Classic Testicular Microlithiasis Research Articles

Testicular Microlithiasis: Another Starry Sky Appearance

A 36-year-old man presented with swelling of his right testicle that had been present for 3 weeks. Ultrasound of the left testicle showed diffuse microlithiasis throughout the testicular parenchyma, giving the appearance of a “starry sky.” Histopathology of the left testicle after surgical removal revealed innumerable microcalcifications of the parenchyma, confirming the ultrasound findings (figure 1 ▶). The right testicle showed similar ultrasound and histopathologic findings as the left testicle (figure 2 ▶). Color Doppler studies showed a marked increase in the vascularity of the testicular parenchyma (figure 3 ▶). Thus, the diagnosis of testicular microlithiasis (TM) was made with a high degree of certainty, leading to a review of the literature on this entity. Figure 1. Left (contralateral) testicle showing “starry sky” appearance due to microlithiasis on ultrasound. Sagittal and transverse sections of patient’s left testis reveal innumerable microcalcifications of the testicular parenchyma. Figure 2. Right (ipsi-lateral/involved) testicles showing microlithiasis and distorted architecture on ultrasound. Sagittal and transverse sections of patient’s right testis reveal innumerable microcalcifications of the testicular parenchyma. Figure 3. Markedly increased vascularity of the patient’s testicular structures evident upon examination by color Doppler. TM is a relatively rare condition identified in approximately 0.6% of testicular ultrasonograms.1,2 TM can be divided into classic and limited on the basis of the presence of five or more microliths on one or more images of the testes.2 Classic TM is present if there is at least one ultrasound image that identifies five or more microliths in either or both testes. Patients who do not meet the criteria for chronic TM, but have at least one microlith are considered to have limited TM.2 TM has been associated in both benign and malignant conditions such as Klinefelter syndrome,3 male pseudohermaphroditism,4 Down syndrome,5 subfertility,6 infertility,7 cryptorchism,8 hypogonadism,3 fragile X syndrome,9 pseudoxanthoma elasticum,10 and pulmonary microlithiasis.11 Many of these benign conditions are risk factors for testicular malignancies. There are several reports of an association of TM with testicular cancer, with as many as 30% to 75% of patients with testicular tumors presenting with a concomitant TM.2,4,7,8,12–14 The relative risk of testicular tumors in the setting of TM is >20-fold, mandating sonographic surveillance for tumor.14 Thus, TM is believed by some authors to be a predisposing factor, a possible indirect indicator of premalignant disease or a tumor marker. Although there is a scarcity of prospective studies on the risk of cancer developing in individuals with asymptomatic TM without other masses, tumor development during follow-up of TM has been described to have a latency period between 15 months and 11 years.4 If no malignancy is identified on initial evaluation, close clinical follow-up with periodic (every 6 to 12 months) scrotal ultrasound examination is probably indicated. In high risk patients or patients with contralateral tumors, tumor markers and biopsy may also be indicated based on clinical suspicion. Thus, microlithiases are believed to be a predisposing factor, a possible indirect indicator of premalignant disease, or a tumor marker.

Testicular Microlithiasis

Testicular microlithiasis (TM) is characterized on sonography by multiple microprecipitates in the testes. The correlation between TM and testicular malignancies is variable. The purpose of this study was to review our 10-year experience regarding the prevalence of TM and its association with testicular malignancies. This was a retrospective study in which 3254 testicular sonographic examinations over a 10-year period identified 137 patients with TM. Testicular microlithiasis was divided into 2 groups: classic TM (CTM; >or= 5 calcifications per image) and limited TM (<5 calcifications/image). A control population without TM was also randomly selected during the same period. Associations with testicular cancers and other findings were then noted and compared between the TM and control groups. One hundred thirty-seven (4.6%) of the 2957 individual patients with scrotal sonographic examinations had TM; 8 (5.8%) of the 137 patients with TM had testicular cancer, whereas 1 (0.73%) of the 137 patients without TM had primary testicular cancer (P = .04). There were 9 testicular neoplasms in 8 patients, all of whom had CTM. Thirty patients with TM and no malignancy were followed for an average of 19 months (range, 1-90 months; SD, 19.7 months); none had tumor development. We found a strong association between TM and testicular malignancy. We think that the most prudent use of resources for early detection of malignancy would be to have all patients with CTM perform testicular self-examinations, and follow-up sonography should be limited to a subgroup of patients with CTM and other associated risk factors.

Calcificaciones intratesticulares en la edad pediátrica

IntroductionTesticular microlithiasis (TM) represents an uncommon occurrence at paediatrics with a radiological incidence between 0.16 to 0.6% according to reports. The greater use of ultrasound as well as the availability of high-frequency probes has increased the number of incidental TM being diagnosed. Material and MethodFrom january 1998 to october 2002 seven children, aged 9 to 13 years (average 11 years and 1 months), were diagnosed of MT in our department. Sonographic appearance was hyperechogenic multiple small foci of 1-3mm without acoustic shadowing of the testicular parenchyma. AimTo evaluate sonographic patterns of TM, their associations, clinical consequences and to determine their management. ResultsAll children were asymptomatic and the reasons for the ultrasound were: cryptorchism (3), short height (1), gynecomastia (1), varicocele (1) and scrotum trauma (1). It should be noted that 3 of the cases showed bilateral TM. Out of 10 testicles with TM, 8 met classic testicular microlithiasis (CTM) criteria (at least one image that showed five or more microliths in either or both testes) and 2 had limited testicular microlithiasis (LTM) (to have at least one microlith). Clinical and radiological follow-up is being performed annually, ranging from 18 months to 6 years, during which there hasn’t been progression or regression in the number of TM or in their distribution. In none of these cases there has been shown a related testicular cancer. ConclusionsIn other broad reviews it has been shown that there is no evidence to suggest that the TM have to be considered as premalignant lesions by themselves. However, the association among TM and cancer exists. Because of that, and due to the lack of consensus, we recommend annual clinical and radiological (ultrasound) follow-up until puberty, and thereafter the patient should be informed of unknown natural history of this condition. We do not recommend more invasive procedures such as biopsy except: 1) apart form the TM there is a change in the echogenicity or 2) if there is a change in the number or distribution of the TM.

