Prevalence Of Testicular Microlithiasis Research Articles

Histological Features of Sporadic and Familial Testicular Germ Cell Tumors Compared and Analysis of Age-Related Changes of Histology.

Simple SummaryTesticular germ cell tumors (TGCT) are highly heritable, and earlier studies reported a higher prevalence of certain microscopic features in familial cases compared with sporadic cases. Reasoning by analogy relative to different causal genes for different histologic subtypes of familial kidney cancer, we searched for etiologically informative histopathology associations in familial testicular germ cell cancer. We conducted a detailed, blinded pathology review of familial and sporadic TGCT cases to investigate whether we could identify differences between these two patient subsets and to study the effect of age at diagnosis on histologic features in both groups combined. Our results show no specific histologic differences between familial and sporadic TGCTs. However, we observed histologic features that varied with age at diagnosis among the two groups combined. Thus, our results suggest that there are no histological differences between familial and sporadic TGCT that might identify genetically distinct disease subsets.This study aimed to compare histological features of familial and sporadic testicular germ cell tumors (TGCTs) and surrounding parenchyma, since discriminating features might be etiologically relevant and clinically useful. The study of parenchyma was prompted by reports claiming a higher prevalence of testicular microlithiasis in familial cases. Histological features of TGCTs and surrounding parenchyma of 296 sporadic and 305 familial cases were compared. For each case, one representative hematoxylin and eosin-stained slide was available. Slides were independently scored by two expert pathologists using a semi-quantitative data abstract. Discrepancies were resolved by consensus. A logistic regression model was used to assess the ability to discriminate between sporadic and familial GCT. The histological composition of a tumor, amount of lymphocytic infiltration, amount of germ cell neoplasia in situ (GCNIS), and presence of testicular microlithiasis (TM) did not discriminate between sporadic and familial GCT (area under the curve 0.56, 95%CI 0.51–0.61). Novel observations included increasing lymphocytic infiltration and decreasing GCNIS and TM with increasing age at diagnosis. The presence of tubules with infiltrating lymphocytes was mainly associated with pure seminomas and nonseminomas with a seminoma component. Among seminomas, tubules with infiltrating lymphocytes decreased with increasing age. No discernable differences between sporadic and familial TGCTs were found. The age-related changes in the tumors and surrounding parenchyma in these groups combined are consistent with a host response building up over time predominantly affecting seminomas, the seminoma-component of nonseminomas and GCNIS. TM may gradually dissolve with age. Our hypothesis that histological differences between sporadic and familial TGCT might identify genetically distinct disease subsets was not supported.

Prevalence and risk factors of testicular microlithiasis in patients with hypospadias: a retrospective study

BackgroundIt has been described that the incidence of testicular microlithiasis is high in several congenital disorders which may be associated with testicular impairment and infertility. Several reports have shown that a prepubertal or pubertal hormonal abnormality in the pituitary-gonadal axis was identified in some patients with hypospadias that is one of the most common disorders of sex development. However, exact prevalence or risk factors of testicular microlithiasis in patients with hypospadias have not reported so far. In the present study, to clarify the prevalence and risk factors of testicular microlithiasis in patients with hypospadias, a retrospective chart review was performed.MethodsChildren with hypospadias who underwent testicular ultrasonography between January 2010 and April 2016 were enrolled in the present study. Severity of hypospadias was divided into mild and severe. The prevalence and risk factors of testicular microlithiasis or classic testicular microlithiasis were examined.ResultsOf 121 children, mild and severe hypospadias were identified in 66 and 55, respectively. Sixteen children had undescended testis. Median age at ultrasonography evaluation was 1.7 years old. Testicular microlithiasis and classic testicular microlithiasis were documented in 17 children (14.0%) and 8 (6.6%), respectively. Logistic regression analysis revealed that presence of undescended testis was only a significant factor for testicular microlithiasis and classic testicular microlithiasis. The prevalence of testicular microlithiasis or classic testicular microlithiasis was significantly higher in children with undescended testis compared to those without undescended testis (testicular microlithiasis; 43.8% versus 9.5% (p = 0.002), classic testicular microlithiasis; 37.5% versus 1.9% (p < 0.001).ConclusionsThe current study demonstrated that the presence of undescended testis was only a significant risk factor for testicular microlithiasis or classic testicular microlithiasis in patients with hypospadias. As co-existing undescended testis has been reported as a risk factor for testicular dysfunction among patients with hypospadias, the current findings suggest that testicular microlithiasis in children with hypospadias may be associated with impaired testicular function. Conversely, patients with isolated HS seem to have lower risks for testicular impairment. Further investigation with longer follow-up will be needed to clarify these findings.

