Objective: To review the findings of testicular ultrasonography (US) in patients referred for testicular symptoms including pain, swelling and infertility, and to determine the prevalence of testicular microlithiasis (TM) and ist relevance to the development of testicular cancer. Methods: Records of 3,026 patients referred for testicular US between 1994 and 1999 were evaluated. The indications for testicular US diagnosis, management and relevant histological details were obtained from medical records. Patients with TM had an annual sonographic follow–up unless they had testicular cancer, in which case follow–up repeat US with clinical reviews was more frequent. Results: TM was found in 54 patients (1.77%; median age 34 years, range 12–83 years). The median follow–up was 36 months (range 12–18 months). Sixteen of these patients had testicular malignancy (30%). The remaining 38 patients had hydrocele and epididymal cysts (14), varicocele (7), epididymitis (2) and small testes (8), with 14 patients having no other pathology. One patient with a small testis developed a seminoma while under surveillance. Another patient with metastatic embryonal–cell carcinoma at initial diagnosis was found to have a seminoma 4 years following chemotherapy. The relative risk of testicular tumours in the presence of TM was 13.2 (confidence interval 8.3–21.5). Conclusion: TM can no longer be regarded simply as a benign condition because of its association with testicular malignancy. In our series, 2 patients (5.2%) developed interval testicular cancers during follow–up US. There is no convincing evidence to suggest that TM might be premalignant. In rare instances of radiologically indeterminate cases, biopsy of the testis may be necessary.

Keywords:
Testicular microlithiasis, Malignancy
1.
Ganem JP, Workman KR, Shaban SF: Testicular microlithiasis is associated with testicular pathology. Urology 1998;53:209–213.
2.
Hobarth K, Susani M, Szabo N, Kratzik C: Incidence of testicular microlithiasis. Urology 1992;40:464–467.
3.
Vegni–Talluri M, Bigliardi E, Vanni MG, Tota G: Testicular microliths: Their origin and structure. J Urol 1980;124:105–107.
4.
Nistal M, Paniagua R, Diez–Pardo JA: Testicular microlithiasis in 2 children with bilateral cryptorchidism. J Urol 1978;121:535–537.
5.
Renshaw AW: Testicular microlithiasis: Incidence, histology and proposed pathological criteria for testicular microlithiasis. J Urol 1998;160:1625–1628.
6.
Kaveggia FF, Strassman MJ, Apfelbach GL, Hatch JL, Wirtanen GW: Diffuse testicular microlithiasis associated with intratubular germ cell neoplasia and seminoma. Urology 1996; 48:794–796.
7.
Nilsson A, Nilsson S: Testicular germ cell tumours after clomiphene therapy for subfertility. J Urol 1985;134:560–562.
8.
Priebe CJ Jr, Garret R: Testicular calcification in a 4–year–old boy. Pediatrics 1970;46:785– 788.
9.
Patel MD, Olcott EW, Kerschman RL, Callen PW, Gooding AW: Sonographically detected testicular microlithiasis and testicular carcinoma. J Clin Ultrasound 1993;21:447–452.
10.
Janzen DL, Mathieson JR, Marsh JI, et al: Testicular microlithiasis: Sonographic and clinical features. Am J Roentgenol 1992;158:1057– 1060.
11.
Jaramillo D, Perez–Atayde A, Tele RL: Sonography of testicular microlithiasis. Urol Radiol 1989;11:55–57.
12.
Backus ML, Mack LA, Middleton WD, King BF, Winter TC III, True LD: Testicular microlithiasis: Imaging appearances and pathological correlation. Radiology 1984;192:781– 785.
13.
Otite U, Nambirajan T, Burney DM, Badenoch DF, Nargund VH: Testicular seminoma diagnosed by annual ultrasound surveillance for testicular microlithiasis. Br J Urol Int 2000;86: 4–5. Web publication on BTU Website.
14.
Salisz JA, Goldman KA: Testicular calcifications and neoplasia in patient treated for subfertility. Urology 1990;36:557–560.
15.
Frush DP, Kliewer MA, Madden JF: Testicular microlithiasis and subsequent development of metastatic germ cell tumour. Am J Roentgenol 1996;167:889–890.
16.
Winter TC III, Zunkel DE, Mack LA: Testicular carcinoma in a patient with previously demonstrated testicular microlithiasis. J Urol 1996;155:648.
17.
Miller RL, Wissman R, White S, Ragosin R: Testicular microlithiasis: A benign condition with a malignant association. J Clin Ultrasound 1996;24:197–202.
2001
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