21 In the setting of interstitial nephritis, contrast imaging of affected kidneys can sometimes produce a characteristic striated nephrogram.15 A less-common renal manifestation of sarcoidosis is that of an apparent renal mass. On imaging, renal sarcoidosis can mimic lymphoma, but the differential diagnosis includes tuberculosis as well as primary or metastatic Inhibitors,research,lifescience,medical renal cancer.21 Treatment The treatment of sarcoidosis largely

depends on its severity. Most patients will see spontaneous resolution of the disease within 2 years.19 However, for patients with unresolving sarcoidosis, severe or acute symptoms, or disease affecting function of a major organ system, medical treatment is usually initiated. In general, corticosteroids ameliorate Inhibitors,research,lifescience,medical radiographic, symptomatic, and metabolic manifestations of disease.12 Ketoconazole has also shown potential to lower vitamin D and calcium levels in patients with abnormalities of calcium metabolism.12 For sarcoidosis of the genitourinary tract, considerations of malignancy and fertility must also be considered. Because of the unpredictable nature of epididymal involvement, a screening

semen analysis is recommended on diagnosis of sarcoidosis in patients concerned with future fertility, with a low threshold Inhibitors,research,lifescience,medical for repeat tests or sperm banking before or during treatment. In the setting of severe oligospermia or azoospermia, pulsed steroid therapy may allow improvement in sperm counts by causing regression of

obstructive epididymal granulomas.14 Inhibitors,research,lifescience,medical Primary epididymal tumors are almost universally benign, so epididymal involvement of sarcoidosis does not require an aggressive diagnostic approach. The principal concerns pertain to patient symptoms and fertility. In addition to a screening semen analysis and possible sperm banking, proper documentation of size and location should be made with physical examination and Akt inhibitor scrotal ultrasound. Subsequently, excisional biopsy should be considered if the mass causes bothersome symptoms or is unresponsive to medical treatment. When testicular sarcoid involvement Inhibitors,research,lifescience,medical is from suspected, the paramount goals are ruling out malignancy and protecting the patient’s fertility if future conception is desired. Primary testicular masses carry a much higher risk of malignancy than epididymal masses. In light of the possible etiologic link between testicular cancer and sarcoidosis, all patients with a testicular mass and sarcoidosis should be strongly encouraged to undergo an inguinal exploration. Whereas some advocate orchiectomy for all patients with unilateral masses,1,16 others believe that radical orchiectomy should be reserved for diffuse testicular disease, indeterminate pathologic findings, or failed organ preservation.4 At a minimum, an exploration with intraoperative ultrasound, biopsies, and frozen-section analysis should be performed to rule out malignancy.