17 Testicular sarcoid is usually associated with sarcoid disease in the epididymis, but may also be found as isolated testicular disease. Patients with testicular manifestation of sarcoidosis usually present with a nodular, diffuse, and painless mass in 1 testicle. On ultrasound Roxadustat concentration examination, these masses most commonly appear as hypoechoic lesions,15 although they can also be hyperechoic. On MRI, they exhibit Inhibitors,research,lifescience,medical low signal intensity on T2-weighted images and enhance with contrast on T1 images.15 The unclear relationship between malignancy and sarcoidosis has been a cause for much debate with regard to the management

of testicular masses in sarcoidosis. Sarcoidosis does confer an increased risk of lymphoproliferative

disease and some solid tumor malignancies.18 Inhibitors,research,lifescience,medical However, it has been suggested that sarcoid reactions might occur as part of the body’s response to certain tumors and are not, in fact, the initiating event for neoplasm. Tumor-related sarcoid reactions have been found to occur in 4% of patients with sarcoma and with higher frequency in lymphoma patients.19 Interestingly, in patients with sarcoid and certain concomitant Inhibitors,research,lifescience,medical malignancies, sarcoid reactions are 4 times as likely to be found in tumor-cell-free lymph nodes than in nodes containing malignant cells.19 Simultaneous testicular cancer and sarcoidosis have been demonstrated in multiple reports. A review of published cases in 1998 found 49 reported patients with testicular malignancy and Inhibitors,research,lifescience,medical sarcoidosis.19 Interestingly, in 37 of these patients the sarcoidosis was diagnosed on follow-up of testicular cancer, suggesting that it might have developed as a reaction to testicular malignancy. Rayson and colleagues20 found that among patients seen at

the Mayo Clinic over a 46-year span, the incidence of sarcoidosis among patients with testicular cancer was more than 6 per 10,000-approximately 100 times the baseline Inhibitors,research,lifescience,medical incidence observed in young white men. The details of the etiology and frequency of this association remain unknown.12 Sarcoidosis can also manifest as other scrotal masses, including granuloma of the vas deferens or scrotal skin. However, these are quite rare, and little is known about sarcoidosis of these sites. Urinary not stone disease occurs in approximately 10% of sarcoidosis patients.12 In up to 4% of sarcoidosis patients, nephrolithiasis is the initial or only cause of symptoms.6,7 Hypercalcemia with or without hypercalcuria is due to the acquisition of α hydroxylase activity in mononuclear cells within sarcoid granulomas.21 This activity allows for increased conversion of vitamin D from its inactive to active form. Subsequently, an increased level of 1,25 dihydroxyvitamin D3 promotes bone resorption and intestinal absorption of calcium.12 Sarcoid-induced changes in calcium metabolism can also cause nephrocalcinosis with subsequent renal impairment, even in the absence of renal granulomas.