery and Lapa- roscopic Female Pelvic Reconstruction, State University of New York School of Medicine, Stony Brook University Health Sciences Center, SUNY-Stony Brook, HSC L-9, 040, Stony Brook, NY 11794-8093. E-mail: jarehman@notes.cc.sunysb.edu Submitted: November 26, 2004, accepted (with revisions): March 1, 2005 FIGURE 1. Scrotal ultrasound scan showing hypo- echoic areas. CASE REPORT © 2005 ELSEVIER INC. 0090-4295/05/$30.00 ALL RIGHTS RESERVED doi:10.1016/j.urology.2005.03.008 657.e9