Skip to main content
SpringerLink
Log in

Association between testicular microlithiasis and primary malignancy of the testis: our experience and review of the literature

Associazione tra microlitiasi e neoplasie testicolari maligne: nostra esperienza e revisione della letteratura

  • Uro-Genital Radiology Radiologia Uro-Genitale
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Purpose

The aims of this study were to evaluate the association of testicular microlithiasis with testicular neoplasm, to assess the accuracy of ultrasonography (US) in comparison with histology in detecting microlithiasis, and to identify the prevalent cytohistological features that accompany testicular cancer.

Materials and methods

Between 2004 and 2005, 14 patients were referred to us for US examination, 13 of whom underwent surgery for testicular cancer. Their age ranged from 19 to 43 years, except for one patient aged 60. US findings and histological examination were compared to assess the accuracy of US in detecting microlithiasis associated with testicular cancer.

Results

In two patients (15.3%), microlithiasis had been detected in a previous US examination, and two patients (15.3%) had altered sperm function. At US examination, testicular cancer was associated with microlithiasis in seven out of 13 patients (53.8%) (the distribution pattern of microlithiasis was intranodular in two, perinodular in two and both intra-and perinodular in three), and colour-Doppler US showed perinodular and intranodular vascularity. Histological evaluation identified nine seminomas, two mixed germ-cell tumours, one embryonal carcinoma, one yolk-sac tumour and one benign Sertoli-cell tumour. In nine (69.2%) patients, microlithiasis was confirmed at histologic evaluation, and its distribution was intranodular in two, perinodular in five and both intra-and perinodular in two. Tubular hyalinisation was demonstrated in 12 out of 13 patients (92.3%).

Conclusions

Testicular microlithiasis and poor sperm function represent risk factors for testicular cancer: in our study, 30.6% of the patients who developed cancer presented these features. At US examination, testicular microlithiasis is often associated with testicular cancer (53.8%). A high accuracy has been demonstrated for US in detecting microlithiasis (53.8%) compared with histological evaluation (69.2%). At histology, tubular hyalinisation (92.3% of cases) is, with testicular microlithiasis, the most frequent finding in the parenchyma adjacent to testicular cancer.

Riassunto

Obiettivo

Analizzare se esistono correlazioni fra la microlitiasi testicolare e le neoplasie testicolari maligne e valutare l’affidabilità dell’ecografia nel rilevare la microlitiasi confrontandola con l’esame istologico; ricercare quali siano gli aspetti citoistologici prevalenti di accompagnamento alla eteroplasia testicolare.

Materali e metodi

Dal 2004 al 2005, sono giunti alla nostra osservazione e sottoposti ad indagine ecografica 14 pazienti, di cui 13 operati per neoplasia maligna, di età compresa tra 19 e 43 anni e solo un caso di 60 anni. Abbiamo comparato l’affidabilità dell’esame ecografico ed istologico nel rilevare le microlitiasi testicolari associate alla neoplasia testicolare maligna.

Risultati

Due pazienti (15,3%) presentavano microlitiasi testicolare in precedente indagine ecografica e due pazienti (15,3%) presentavano alterazioni dello spermiogramma. All’indagine ecografica la neoplasia testicolare maligna nel 53,8% (7/13) era associata alla presenza di microlitiasi testicolare (in 2/7 in sede intranodulare, in 2/7 in sede perinodulare e in 3/7 casi in sede peri-intranodulare) e presentava vascolarizzazione peri ed intranodulare all’eco color doppler. All’esame istologico, 9 risultarono seminomi, 2 forme miste, 1 carcinoma embrionario, 1 tumore del sacco vitellino e 1 tumore a cellule di Sertoli sottotipo sclerosante. In 9 casi su 13 (69,2%) di neoplasie testicolari maligne, sono state rilevate microcalcificazioni (in 2/9 intranodulare, in 5/9 perinodulari e in 2/9 peri ed intranodulari). In 12/13 casi (92,3%) era presente scleroialinosi dei tubuli.

Conclusioni

Le microlitiasi testicolari e le alterazioni del liquido seminale rappresentano fattore di rischio nelle neoplasie maligne del testicolo: infatti, complessivamente, il 30,6% ha sviluppato una eteroplasia maligna. All’indagine ecografica, le microlitiasi testicolari sono spesso presenti (53,8%) in accompagnamento alle neoplasie testicolari maligne. È stata rilevata buona attendibilità dell’ecografia nel rilevare la microlitiasi testicolare (53,8%) rispetto l’esame istologico (69,2%). La scleroialinosi dei tubuli (presente nel 92,3% dei casi) appare, insieme alla microlitiasi testicolare, il reperto più frequente nel parenchima adiacente alla eteroplasia testicolare maligna.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References/Bibliografia

