Intrathoracic lymphadenopathy: Sarcoidosis or metastatic seminoma? The diagnostic dilemma revisited

There exists a rare enigmatic relation between testicular germ cell tumors (particularly seminoma)and granulomatous inflammation of lymph nodes and organs akin to sarcoidosis. We report a young patient with stage I testicular seminoma followed by close surveillance after radical orchidectomy, who developed hilar and subcarinal lymphadenopathy more than two years after the original diagnosis. A mediastinal biopsy was consistent with noncaseating granuloma with no evidence of tumor. Our case highlights the importance of histologic confirmation of the etiology of lymphadenopathy in these cases. We reiterate that histological examination remains the cornerstone for establishing a definite and accurate diagnosis of testicular seminoma relapse.