Prevalence of testicular microlithiasis in 4850 men from the general Danish population and correlation with Semen parameters and male infertility

Prevalence of testicular microlithiasis in 4850 men from the general Danish population and correlation with Semen parameters and male infertility

Prevalence and Chronological Changes of Testicular Microlithiasis in Isolated Congenital Undescended Testes Operated On at Less Than 3 Years of Age

To clarify the prevalence and chronological changes of testicular microlithiasis in isolated congenital undescended testes, retrospective chart review was performed. Among children with palpable isolated undescended testes who underwent orchiopexy at less than 3 years of age between January 2009 and May 2016, those who had preoperative testicular ultrasonography were enrolled. Testicular microlithiasis was classified as limited or classic. Sixty-five patients (54 unilateral undescended testes and 11 bilateral undescended testes) were enrolled. Preoperative evaluation demonstrated limited testicular microlithiasis in only 2 undescended testes in 2 patients (1 with unilateral undescended testes and 1 with bilateral undescended testes). Of these patients, 1 with unilateral undescended testes had limited testicular microlithiasis and the other with bilateral undescended testes had classic testicular microlithiasis after surgery. Among 53 unilateral undescended testes without microlithiasis preoperatively, limited and classic testicular microlithiasis was found in 1 and 6 testes, respectively, during follow-up. Testicular microlithiasis was identified in 2 on the contralateral descended testis of unilateral undescended testes postoperatively. Among 10 patients with bilateral undescended testes without microlithiasis preoperatively, limited testicular microlithiasis was detected in 4 during follow-up. Testicular microlithiasis was not diminished or resolved during follow-up. The overall prevalence of testicular microlithiasis in undescended testes (21.1%) was significantly higher than that in the contralateral descended testis in patients with unilateral undescended testes (3.7%) (P < .01). Most testicular microlithiasis was identified postoperatively and never improved. The prevalence of testicular microlithiasis in isolated congenital undescended testes increased with time even if operated on early in life.

Characteristics of symptomatic men with testicular microlithiasis - A Danish cross-sectional questionnaire study.

SummaryTesticular microlithiasis (TML) is an incidental finding at ultrasonography of the scrotum. A link between testicular microlithiasis and testicular cancer has been suggested. However, the majority of studies are retrospective using ultrasonography with minor data on health status and life style characteristics. Our objective was to investigate if lifestyle and health are associated with TML. In 2014, we conducted a self‐administered questionnaire survey including 1538 men, who all due to testicular/scrotal symptoms had an ultrasound investigation of the scrotum during 2004–2013. The men were divided into men with TML and men without. The 23‐items questionnaire included items on age, height, weight, lifestyle (alcohol consumptions, smoking habits, workload, exercise and food), previous diseases in the testicles, pain and consumption of analgesics. The prevalence of TML was 12.8%. Overall, lifestyle factors did not vary between men with or without TML. However, men with TML did consume more crisp than men without. Development of TML was not associated to classic life style factors such as alcohol consumption, smoking habits, or mothers smoking during pregnancy. Also, age and height could not be linked to presence of TML. We did find, however, that men with TML experienced less physical activity and consumed more crisp than men without TML. Since ingestion of crisps has potential carcinogenic effect (acrylamide), this finding needs confirmation in a separate study.

Testicular Microlithiasis: Patient Compliance in a Two-Year Follow-Up Program.

