Iwasaki Takahiro, Ishii Hiroshi, Otani Satoshi, Oka Hiroaki, Amemiya Yuka, Iwata Atsuko, Umeki Kenji, Shirai Ryo, Kishi Kenji, Tokimatsu Issei, Hiramatsu Kazufumi, Kadota Jun-ichi
Department of Respiratory Medicine (Internal Medicine 2), Oita University Hospital.
Nihon Kokyuki Gakkai Zasshi. 2009 Jul;47(7):631-5.
A 47-year-old man was admitted for further examination of uveitis. He had noticed scrotal swelling before his admission. A computed tomographic scan of the chest showed hilar and mediastinal lymphadenopathy, multiple micronodules and thickening of the interlobular septum, and these findings were consistent with sarcoidosis. Bronchoalveolar lavage fluid showed lymphocytosis. Gallium-67 scintigraphy revealed an abnormal accumulation in the hilar and mediastinal lymph nodes and in the bilateral scrotum. The resected and biopsied specimens of the epididymis and testis demonstrated numerous noncaseating epithelioid cell granulomas but no evidence of neoplasm. Therefore, systemic sarcoidosis was diagnosed. A review of the Japanese literature found most cases to be associated with a history of painless scrotal swelling with chest roentgenogram findings of stage I or II, while also indicating it was important to perform biopsy or surgically resect any epididymal and testicular lesion.
一名47岁男性因葡萄膜炎进一步检查入院。入院前他注意到阴囊肿胀。胸部计算机断层扫描显示肺门和纵隔淋巴结肿大、多发微小结节以及小叶间隔增厚,这些表现符合结节病。支气管肺泡灌洗液显示淋巴细胞增多。镓-67闪烁显像显示肺门和纵隔淋巴结以及双侧阴囊有异常聚集。附睾和睾丸的切除活检标本显示大量非干酪样上皮样细胞肉芽肿,但无肿瘤证据。因此,诊断为系统性结节病。回顾日本文献发现,大多数病例与无痛性阴囊肿胀病史相关,胸部X线表现为I期或II期,同时也指出对任何附睾和睾丸病变进行活检或手术切除很重要。