  1. Hobarth K, Susani M, Szabo N, Kratzik C (1992) Incidence of testicular microlithiasis. Urology 40:464–467

    Article  PubMed  CAS  Google Scholar 

  2. Nistal M, Paniagua R, Diez-Pardo JA (1979) Testicular microlithiasis in two children with bilateral cryptorchidism. J Urol 121:535–537

    PubMed  CAS  Google Scholar 

  3. Cast JE, Nelson WM, Early AS et al (2000) Testicular microlithiasis: prevalence and tumor risk in a population referred for scrotal sonography. AJR Am J Roentgenol 175:1703–1706

    PubMed  CAS  Google Scholar 

  4. Miller FN, Rosairo S, Clarke JL et al (2007) Testicular calcification and microlithiasis: association with primary intra-testicular malignancy in 3477 patients. Eur Radiol 17:363–369. DOI 10.1007/s00330-006-0296-0

    Article  PubMed  Google Scholar 

  5. Peterson AC, Bauman JM, Light DE et al (2001) The prevalence of testicular microlithiasis in an asymptomatic population of men 18 to 35 years old. J Urol 166:2061–2064

    Article  PubMed  CAS  Google Scholar 

  6. Kim B, Winter TC 3rd, Ryu JA (2003) Testicular microlithiasis: clinical significance and review of the literature. Eur Radiol 13:2567–2576

    Article  PubMed  Google Scholar 

  7. Derogee M, Bevers R, Prins H et al (2001) Testicular microlithiasis, a premalignant condition: prevalence, histopatologic findings, and relation to testicular tumor. Urology 57:1133–1137

    Article  PubMed  CAS  Google Scholar 

  8. Backus ML, Mack LA, Middleton WD et al (1994) Testicular microlithiasis: imaging appearances and pathologic correlation. Radiology 192:781–785

    PubMed  CAS  Google Scholar 

  9. Blasetti M, De Rocco L, Bagnato R (1994) La microlitiasi testicolare. Aspetti ecografici e istologici. Radiol Med 87:898–900

    CAS  Google Scholar 

  10. Diekmann K, Pichlmeier U (2004) Clinical epidemiology of testicular germ cell tumors. World J Urol 22:2–14

    Article  Google Scholar 

  11. Laguna P, Pizzoccaro G, Klepp O et al and the EAU Working Group on Oncological Urology (2001) EAU guidelines on testicular cancer. Eur Urol 40:102–110

    Article  PubMed  CAS  Google Scholar 

  12. Nistal M, Panigua R (1997) Non neoplastic diseases of the testis. In: Bostwick DG, Eble JN (eds) Urologic Surgical Pathology. Mosby, Boston, pp 501–505

    Google Scholar 

  13. Bunge R, Bradbury J (1961) Intratubular bodies of the human testis. J Urol 85:306–310

    PubMed  CAS  Google Scholar 

  14. Vegni-Talluri M, Bigliardi E, Vanni MG, Tota G (1980) Testicular microliths: their origin and structure. J Urol 124:105–107

    PubMed  CAS  Google Scholar 

  15. Nistal M, Martinez-Garcia C, Paniagua R (1995) The origin of testicular microliths. Int J Androl 18:221–229

    PubMed  CAS  Google Scholar 

  16. Drut R, Drut RM (2002) Testicular microlithiasis: histologic and immunohistochemical findings in 11 pediatric cases. Pediatr Dev Pathol 5:544–550

    Article  PubMed  Google Scholar 

  17. Renshaw A (1998) Testicular calcifications: incidence, histology and proposed pathological criteria for testicular microlithiasis. J Urol 160:1625–1628

    Article  PubMed  CAS  Google Scholar 

  18. Puttemans T (1999) Doppler Couleur du scrotum, Sauramps Medical, Montpellier France

  19. Middleton WD, Teefev SA, Santillan CS (2002) Testicular microlithiasis: prospective analysis of prevalence and associated tumor. Radiology 224:425–428

    Article  PubMed  Google Scholar 

  20. Otite U, Webb JA, Oliver RT et al (2001) Testicular microlithiasis: is it a begnin condition with malignant potential? Eur Urol 40:538–542

    Article  PubMed  CAS  Google Scholar 

  21. Lopez Laur JD, Chiapetta Menendez J, Anchelerguez Moreno R, Prats Roma J (2002) Intratesticular calcifications: clinical significance. Actas Urol Esp 26:92–97

    PubMed  CAS  Google Scholar 

  22. Bach AM, Hann LE, Shi W et al (2003) Is there an increased incidence of contralateral testicular cancer in patients with intratesticular microlithiasis? AJR Am J Roentgenol 180:497–500

    PubMed  Google Scholar 

  23. Ringdahl E, Claybrook K, Teague JL, Northrup M (2004) Testicular microlithiasis and its relation to testicular cancer on ultrasound findings of symptomatic men. J Urol 172:1904–1906

    Article  PubMed  Google Scholar 

  24. de Gouveia Brazao CA, Pierik FH, Oosterhuis JW et al (2004) Bilateral testicular microlithiasis predicts the presence of the precursor of testicular germ cell tumors in subfertile men. J Urol 171:158–160