Introduction: We present a retrospective 2-year follow-up cohort of 103 men with testicular microlithiasis (TML) and discuss patient compliance and the value of surveillance. Methods: A retrospective analysis of patients examined with scrotal ultrasonography (US) in the period from 2008 through 2010 was performed. A total of 103 men with TML were diagnosed and offered US follow-up every 6 months for 2 years. They were retrospectively analyzed regarding demographics and follow-up details, including the development of any kind of malignancy until March 2015, using the Danish Electronic Pathology Registry. Results: The prevalence of TML was 10.3%. Of the 103 men with TML, 23 (22.3%) had TML in the left testicle, 38 (36.9%) in the right (p=0.002), and 42 (40.8%) had bilateral TML. Patient compliance was low with 11.7% participating in all US follow-up examinations. 5 men presented risk factors (testicular atrophy (N=1) and previous testicular cancer (N=4)), but no cases of testicular malignancy were found in the follow-up period. Conclusion: The low patient compliance conflicts with the ESUR Scrotal Imaging Subcommittee guidelines that recommend scrotal US follow-up annually for TML until the age of 55 years. The fact that no cancers were found during follow-up using the pathology registry calls the value of follow-up into question.

Testicular microlithiasis in acquired undescended testis after orchidopexy at diagnosis

The aim of this study was to observe the prevalence of testicular microlithiasis (TM) in surgically corrected acquired undescended testis (UDT). The prevalence of TM was assessed by ultrasound. Boys and young men who had undergone orchidopexy (ORP) for acquired UDT in mid or late childhood were observed to study the long-term testicular volume. During this examination, the presence or absence of TM was also assessed. TM was defined as echogenic foci without shadowing within the testis parenchyma. We included 106 patients who had undergone ORP at the Medical Center Alkmaar (1986-1999) and 155 patients who had undergone ORP at the Juliana Children's Hospital (1996-2009). The majority of patients were white, Caucasian (82%). The median age at follow-up, 25.8years (range 14.0-31.6years) was higher in Medical Center Alkmaar than in Juliana Children's Hospital 13.4years (range 5.1-26.6years). From 2009 to 2011, these 261 patients (median age 18.9years) underwent an ultrasound examination. Median follow-up after ORP was 11.3years (range 1.4-23.5years); age at ORP ranged from 2.1 to 16.2years, with a median of 8.5years. TM was found in 17 (6.5%) patients (median age at follow-up 20.4years; range 11-28). No significant association was found with the incidence of TM and the operated testis, the age at ORP or the racial variance (p>0.05). ORP at diagnosis for acquired UDT is associated with a 6.5% prevalence of TM in boys and young adults.

Testicular microlithiasis in Japanese male infertility patients: Clinical implications for predicting future testicular malignancy.

e15579 Background: Testicular microlithiasis (TM) is commonly diagnosed by scrotal ultrasonography (US) in which it appears as multiple, small, uniform, echogenic foci without shadowing, scattered randomly throughout the testicular parenchyma. It is also prevalent in several urologic diseases including subfertility and testicular germ cell tumor. TM has been reported to be associated with carcinoma in situ (CIS) and the development of second testicular germ cell tumor (TGCT) after contralateral orchiectomy treatment for primary TGCT; however, no prospective studies have investigated the relationship between the detection of TM in patients without TGCT and future development of TGCT. In the present study, therefore, we investigated the prevalence of TM in the testes of male infertility patients and unilateral TGCT patients to determine if TM could be a predictor of future germ cell tumor in such patients. Methods: A total of 1,139 subfertile patients (296 with nonobstructive azoospermia, 58 with obstructive azoospermia, and 785 with oligozoospermia) and 22 unilateral testicular germ cell tumor patients were enrolled in the study. Prevalence of testicular microlithiasis according to testicular ultrasonography was compared between patients, and development of testicular germ cell tumors was monitored for at least 3 years. All patients were fully informed about the study, and their prior consent was obtained according to the recommendation of the institutional ethics committee. Results: The prevalence of TM was significantly higher in unilateral TGCT patients (40.9%) than in subfertile men (8.6%). No infertile patients without TM developed TGCT but one infertile patient with TM developed TGCT (seminoma) during follow up. One seminoma patient with TM in his remaining testis went on to developed testicular seminoma 3years after primary surgery. Conclusions: Testicular microlithiasis is more common in testicular germ cell tumor patients than in subfertile men. Since TM could be a surrogate marker for future TGCT in both patient populations, TM patients are recommended to perform careful self-checking of the testes and periodical testicular ultrasonography.

