[Systemic sarcoidosis with involvement of the spermatic cord]

A 49-year-old man presented with an enlarging, painful, right inguinal mass and small red nodules around his nose and upper lip. He had undergone an operation for a right inguinal hernia in childhood. Because malignancy was suspected, the right spermatic cord, testis, and epididymis were resected. Histological examination of the lesion in the spermatic cord revealed non-caseating epithelioid-cell granuloma and no acid-fast bacilli, which was compatible with sarcoidosis. A chest X-ray film and computed tomograms showed enlarged hilar lymph nodes and reticular infiltrates. Histological examination of specimens obtained by transbronchial lung biopsy and by skin biopsy also showed non-caseating epithelioid-cell granulomas. After resection of the spermatic cord, the activity of angiotensin-converting enzume was 29.9 IU/L, which was above the reference range. Systemic sarcoidosis with involvement of the spermatic cord was diagnosed. Because he had no respiratory symptoms and his skin lesions resolved without treatment, he is currently under observation and is not receiving corticosteroid therapy.