Testicular microlithiasis is a relatively uncommon condition with a small calcification of both testicles.

The primary standard of diagnosis is that there are 5 small stones in a testicle, although definitions have varied in the past. In most cases, the small testicular stones are bilateral.

Epidemiology

Testicular small stones are found in up to 0.6% of patients undergoing testicular ultrasound. Some reports suggest that up to 5.6% of the general population is between the ages of 17 and 35 (3). Although small testicular stones are present in about 50% of men with germ cell tumors, this is very common in patients without cancer, and the direct association between them is still debated.

Relate to

• Testicular germ cell tumors
• Klinefelter syndrome
• Hidden testicles
• Testicular infarction
• Testicular granulomatosis
• Infertility (17)
• Down syndrome
• Aveolar microlithiasis (Aveolar microlithiasis)

Clinical symptoms of testicular microscopy

Testicular small stones are asymptomatic and are often found by an ultrasound examination of the testicles, or found in symptomatic conditions.

Pathology

Microcalcification may be an indicator of duct degeneration, but is not a risk factor for duct degeneration (10).

Ultrasound characteristics of small testicular bronchoscopy

An ultrasound is the method of choice for examining the testicles. Small pebbles that appear are thick, non-glossy echoes of the back small size limited to 1-3mm in diameter. These spots are usually of the same size, appear within the testicular parenchyma and evenly distributed, or may be distributed peripheral or clumped (2).

A classification flow chart used in ultrasound is suggested as (13):

• Limited TML: less than 5 microcalcifications / cross section.
• Classic TML: greater than or equal to 5 microcalcifications / cross section.
• TML diffuse: many microcalcification nodules

TREATMENT AND PROSPECTS SMALL COMPULSORY DISEASE

Testicular small stones are asymptomatic and benign. The association of testicular tumors, particularly germ cell tumors (GCT), remains controversial. An approximately 12-fold increased risk of GCT in symptomatic testicles with small stones has been reported (with small stones found in almost 50% of CTG cases), however, no increased risk was found. asymptomatic on testicles. It’s also not clear if early detection has any benefit over self-examination. Hence, screening is unlikely to be beneficial (1.17).

Some publications recommend frequent self-examination rather than ultrasound examination, while others recommend annual follow-up ultrasound when accompanied by other pre-malignant factors.

The ESUR recommends follow-up ultrasound to age 55, only when there are risk factors including:

• Hidden testicles
• Testicular surgery
• Testicular atrophy (e.g. volume less than 12cc)
• Germ cell pre-tension (15)
• Family history of germ cell tumors.

Translated from: https://radiopaedia.org/

Dr. Dang Xuan Ky

References:

1. Tan IB, Ang KK, Ching BC et-al. Testicular microlithiasis predicts concurrent testicular germ cell tumors and intratubular germ cell neoplasia of unclassified type in adults: a meta-analysis and systematic review. 2010; doi: 10.1002 / cncr.25231 – Pubmed citation

2. Cast JE, Nelson WM, Early AS et-al. Testicular microlithiasis: prevalence and tumor risk in a population referred for scrotal sonography. AJR Am J Roentgenol. 2000; 175 (6): 1703-6. AJR Am J Roentgenol (full text) – Pubmed citation

3. Costabile RA. How worrisome is testicular microlithiasis ?. Curr Opin Urol. 2007; 17 (6): 419-23. doi: 10.1097 / MOU.0b013e3282f0ffea – Pubmed citation

4. Shanmugasundaram R, Singh JC, Kekre NS. Testicular microlithiasis: Is there an agreed protocol ?. Indian J Urol. 2007; 23 (3): 234-9. doi: 10.4103 / 0970-1591.33442 – Free text at pubmed – Pubmed citation

5. DeCastro BJ, Peterson AC, Costabile RA. A 5-year followup study of asymptomatic men with testicular microlithiasis. J. Urol. 2008; 179 (4): 1420-3. doi: 10.1016 / j.juro.2007.11.080 – Pubmed citation

6. Dagash H, Mackinnon EA. Testicular microlithiasis: what does it mean clinically ?. BJU Int. 2007; 99 (1): 157-60. wait: 10.1111 / j.1464-410X.2006.06546.x – Pubmed citation

7. Otite U, Webb JA, Oliver RT et-al. Testicular microlithiasis: is it a benign condition with malignant potential ?. Eur. Urol. 2002; 40 (5): 538-42. Pubmed citation

8. Dell’Acqua A, Tomà P, Oddone M et-al. Testicular microlithiasis: US findings in six pediatric cases and literature review. Eur Radiol. 1999; 9 (5): 940-4. Pubmed citation

9. Miller FN, Sidhu PS. Does testicular microlithiasis matter? A review. Clin Radiol. 2002; 57 (10): 883-90. Pubmed citation

10. Winter TC, Kim B, Lowrance WT, Middleton WD. Testicular Microlithiasis: What Should You Recommend ?. AJR. American journal of roentgenology. 206 (6): 1164-9. wait: 10.2214 / AJR.15.15226 – Pubmed

11. de Gouveia Brazao CA, Pierik FH, Oosterhuis JW et-al. Bilateral testicular microlithiasis predicts the presence of the precursor of testicular germ cell tumors in subfertile men. J. Urol. 2004; 171 (1): 158-60. wait: 10.1097 / 01.ju.0000093440.47816.88 – Pubmed citation

12. Richenberg J, Belfield J, Ramchandani P et-al. Testicular microlithiasis imaging and follow-up: guidelines of the ESUR scrotal imaging subcommittee. Eur Radiol. 2015; 25 (2): 323-30. wait: 10.1007 / s00330-014-3437-x – Pubmed citation

13. Richenberg J, Belfield J, Ramchandani P, Rocher L, Freeman S, Tsili AC, Cuthbert F, Studniarek M, Bertolotto M, Turgut AT, Dogra V, Derchi LE. Testicular microlithiasis imaging and follow-up: guidelines of the ESUR scrotal imaging subcommittee. (2015) European radiology. 25 (2): 323-30. wait: 10.1007 / s00330-014-3437-x – Pubmed

14. Thomas C. Winter, Bohyun Kim, William T. Lowrance, William D. Middleton. Testicular Microlithiasis: What Should You Recommend ?. (2016) American Journal of Roentgenology. 206 (6): 1164-9. wait: 10.2214 / AJR.15.15226 – Pubmed

15. Balawender K, Orkisz S, Wisz P. Testicular microlithiasis: what urologists should know. A review of the current literature. (2018) Central European journal of urology. 71 (3): 310-314. wait: 10.5173 / ceju. 2018.1728 – Pubmed

16. Trout AT, Chow J, McNamara ER, Darge K, Ramirez Grueso R, Munden M, Rothan SM, Navarro OM, Tijerín Bueno M, Bove KE, Chikwava KR, Heider A, Hicks MJ, Somers GR, Zhang B, Dillman JR. Association between Testicular Microlithiasis and Testicular Neoplasia: Large Multicenter Study in a Pediatric Population. (2017) Radiology. 285 (2): 576-583. doi: 10.1148 / radiol. 2017162625 – Pubmed

17. Balawender K, Orkisz S, Wisz P. Testicular microlithiasis: what urologists should know. A review of the current literature. (2018) Central European journal of urology. 71 (3): 310-314. wait: 10.5173 / ceju. 2018.1728 – Pubmed