Scrotal calcification in a symptomatic paediatric population: Prevalence, location, and appearance in a cohort of 516 patients

To describe the prevalence of all forms of scrotal calcification within a symptomatic paediatric population and to compare this with previous reported data in paediatric and adult populations. A retrospective analysis of testicular ultrasound examinations performed in a single institution over a 55 month period. All examinations were performed by experienced operators using high-frequency linear array transducers. Types of scrotal calcification and position were recorded with all available images analysed by experienced radiologists. A total 516 male patients under the age of 19 years (mean age 10.5 years) were included. The prevalence of testicular microlithiasis (TM) was 8.7% and the prevalence of non-TM macrocalcification was 0.4%. 2.3% of the patients had scrotal pearls and 0.2% had epididymal calcification recorded. No other form of calcification was identified. Asingle patient had a co-existing testicular tumour and TM at examination. The prevalence of TM in the symptomatic paediatric population is greater than that reported in the symptomatic adult population, whereas the prevalence of intra-testicular macrocalcification is lower. It is speculated that TM and macrocalcification represent different pathways for the possible risk of testicular tumour development.

Testicular Volume and Testicular Microlithiasis in Boys With Down Syndrome

Studies have suggested that testicular microlithiasis and Down syndrome are linked, yet a correlation remains unclear. We investigated the prevalence of testicular microlithiasis in patients with Down syndrome. We hypothesized that testicular microlithiasis is present at a higher rate in these patients. We further hypothesized that patients with Down syndrome have lower testicular volumes than normal age matched boys. We tested our hypothesis by ultrasound investigation in boys 0 to 18 years old with Down syndrome. Testicular ultrasound was performed in 79 boys with Down syndrome. Mean patient age was 8.8 years (range 0.4 to 18.3). Testicular microlithiasis was assessed and testicular volume was measured according to the formula, π/6 × length × width × height. Testicular microlithiasis was present in 18 boys (22.8%). It was diagnosed in 6 of 28 boys younger than 7 years (21.4%), in 6 of 28 boys 7 to 12 years (21.4%) and in 6 of 23 boys 12 years or older (26.1%). No significant difference was found in the prevalence of testicular microlithiasis between these 3 groups. Mean testicular volumes in patients with Down syndrome (2.19 ml) were significantly smaller than the normative values. This study demonstrated a 22.8% prevalence of testicular microlithiasis in boys with Down syndrome, which is significantly increased compared to normative values. In addition, testis volume is significantly smaller in boys with Down syndrome compared to normative values.

Prevalence of Testicular Microlithiasis in Males Aged 0 to 18 Years Referred for Scrotal Sonography

