Abstract
Testicular microlithiasis (TM) is an uncommon condition characterized by calcium deposits within the seminiferous tubules. On ultrasound (US), it is seen as multiple, uniform, nonshadowing echogenic foci in the testis. Although its true prevalence in the general population is still unknown, reported prevalences range from 0.6 to 9%. The TM is often associated with germ cell tumor (GCT) or intratubular germ cell neoplasia. The incidence of GCT in patients with TM was reported as 6–46%. There are several reports demonstrating interval development of GCT in patients with TM. These may suggest a premalignant nature of TM; however, more recent studies show a lower incidence of associated GCT and no interval development of tumor in relatively longer duration follow-up. Additionally, previously reported cases of interval tumor development had predisposing factors for testicular GCT. According to the recent literature, it is suggested that both TM and testicular GCT may be caused by a common defect, such as tubular degeneration, and TM may present as a marker for such abnormalities; however, because of a high incidence of association with GCT, it is prudent to follow up patients with TM with physical examination and US at least annually and to encourage self-examination. The routine use of biochemical tumor markers, abdominal and pelvic CT, or testicular biopsy does not seem to be justified.
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References
Doherty FJ, Mullins TL, Sant GR, Drinkwater MA, Ucci AA (1987) Testicular microlithiasis: a unique sonographic appearance. J Ultrasound Med 6:389–392
Otite U, Webb JAW, Oliver RTD, Badenoch DF, Nargund VH (2001) Testicular microlithiasis: Is it a benign condition with malignant potential? Eur Urol 40:538–542
Derogee M, Bevers RFM, Prins HJ, Jonges TGN, Elbers FH, Boon TA (2001) Testicular microlithiasis, a premalignant condition: prevalence, histopathologic findings, and relation to testicular tumor. Urology 57:1133–1137
Peterson AC, Bauman JM, Light DE, McMann LP, Costabile RA (2001) The prevalence of testicular microlithiasis in an asymptomatic population of men 18 to 35 years old. J Urol 166:2061–2064
Backus ML, Mack LA, Middleton WD, King BF, Winter TC III, True LD (1994) Testicular microlithiasis: imaging appearances and pathologic correlation. Radiology 192:781–785
Bennett HF, Middleton WD, Bullock AD, Teefey SA (2001) Testicular microlithiasis: US follow-up. Radiology 218:359–363
Middleton WD, Teefey SA, Santillan CS (2002) Tesicular microlithiasis: prospective analysis of prevalence and associated tumor. Radiology 224:425–428
Cast JEI, Nelson WM, Early AS et al. (2000) Testicular microlithiasis: prevalence and tumor risk in a population referred for scrotal sonography. Am J Roentgenol 175:1703–1706
Vegni-Talluri M, Bigliardi E, Vanni MG, Tota G (1980) Testicular microliths: their origin and structure. J Urol 124:105–107
Drut R, Drut RM (2002) Testicular microlithiasis: histologic and immunohistochemical findings in 11 pediatric cases. Pediatr Dev Pathol 5:544–550
Janzen DL, Mathieson JR, Marsh JI et al. (1992) Testicular microlithiasis: sonographic and clinical features. Am J Roentgenol 158:1057–1060
Renshaw AA (1998) Testicular calcifications: incidence, histology and proposed pathological criteria for testicular microlithiasis. J Urol 160:1625–1628
Hobarth K, Susani M, Szabo N, Kratzik C (1992) Incidence of testicular microlithiasis. Urology 40:464–467
Bach AM, Hann LE, Hadar O et al. (2001) Testicular microlithiasis: What is its association with testicular cancer? Radiology 220:70–75
Miller F, Rosairo S, Clarke J, Sidhu P (2000) Testicular calcification: appearances, anatomical distribution and association with primary intra-testicular malignancy in 2924 patients. Radiology 217(P):366
