Korean J Urol.  2013 Aug;54(8):558-560. 10.4111/kju.2013.54.8.558.

Corticosteroid Therapy Improves the Outcome of Semen Analysis in an Oligozoospermic Patient With Epididymal Sarcoidosis

• Canguven O
• Balaban M
• Selimoglu
• Albayrak S

• KMID: 1840471
• DOI: http://doi.org/10.4111/kju.2013.54.8.558

Abstract

Sarcoidosis is a multisystem, inflammatory disorder characterized by the presence of noncaseating epithelioid granulomas. Sarcoidosis can involve the genitourinary system by affecting the kidney and genitals. Most characteristic genital lesions proceed to granuloma and can comprise the epididymis, testis, and vas deferens. Few case reports have been published on this rare entity. We report a case in which a man presented with bilateral epididymal sarcoidosis and severe oligospermia. Corticosteroid treatment, which was applied in gradually decreasing doses for 6 months, dissolved the testicular granuloma. Consequently, semen analysis demonstrated a significant increase in the sperm count to within normal limits.

Keyword

Infertility; Testicular diseases; Sperm count; Spermatogenesis

MeSH Terms

Epididymis
Granuloma
Humans
Infertility
Kidney
Male
Oligospermia
Sarcoidosis
Semen
Semen Analysis
Sperm Count
Spermatogenesis
Testicular Diseases
Testis
Urogenital System
Vas Deferens

Figure

• 

  FIG. 1 Magnetic resonance imaging showing T1 sagittal postcontrast-enhanced lesions on the (A) left and (B) right epididymides.

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  FIG. 2 Epithelioid granuloma (white arrow) beside the epididymal duct (black arrow) (H&E, ×100).

Reference

1. Porter N, Beynon HL, Randeva HS. Endocrine and reproductive manifestations of sarcoidosis. QJM. 2003. 96:553–561.

2. Turk CO, Schacht M, Ross L. Diagnosis and management of testicular sarcoidosis. J Urol. 1986. 135:380–381.

3. Hassan A, El-Mogy S, Zalata K, Mostafa T. Bilateral epididymal sarcoidosis. Fertil Steril. 2009. 91:1957.

4. Rees DA, Dodds AL, Rathbone N, Davies JS, Scanlon MF. Azoospermia in testicular sarcoidosis is an indication for corticosteroid therapy. Fertil Steril. 2004. 82:1672–1674.

5. Ryan DM, Lesser BA, Crumley LA, Cartwright HA, Peron S, Haas GP, et al. Epididymal sarcoidosis. J Urol. 1993. 149:134–136.

6. Handa T, Nagai S, Hamada K, Ito I, Hoshino Y, Shigematsu M, et al. Sarcoidosis with bilateral epididymal and testicular lesions. Intern Med. 2003. 42:92–97.

7. Rudin L, Megalli M, Mesa-Tejada R. Genital sarcoidosis. Urology. 1974. 3:750–754.

8. Woodward PJ, Sohaey R, O'Donoghue MJ, Green DE. From the archives of the AFIP: tumors and tumorlike lesions of the testis: radiologic-pathologic correlation. Radiographics. 2002. 22:189–216.

9. Paparel P, Devonec M, Perrin P, Ruffion A, Decaussin-Petrucci M, Akin O, et al. Association between sarcoidosis and testicular carcinoma: a diagnostic pitfall. Sarcoidosis Vasc Diffuse Lung Dis. 2007. 24:95–101.

10. Svetec DA, Waguespack RL, Sabanegh ES Jr. Intermittent azoospermia associated with epididymal sarcoidosis. Fertil Steril. 1998. 70:777–779.