: Background: Testicular microlithiasis (TM) is a relatively uncommon and usually asymptomatic condition that is characterized by multiple 1-3 mm nonshadowing echogenic foci within the parenchyma of the testis.Objectives: The prevalence of testicular microlithiasis was assessed retrospectively in males ranging from 0-18 years who had been referred for scrotal ultrasound.Materials and Methods: Scrotal ultrasound examinations were performed in males aged 0-18 years old, producing 401 scans in 363 patients. The accumulated data included referring specialist, indication for sonography, consultant radiologist, number of images available for review of the left and right testis, associated anomalies, histological results, and testicular tumor markers.Results: Testicular microlithiasis was found in 21 patients (5.8%). The mean age of the patients with and without testicular microlithiasis was 11.3 and 6.7 years, respectively (P = 0.000). Significantly more images were available for patients with testicular microlithiasis (P = 0.000), yet only 8 of the 21 cases (38.1%) were identified by the consultant radiologists. None of the boys with testicular microlithiasis were found to have a testicular malignancy.Conclusions: Our study showed a prevalence of testicular microlithiasis of 5.8% in symptomatic boys. The prevalence seemed to increase with age. Consultant radiologists are advised to be more vigilant towards testicular microlithiasis and to scan and store a sufficient number of imaging planes during ultrasonography. Implication for health policy/practice/research/medical education:The prevalence of testicular microlithiasis is 4.7% in boys aged 0–18 years who were referred for scrotal sonography and seemed to increase with age. Since testicular microlithiasis migth be associated with testicular malignancies and infertility, consultant radiologists are advised to be more vigilant towards testicular microlithiasis and to scan and store a sufficient number of imaging planes during ultrasonography. Please cite this paper as:Goede J, Hofman HA, Wagenvoort AM, Pierik FH, Hack WWM. Prevalence of Testicular Microlithiasis in Males Aged 0 to 18 Years Referred for Scrotal Sonography.Nephro-Urol Mon.2012;4(1):377-80.DOI: 10.5812/kowsar.22517006.1898 Copyright © 2012, Kowsar M.P.Co. All rights reserved.

Prevalence of Testicular Microlithiasis in Males Aged 0 to 18 Years Referred for Scrotal Sonography

Background: Testicular microlithiasis (TM) is a relatively uncommon and usually asymptomatic condition that is characterized by multiple 1-3 mm nonshadowing echogenic foci within the parenchyma of the testis. Objectives: The prevalence of testicular microlithiasis was assessed retrospectively in males ranging from 0-18 years who had been referred for scrotal ultrasound. Materials and Methods: Scrotal ultrasound examinations were performed in males aged 0-18 years old, producing 401 scans in 363 patients. The accumulated data included referring specialist, indication for sonography, consultant radiologist, number of images available for review of the left and right testis, associated anomalies, histological results, and testicular tumor markers. Results: Testicular microlithiasis was found in 21 patients (5.8%). The mean age of the patients with and without testicular microlithiasis was 11.3 and 6.7 years, respectively (P = 0.000). Significantly more images were available for patients with testicular microlithiasis (P = 0.000), yet only 8 of the 21 cases (38.1%) were identified by the consultant radiologists. None of the boys with testicular microlithiasis were found to have a testicular malignancy. Conclusions: our study showed a prevalence of testicular microlithiasis of 5.8% in symptomatic boys. The prevalence seemed to increase with age. Consultant radiologists are advised to be more vigilant towards testicular microlithiasis and to scan and store a sufficient number of imaging planes during ultrasonography. © 2012, Kowsar M.P.Co.

Extragonadal Tumor and Testicular Microlithiasis: “Burned-out” Tumors Are Represented by Macrocalcification

