Testicular microlithiasis is associated with testicular pathology

Abstract

Objectives. To evaluate the impact of testicular microlithiasis (TM) on male health by describing our experience. TM is an uncommon condition characterized by calcium deposits in the lumina of seminiferous tubules. These intratesticular calcifications appear as bright, 2- to 3-mm echogenic foci on testicular ultrasound (US). Methods. Patients diagnosed with TM by high-frequency testicular US over a 4-year period from two separate institutions were included in this study. Approximately 1100 testicular USs were performed (both hospitals combined) over the 4-year period. Patients were clinically identified by the characteristic appearance of TM on testicular US. Pathologic specimens were obtained in 14 (64%) of 22 patients. Results. Thirty-eight testicles (16 bilateral cases) in 22 patients were found to have TM. The incidence of TM was approximately 2%. Mean age at presentation was 29 years (range 8 to 63). Eight (36%) of 22 patients had testicular malignancies. Five (23%) of 22 patients were infertile. Three (14%) of 22 patients presented with unilateral necrosis of the testes due to spermatic cord torsion. Two patients had varicoceles, 1 patient had epididymitis, and another patient had torsion of an appendix testis. Previously unreported associations of TM and neurofibromatosis (1 patient) and acquired immunodeficiency syndrome (AIDS) (1 patient) were noted. No patient with TM later developed a testicular malignancy, yet the mean follow-up was only 31 months (range 1 to 108). One patient with unilateral TM developed bilateral TM, and 1 patient with bilateral TM subsequently developed unilateral TM. One patient developed spermatic cord torsion and testicular infarction 4 years after previously documented TM. Conclusions. TM is usually diagnosed by testicular US performed for various indications. TM is an uncommon condition that is found in testes with both malignant and nonmalignant conditions. The association of TM and testicular malignancy suggests regular follow-up with testicular US examinations.