Bleeding, Dysphagia, Dysphonia, Dysarthria, Severe Sore Throat, and Possible Recurrent Laryngeal, Hypoglossal, and Lingual Nerve Injury Associated with Routine Laryngeal Mask Airway Management: Where Is the Vigilance?

Bleeding, Dysphagia, Dysphonia, Dysarthria, Severe Sore Throat, and Possible Recurrent Laryngeal, Hypoglossal, and Lingual Nerve Injury Associated with Routine Laryngeal Mask Airway Management: Where Is the Vigilance?

Microlitiasis testiculares en la edad pediátrica

AimTo evaluate the ecographic patterns of testicular microlithiasis (TM) in paediatric age, its associations, clinical implications and how to manage them. Material and methodsMaterial and methods: We study four children between 11 and 13 years old with testicular microlithiasis. The ecographic study is realized with a 7.5 Mhz linear probe. ResultsTwo of the cases present bilateral microlithiasis. In five of the testicles, the presentation fits the pattern of classic testicular micro-lithiasis (CTM) (≥?5 echogenic foci per transducer field) and one testicle presents limited testicular microlithiasis (< 5 echogenic foci per transducer field). Distribution in the case of CTM is diffuse in two testes, peripheral in another two testicles and central in one of them. In one of the bilateral presentations, a biopsy of both testes is performed, observing intratubular calcification in both. None of them has developed a tumor during the follow-up period, which ranges from nine months to four years. ConclusionsTM have a characteristic echographic appearance. In the absence of focal lesions, they must undergo echographic and clinical control. Neither tumor marker assessment nor biopsy is necessary.

Testicular microlithiasis: US follow-up.

To determine in patients with testicular microlithiasis (TM) the short-term natural history of classic TM (CTM) and limited TM (LTM). In 104 patients, testicular microliths were identified on ultrasonographic (US) images; 39 patients had five or more microliths on at least one US image (criterion for CTM), and 65 patients had fewer than five microliths (criterion for LTM). Attempts were made to have all patients return for follow-up US to assess for change in TM or development of tumor. Seven (18%) of the 39 patients with CTM and one (2%) of the 65 patients with LTM had tumor at presentation (P =.004). Among all 104 patients, follow-up US was performed in 72 patients (31 with CTM, 41 with LTM), with mean follow-up of 45 months (range, 12-90 months). None of these patients had interval development of testicular neoplasm. LTM did not progress to CTM in any patient. Progression in number of microliths was seen in two patients with CTM. Patients with LTM have a lower prevalence of associated malignancy than do patients with CTM. The risk of developing malignancy in patients with isolated TM (LTM or CTM) is low at short-term follow-up. These results raise the question of the need for routine US in this patient population.

Numerical study of the tip-sample interaction in the photon scanning tunneling microscope

The differential method was used to model the scanning of a tip above a given surface defect in the photon scanning tunneling microscope illumination conditions. In order to estimate the influence of the tip-sample interaction, we consider two configurations. In the coupled configuration, the computation is complete and takes into account the tip-sample interaction. In the uncoupled configuration, we use an outgoing wave condition in order to forbid artificially the creation of a multiple scattering system between the tip and the surface. We show that, since the observed sample is dielectric, the tip can be regarded as a passive sensor even if the tip is coated with metal. We also investigate the case of a metallic sample for the two classical TE and TM states of polarization of the incident plane wave.

Energy-balance criterion for diffraction in nonlinear optics

The paper establishes an energy-balance theorem valid for the field diffracted in nonlinear optics by a periodically or randomly modulated surface. In the case of a periodic surface (grating) the explicit form of this criterion is derived for the two classical TE and TM polarizations. It is then used to check the numerical results obtained with the computer codes based on a new electromagnetic theory of diffraction in nonlinear optics recently published. Numerical examples are given for loss-less and lossy dielectric gratings.

Effects of hypotonic saline loading in hydrated dog: evidence for a saline-induced limit on distal tubular sodium transport.

We performed studies on dogs under hydrated conditions, utilizing the rate of free water formation (C(H2O)) as an index of the rate of distal tubular sodium transport. Since C(H2O) could be progressively increased with no evidence of a maximal rate during loading with hypotonic (2.5%) mannitol, it was concluded that there is no limit on distal tubular sodium transport during mannitol loading. In contrast, during hypotonic (0.45%) saline loading C(H2O) rose initially, but as urine flow (V) exceeded 25% of the filtered load C(H2O) attained maximal levels (up to 20% of the filtered load) and remained stable as V increased to 50% of the filtered load. It was concluded that saline loading progressively inhibits proximal sodium reabsorption. Initially, the distal tubule absorbes a large fraction of the proximal rejectate and sodium excretion rises slightly. Eventually, an alteration in distal sodium transport appears which culminates in a maximal rate or transport limit. This distal transport limit provoked by saline loading could not be characterized by a classical Tm as seen with glucose and does not seem to be consequent to high rates of flow through the distal tubule. Regardless of the precise nature of this limit, the major increment in sodium excretion develops during saline loading only after saline alters the capacity of the distal tubule to transport sodium.