To the Editor: The recent case report 1 and subsequent correspondence 2,3 raise some important issues surrounding the presence of testicular microlithiasis and nontesticular microlithiasis (macrocalcification) in both the pediatric and adult testis. We note the opinion of Harris 2 with regard to the occurrence of macrocalcification as more likely to represent the presence of a “burned-out” tumor rather than the presence of microlithiasis as advocated by Meyer and Gilbertson-Dahdal. 1,3 It seems to us unlikely that testicular microlithiasis is representative of a burned-out tumor as advocated by Meyer and Gilbertson-Dahdal. 1 Unfortunately the description and depiction of intratesticular calcification in many of the older articles they cite would not stand up to modern-day scrutiny; vague sonographic methods and assessment are only too evident (eg, Figure 4 in the article by Grantham et al 4 depicts areas of macrocalcification described as bright echogenic foci), likely a manifestation of the less sophisticated transducers of that period. The histologic characteristics of testicular microlithiasis are very different from those of the necrosis, macrocalcification, and possible tumor cell remnants associated with a burned-out tumor 5 ; testicular microlithiasis clearly shows calcified intratubular bodies on histologic specimens. 6 The sonographic features of testicular microlithiasis as classically described are unique to this entity and are not mimicked by other forms of intratesticular calcification. However, the underlying association of testicular microlithiasis as well as burned-out tumors (manifested by macrocalcification) with intratubular germ cell neoplasia, a precursor of a germ cell tumor, indicates an increased risk of tumor development in both testicular microlithiasis and macrocalcification groups. Hence, testicular microlithiasis is associated with intratubular germ cell neoplasia and with that association an increased risk of developing a tumor. Thus, an area of macrocalcification may represent a burned-out tumor, but the remainder of the testis remains at risk if intratubular germ cell neoplasia is present, and it usually is present. We believe that the finding of testicular microlithiasis in the case of Meyer and Gilbertson-Dahdal 1 is more likely to indicate the simultaneous presence of intratubular germ cell neoplasia and not areas of a burned-out tumor. The finding of testicular microlithiasis is incidental and is a marker of the risk associated with intratubular germ cell neoplasia, with no manifestation in the testis of a focal tumor or macrocalcification to indicate the origin in the testis of the retroperitoneal germ cell tumor: a truly “silent” testis for the presence of the source of the retroperitoneal germ cell tumor. Harris was unable to identify any studies that address the prevalence of macrocalcification. We have addressed the prevalence of all types of calcification on scrotal sonography and related it to the presence of primary testicular tumors in 3447 patients, 7 having earlier described in detail the types of scrotal calcification that may be encountered. 8 Any intratesticular calcification not typical of the description of microlithiasis was termed “nontesticular microlithiasis calcification (macrocalcification),” and this is the type of calcification that may be shown when a burnedout tumor is diagnosed in the presence of an extragonadal germ cell tumor, as indicated by the experience of Harris. 2 The prevalence of testicular microlithiasis in our study population was 2.0% (95% confidence interval [CI], 1.6%– 2.6%), and that of nontesticular microlithiasis calcification was 1.7% (95% CI, 1.3%–2.3%). The association with a metachronous primary germ cell tumor was significant in both types of intratesticular calcification. 7 A small subset of pediatric patients (n = 198) was also analyzed, with the prevalence of testicular microlithiasis recorded as 2.0% (95% CI, 0.6%–5.1%) and that of nontesticular microlithiasis recorded as 0.5% (95% CI, 0.0%–2.8%). Our figures, although not significant in the pediatric group with the small cohort analyzed, warrant further evaluation. A possible scenario would advocate that testicular microlithiasis is present in the pediatric population at the same level as that seen in the adult population, but nontesticular microlithiasis increases in the adult patient. This scenario would support the theory that nontesticular microlithiasis is a manifestation of a burned-out tumor that puts the patient at risk of developing a further germ cell tumor of the testis or is responsible for an existing extra gonadal germ cell tumor. There are scarce data to support this theory; it is time we looked more closely at the prevalence of testicular calcification in the pediatric population. We would agree with Harris 2 that a burned-out tumor is represented by nontesticular microlithiasis macrocalcification, and testicular microlithiasis has associations with germ cell tumors and extragonadal tumors. However, areas of testicular microlithiasis, as classically described on sonography, do not represent tumor involution.

Clinical importance and prevalence of testicular microlithiasis in pediatric patients

To evaluate the prevalence of testicular microlithiasis among pediatric patients with inguinoscrotal affections. Between January 2005 and January 2010, we evaluated, prospectively 1504 children ranging from 1 to 15 years with inguinoscrotal affections with a high-frequency ultrasound system, which employs a 10-MHz transducer. Testicular microlithiasis was identified in 20 testes of eleven children (0.71% of 1504 patients evaluated), through an ultrasound scan. Testicular microlithiasis was found in 5 children with cryptorchidism (3.93% of 127 patients), 4 children with retractile testes (14.8% of 27 patients), 1 child with a hypotrophic testis (100% of 1 patient), and 1 child with inguinal hernia (0.07% of 1349 patients). The children with testicular microlithiasis were submitted to annual physical examinations and ultrasound evaluations. Testicular microlithiasis was a rare condition and occurred in 0.7% of the subjects studied. The association with cryptorchidism, retractile and hypotrophic testis was significant.