McEniff N, Doherty F, Katz J, Schrager CA, Klauber G (1995) Yolk sac tumor of the testis discovered on a routine annual sonogram in a boy with testicular microlithiasis. Am J Roentgenol 164:971–972
Winter TC III, Zunkel DE, Mack LA (1996) Testicular carcinoma in a patient with previously demonstrated testicular microlithiasis. J Urol 155:648
Frush DP, Kliewer MA, Madden JF (1996) Testicular microlithiasis and subsequent development of metastatic germ cell tumor. Am J Roentgenol 167:889–890
Vrachliotis TG, Neal DE (1997) Unilateral testicular microlithiasis associated with a seminoma. J Clin Ultrasound 25:505–507
Thomas K, Wood SJ, Thompson AJM, Pilling D, Lewis-Jones DI (2000) The incidence and significance of testicular microlithiasis in a subfertile population. Br J Radiol 73:494–497
Furness PD III, Husmann DA, Brock JW III et al. (1998) Multi-institutional study of testicular microlithiasis in childhood: a benign or premalignant condition? J Urol 160:1151–1154
Kutcher R, Rosenblatt R, Kremer S (1992) Testicular microlithiasis (letter). Am J Roentgenol 159:1129
Ikinger U, Wurster K, Terwey B, Mohring K (1982) Microcalcifications in testicular malignancy: diagnostic tool in occult tumor? Urology 19:525–528
Salisz JA, Goldman KA (1990) Testicular calcifications and neoplasia in patient treated for subfertility. Urology 36:557–560
Patel MD, Olcott EW, Kerschmann RL, Callen PW, Gooding GAW (1993) Sonographically detected testicular microlithiasis and testicular carcinoma. J Clin Ultrasound 21:447–452
Miller RL, Wissman R, White S, Ragosin R (1996) Testicular microlithiasis: a benign condition with a malignant association. J Clin Ultrasound 24:197–202
Berger A, Brabrand K (1998) Testicular microlithiasis: a possibly premalignant condition. Report of five cases and a review of the literature. Acta Radiol 39:583–586
Ganem JP, Workman KR, Shaban SF (1999) Testicular microlithiasis is associated with testicular pathology. Urology 53:209–213
Bach AM, Hann LE, Shi W, Giess CS, Yoo HH, Sheinfeld J, Thaler HT (2003) Is there increased incidence of contralateral testicular cancer in patients with intratesticular microlithiasis? Am J Roentgenol 180:497–500
Gooding GA (1997) Detection of testicular microlithiasis by sonography. Am J Roentgenol 168:281–282
Giwercman A, Muller J, Skakkebaek NE (1991) Prevalence of carcinoma in situ and other histopathological abnormalities in testes from 399 men who died suddenly and unexpectedly. J Urol 145:77–80
Loy V, Dieckmann KP (1993) Prevalence of contralateral testicular intraepithelial neoplasia (carcinoma in situ) in patients with testicular germ cell tumour. Results of the German multicentre study. Eur Urol 23:120–122
Giwercman A, Maase H von der, Skakkebaek NE (1993) Epidemiological and clinical aspects of carcinoma in situ of the testis. Eur Urol 23:104–110
Kaveggia FF, Strassman MJ, Apfelbach L, Hatch JL, Wirtanen GW (1996) Diffuse testicular microlithiasis associated with intratubular germ cell neoplasia and seminoma. Urology 48:794–796
Parra BL, Venable DD, Gonzalez E, Eastham JA (1996) Testicular microlithiasis as a predictor of intratubular germ cell neoplasia. Urology 48:797–799
Berthelsen JG, Skakkebaek NE (1981) Value of testicular biopsy in diagnosing carcinoma in situ testis. Scand J Urol Nephrol 15:165–168
Song FL, Middleton WD, Winter TC, Swanson PE, Mack LA (1993) Association between intratubular germ cell neoplasia and testicular microlithiasis (abstr). Radiology 189(P):156
Emberton P, Moody AR (1994) Testicular microlithiasis (letter). Am J Roentgenol 162:1002–1003
Quane LK, Kidney DD (2000) Testicular microlithiasis in a patient with a mediastinal germ cell tumor. Clin Radiol 55:642–644
Howard RG, Roebuck DJ, Metreweli C (1998) The association of mediastinal germ cell tumour and testicular microlithiasis. Pediatr Radiol 28:998