    Article  PubMed  Google Scholar 

  25. Silvani M, Bossola PC, Pagani G, Minocci D (2002) Testicular microlithiasis: unusual ultrasound finding. Arch Ital Urol Androl 74:238–240

    PubMed  Google Scholar 

  26. Von Eckardstein S, Tsakmakidis G, Kamischke A et al (2001) Sonographic testicular microlithiasis as an indicator of premalignant conditions in normal and infertile men. J Androl 22:818–824

    Google Scholar 

  27. Derogee M, Bevers RF, Prins HJ et al (2001) Testicular microlithiasis, a premalignant condition: prevalence, histopatologic findings, and relation to testicular tumor. Urology 57:1133–1337

    Article  PubMed  CAS  Google Scholar 

  28. Guzman Martinez-Valls PL, Hita Villaplana G, Fernandez Aparicio T et al (2003) Significance and management of testicular microlithiasis. Arch Esp Urol 56:472–477

    PubMed  Google Scholar 

  29. Bach AM, Hann LE, Hadar O et al (2001) Testicular microlithiasis: what is its association with testicular cancer? Radiology 220:70–75

    PubMed  CAS  Google Scholar 

  30. Heinemann V, Frey U, Linke J, Dieckmann KP (2003) Testicular microlithiasis — one case and four points to note. Scand J Urol Nephrol 37:515–518

    Article  PubMed  Google Scholar 

  31. Rashid HH, Cos LR, Weinberg E, Messing EM (2004) Testicular microlithiasis: a review and its association with testicular cancer. Urol Oncol 22:285–289

    PubMed  Google Scholar 

  32. Pourbagher MA, Kiline F, Guvel S et al (2005) Follow-up of testicular microlithiasis for subseguent testicular cancer development. Urol Int 74:108–112

    Article  PubMed  Google Scholar 

  33. Kocaoglu M, Bozlar U, Bulakbasi N et al (2005) Testicular microlithiasis in pediatric age group: ultrasonography findings and literature review. Diagn Interv Radiol 11:60–65

    PubMed  Google Scholar 

  34. Bennett HF, Middleton WD, Bullock AD, Teefev SA (2001) Testicular microlithiasis: US follow-up. Radiology 218:359–363

    PubMed  CAS  Google Scholar 

  35. Skyrme RJ, Fenn NJ, Jones AR, Bowsher WG (2000) Testicular microlithiasis in a UK population: its incidence, associations and follow-up. BJU Int 86:482–485

    Article  PubMed  CAS  Google Scholar 

  36. Ravichandran S, Smith R, Cornford PA, Fordham MV (2006) Surveillance of testicular microlithiasis? Results of an UK based national questionnaire survey. BMC Urology 6:8. DOI 10:1186/1471-2490-6-8

    Article  PubMed  Google Scholar 

  37. Summaria V, Valentini AL, Goletti S et al (1996) Testicular microlithiasis: diagnostic implications in diffuse and focal forms; atti “International Uroradiology 96”, Zurigo 16–20 giugno 1996, p 14

  38. Trias I, Algaba F, Hocsman H (1991) Intratubular germ cell tumor. Eur Urol 19:81–84

    PubMed  CAS  Google Scholar 

  39. Johnson DE, Fueger JJ, Alfaro PJ et al (1987) Subfertility: an etiologic factor in development of testicular cancer? Urology 30:199–200

    Article  PubMed  CAS  Google Scholar 

  40. Berthelsen JG, Skakkebaek NE (1983) Gonadal function of men with testes cancer. Fertil Steril 39:68–75

    PubMed  CAS  Google Scholar 

  41. Thomas K, Wood SJ, Thompson AJM et al (2000) The incidence and significance of testicular microlithiasis in a subfertile population. Brit J Radiol 73:494–497

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. UO Radiodiagnostica, O.C. “S. Maria delle Croci”, V.le Randi 5, I-48100, Ravenna, Italy

    G. C. Parenti & M. Lusa

  2. Servizio di Anatomia Patologica, O.C. “S. Maria delle Croci”, V.le Randi 5, I-48100, Ravenna, Italy

    S. Zago

  3. Arcispedale S. Anna di Ferrara, Istituto di Radiologia Universitaria, Corso Giovecca 203, I-44100, Ferrara, Italy

    P. Campioni & P. Mannella

Authors
  1. G. C. Parenti
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. Zago
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Lusa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. P. Campioni
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. P. Mannella
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to G. C. Parenti.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Parenti, G.C., Zago, S., Lusa, M. et al. Association between testicular microlithiasis and primary malignancy of the testis: our experience and review of the literature. Radiol med 112, 588–596 (2007). https://doi.org/10.1007/s11547-007-0165-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11547-007-0165-1

Key Words

Parole chiave

Search

Navigation