In fact, sarcoidosis can involve many organs of the genitourinary (GU) system, commonly masquerading as other, more common conditions, including malignancy and infection. We present a patient with a scrotal mass as his presenting manifestation of sarcoidosis. This is followed by a concise review of the diagnosis and management of sarcoidosis, and a review Inhibitors,research,lifescience,medical of the limited literature available specifically pertaining to sarcoidosis of the GU tract. Finally, we provide initial management recommendations for

each GU site of disease. Case Report A 42-year-old African American man presented with a 1-month history of a stable, painless area of swelling in his right hemiscrotum. Past medical history included psoriasis and dyslipidemia. For these conditions his treatments had included methotrexate,

acitretin, calcipotriene, folate, and phototherapy. There was no history of any past surgery. He had no other complaints, and results from a review of Inhibitors,research,lifescience,medical systems were normal. He was in a monogamous relationship, did not use any tobacco, alcohol, or illicit drugs, and denied any history of genitourinary infections, including sexually transmitted diseases. He did state that Inhibitors,research,lifescience,medical he and his wife were trying to conceive a child. On physical examination, the scrotal skin was normal. The patient had bilateral descended, nontender testes of normal size and consistency. No intratesticular Inhibitors,research,lifescience,medical lesions were palpable, but there was a distinct mass in the right epididymal head that was 2 cm in diameter and did not transilluminate. The spermatic cord was normal without clinical varicocele or hernia. Findings from the rest of the physical examination were normal, including in the cardiorespiratory system. Scrotal ultrasound revealed an enlarged and hyperemic right epididymis, as well as a focal rounded hypoechoic noncystic 5-mm nodule in the right testicle (references Figure 1). Testicular cancer markers, including

α-fetoprotein, lactate dehydrogenase, and β human chorionic gonadotropin, Inhibitors,research,lifescience,medical were all normal. Options for management, including surgical exploration, were reviewed, but the patient refused any intervention. Figure 1 Ultrasound images of right scrotal contents. Left images show enlarged, hyperemic right epididymis. Batimastat Right upper and lower images show testicular mass and varicocele, respectively. Within 1 month the patient complained that the epididymal mass was enlarging. He also reported a monthlong history of a steadily worsening nonproductive cough with nasal congestion. Results on physical examination remained unchanged, but a chest radiograph revealed bilateral hilar and mediastinal lymphadenopathy associated with interstitial changes in the lower lung zones. Computed tomography of the chest showed a 2.4-cm node in the right peritracheal region, as well as subcarinal, hilar, and retrocrural lymphadenopathy. There were no foci of cavitation or inhibitor expert consolidation.