Aizenstein RI, Hibbeln JF, Sagireddy B, Wilbur AC, O’Neil HK (1997) Klinefelter’s syndrome associated with testicular microlithiasis and mediastinal germ-cell neoplasm. J Clin Ultrasound 25:508–510
Pierik FH, Dohle GR, van Muiswinkel JM, Vreeburg JT, Weber RF (1999) Is routine scrotal ultrasound advantageous in infertile men? J Urol 162:1618–1620
Nistal M, Paniagua R, Diez-Pardo JA (1979) Testicular microlithiasis in 2 children with bilateral cryptorchidism. J Urol 121:535–537
Jaramillo D, Perez-Atayde A, Teele RL (1989) Sonography of testicular microlithiasis. Urol Radiol 11:55–57
Kragel PJ, Delvecchio D, Orlando R, Garvin DF (1991) Ultrasonographic findings of testicular microlithiasis associated with intratubular germ cell neoplasia. Urology 37:66–68
Kessaris DN, Mellinger BC (1994) Incidence and implication of testicular microlithiasis detected by scrotal duplex sonography in a select group of infertile men. J Urol 152:1560–1561
Lenz S, Thomsen JK, Giwercman A, Hertel NT, Hertz J, Skakkebaek NE (1994) Ultrasonic texture and volume of testicles in infertile men. Hum Reprod 9:878–881
Eckardstein S von, Tsakmakidis G, Kamischke A, Rolf C, Nieschlag E (2001) Sonographic testicular microlithiasis as an indicator of premalignant conditions in normal and infertile men. J Androl 22:818–824
Riebel T, Herrmann C, Wit J, Sellin S (2000) Ultrasonographic late results after surgically treated cryptorchidism. Pediatr Radiol 30:151–155
Khan MA, Beyzade B, Potluri BS (2000) Testicular seminoma in a man with bilateral microlithiasis and a history of cryptorchidism. Scand J Urol Nephrol 34:377–379
Skyrme RJ, Fenn NJ, Jones AR, Bowsher WG (2000) Testicular microlithiasis in a UK population: its incidence, associations and follow-up. Br J Urol Int 86:482–485
Propeck PA, Desouky SS, Warner TF, Pozniak M (1993) Ultrasound of the day. Radiographics 13:693–695
Hobarth K, Szabo N, Klingler HC, Kratzik C (1993) Sonographic appearance of testicular microlithiasis. Eur Urol 24:251–255
Leenen AS, Riebel TW (2002) Testicular microlithiasis in children: sonographic features and clinical implications. Pediatr Radiol 32:575–579
Roberts IS, Loughran CF (1993) Case report: the ultrasound appearances of testicular microlithiasis (‘snow storm’ testis): a case complicated by testicular seminoma. Clin Radiol 47:65–67
Alsikafi NF, Gerber GS (1998) Bilateral metachronous testicular seminoma associated with microlithiasis. J Urol 159:1643–1644
Abu-Yousef M (2000) Case 2: abdominal. Testicular microlithiasis complicated by testicular carcinoma. J Ultrasound Med 19:354
Golash A, Parker J, Ennis O, Jenkins BJ (2000) The interval of development of testicular carcinoma in a patient with previously demonstrated testicular microlithiasis. J Urol 163:239
Cornford PA, Baird AD, Woolfenden KA (2001) Testicular microlithiasis needs long-term surveillance. Scand J Urol Nephrol 35:243–244
Whitman GJ, Hall DA, McCarthy KA, Hulka CA, Simeone JF (1994) Testicular microlithiasis: sonographic features and significance (abstr). Radiology 193 (P):335
Klauber GT, Sant GR, Long JP, McEniff NJ, Doherty FJ, Ucci AA (1996) Testicular microlithiasis in boys: preliminary results and implications. J Urol (part 2) 155:392A, abstract 326
Tuzel E, Yorukoglu K, Gumus B, Kirkali Z (1997) Testicular microlithiasis associated with teratocarcinoma and intratubular germ cell neoplasia: a case report. Int J Urol 4:530–532
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Kim, B., Winter, T.C. & Ryu, Ja. Testicular microlithiasis: clinical significance and review of the literature. Eur Radiol 13, 2567–2576 (2003). https://doi.org/10.1007/s00330-003-2014-5
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DOI: https://doi.org/10.1007/s00330-003-2014-5