Testicular microlithiasis: analysis of prevalence and associated testicular cancer in central-eastern Sicilian andrological patients

The aim of this retrospective study was to determine the prevalence of testicular microlithiasis (TM) in central-eastern Sicilian men and to evaluate the association between TM and testicular tumour or infertility. A total of 1056 Sicilian patients underwent scrotal US between 2005 and 2010. TM was found in 106 men with an overall prevalence of 10%; roughly about four times the median prevalence reported in the previous studies (0.6-18.1%). Forty men (3.8%) had a classic TM, whereas 66 (6.2%) had a limited TM. The prevalence of testicular tumour in this cohort was 2.4% (25/1056). At the moment when the testicular tumour was diagnosed, 15 patients (60%) had TM. There was a significant difference (P < 0.01) between the rate of malignancy in men with TM (15/106; 14.2%) and that in men without TM (10/950; 1.1%) with an odds ratio = 16. The prevalence of TM among infertile patients was 18.8%. These data may relate to an increased awareness towards scrotal US examination and/or to the use of more sensitive equipments. The elevated rate of testicular malignancy in men with TM suggests that this US feature may be regarded as a risk factor for testicular tumour.

Extragonadal Tumor and Testicular Microlithiasis

To the Editor: The recent case report on an extragonadal tumor and testicular microlithiasis1 is commendable for presenting an interesting case with important clinical ramifications. Unfortunately, it includes several misleading or erroneous statements about the appearance of regressed testicular tumors and about the clinical importance of testicular microlithiasis. 1. Most, if not all, of the burned-out germ cell cancers I have seen in the testis in 23 years of practice (probably 5 cases) have been amorphous and chunky, not the “focal microlithiasis” that the authors state is common in these situations. I have not found any data to describe the prevalence of coarse calcifications versus microlithiasis, but most textbooks showing a case of a burned-out tumor show chunky or macrocalcifications and not the tiny calcifications of microlithiasis. 2. The authors state in the “Discussion” section that “The prevalence of testicular microlithiasis is reported to be lower than initially expected and therefore may be more clinically important.” Lower prevalence than what? And how does this statement relate to microlithiasis being more clinically relevant? 3. The authors appear to have overstated the importance of testicular microlithiasis as a risk factor for testicular germ cell tumors. A meta-analysis of 33 studies of testicular microlithiasis2 was published at about the same time as the case report discussed here and was therefore probably unavailable to the authors. The metaanalysis reviewed 33 studies through 2009 and found that testicular microlithiasis was not associated with an increased risk of testicular germ cell tumors in lowrisk, asymptomatic men. It was associated with a very high risk in referral populations. Other studies have reached much the same conclusions for testicular microlithiasis and metachronous testis carcinoma, and testicular microlithiasis in the general population, without any risk factors for testicular carcinoma, most likely does not merit any sonographic follow-up but monthly or bimonthly testicular self-examinations, as in any other young patient of testicular cancer age. The authors do make several comments regarding microlithiasis follow-up in pediatric patients, but they need to make it clearer that their recommendations— if the data support them, and I do not think they do— are targeted at the pediatric population. I note also that the authors did not have references after 2002 for testicular microlithiasis and only list 2 references for testicular microlithiasis and testicular cancer. I suggest an update of their references to more recent articles on the importance of testicular microlithiasis and the risk for developing testicular germ cell tumors to more accurately reflect the current thinking of most experts.3

Testicular Microlithiasis: Prevalence and Clinical Significance in a Population Referred for Scrotal Ultrasonography

