A 32-year-old man was admitted to our urology department for an examination of an enlarged right-intrascrotal mass. Testicular cancer with intrapulmonary metastasis was suspected. A right radical inguinal orchiectomy was performed for the purpose of therapeutic diagnosis. Histopathological findings of the epididymal tissue and testis revealed granulomas without evidence of neoplasm. A computed tomographic scan of the chest showed bilateral hilar and mediastinal lymphadenopathy with multiple micronodules and thickening of the bronchovascular bundles in both upper lung fields. Bronchoscopy showed mucosal irregularity, small nodules, and capillary network at the trachea and bronchi. Histopathology of bronchial lesion and lung nodules also showed noncaseating epithelioid cell granuloma. Systemic sarcoidosis was diagnosed on the basis of the findings. Although sarcoidosis very rarely presents with intrascrotal lesions, steps must be taken to distinguish between sarcoidosis and testicular malignancy, especially in young men.