PurposeTesticular microlithiasis (TM) is an uncommon pathologic condition that is commonly diagnosed by scrotal ultrasonography. Indirect evidence suggests that this syndrome may be associated with an increased risk of testicular malignancy and infertility.Materials and MethodsA total of 1,439 patients undergoing scrotal ultrasound during a 6-year, 5-month period (January 2003 to May 2009) were retrospectively reviewed. Any possible association of TM with pathologic findings was assessed. Among patients with TM, further grading of TM with testicular cancer and semen analysis of the infertile group with TM were also performed.ResultsTM was diagnosed in 87 patients (6.0%) out of a total of 1,439. Of all established pathologic entities, only testicular malignancy and infertility were meaningfully associated with TM. There was no significant difference in the prevalence of testicular cancer between each grade. Seminal profiles (sperm count, motility, morphology, and white blood cell count) were not found to be statistically different between infertile men with and without TM.ConclusionsThe prevalence of TM in symptomatic men was found to be 6.0% with significant co-occurrence of TM, testicular cancer, and infertility. Further grading of TM does not seem to be essential with regard to the detection of patients with testicular cancer and TM. TM showed no significant effect on the seminal profiles of infertile men.

Prevalence of Testicular Microlithiasis in Males with Congenital Adrenal Hyperplasia and Its Association with Testicular Adrenal Rest Tumors

Background: Testicular microlithiasis (TM) is characterized by calcium deposits within the seminiferous tubules and is associated with benign and malign conditions. Aim: To determine TM prevalence in patients with congenital adrenal hyperplasia (CAH) and its association with testicular adrenal rest tumors (TART). Patients and Methods: Scrotal ultrasound using a high-frequency linear transducer (12 MHz) was performed in 41 patients aged 12.1 ± 4.7 (range 3.5–23.3) years and 49 healthy similarly aged controls. TM was classified with respect to the number of microliths per ultrasound field as limited (LTM, <5 microliths) and classic (CTM, ≧ 5 microliths). CTM was graded as grade 1 (5–10 microliths), grade 2 (11–20 microliths), and grade 3 (>20 microliths). Results: TM was detected bilaterally in 9 (21.9%) patients and 2 (4.1%) control cases (1 bilateral, 1 unilateral). Four patients had LTM, one evaluated as grade 1, one as grade 2, and three as grade 3. There were 9 patients with TART. Four patients had TM and TART concomitantly. Conclusion: Because TM is frequently found in patients with CAH and may also exist concomitantly with TART, we recommend that these patients be followed annually by testicular ultrasound.

Testicular Microlithiasis in Boys and Young Men With Congenital or Acquired Undescended (Ascending) Testis

We assessed the prevalence of testicular microlithiasis by ultrasound in boys and young men with congenital or acquired undescended (ascending) testis. During followup for testicular growth patients with congenital or acquired undescended (ascending) testis were also screened by ultrasound for testicular microlithiasis, which was defined as echogenic foci without shadowing within the testis parenchyma. Classic microlithiasis was defined as 5 or more echogenic foci in either or both testes and limited microlithiasis as fewer than 5 foci. We performed 181 ultrasounds in 181 patients (199 congenital undescended testes) with a mean age of 12.6 years (range 2.6 to 28.6) and 636 ultrasounds in 320 patients (350 acquired undescended/ascending testes) with a mean age of 12.4 years (4.1 to 24.1). Age in both patient groups was equivalent. Median followup was 1.34 years (range 0 to 3.2). Testicular microlithiasis was found in 14 patients (2.8%), of whom 11 (2.2%) displayed classic testicular microlithiasis and 3 (0.6%) exhibited limited testicular microlithiasis. Among these 14 patients 5 had congenital undescended testes, which demonstrated classic microlithiasis. Of these 5 patients 4 had chromosomal deformities. The remaining 9 patients had acquired undescended (ascending) testis, which exhibited classic microlithiasis in 6 instances and limited microlithiasis in 3. The prevalence of testicular microlithiasis in patients with undescended testis is 2.8%. There is no difference in the prevalence of testicular microlithiasis between congenital and acquired undescended (ascending) testes.

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.