From the Guidelines
Testicular microlithiasis is a condition characterized by the presence of small calcium deposits within the seminiferous tubules of the testicles, which appear as small bright spots on ultrasound examinations of the scrotum, and does not confer an increased risk of malignant neoplasm in the absence of solid mass and risk factors for developing germ cell tumor (GCT) 1.
Definition and Diagnosis
Testicular microlithiasis is typically asymptomatic and is often discovered incidentally during ultrasound evaluations performed for other reasons. The condition occurs in approximately 5-10% of men, with varying degrees of severity.
Risk Factors and Association with Testicular Cancer
While the condition itself doesn't require treatment, it has been associated with a slightly increased risk of testicular cancer in some studies, though this association remains controversial 1.
Management and Recommendations
For men diagnosed with testicular microlithiasis, no further evaluation is required in the absence of solid mass and risk factors for developing GCT 1. However, in cases where there are additional risk factors for testicular cancer (such as prior testicular cancer, undescended testicles, or family history), periodic ultrasound monitoring may be advised.
Pathophysiology and Effects on Fertility
The exact cause of these calcifications remains unclear, but they likely result from degeneration of cells within the seminiferous tubules, leading to calcium deposition. The condition does not affect fertility or testicular function in most cases.
Current Guidelines and Recommendations
According to the most recent guidelines, testicular microlithiasis in the absence of solid mass and risk factors for developing GCT does not require further evaluation 1. The European Association of Urology guidelines on testicular cancer also emphasize the importance of identifying risk factors and performing regular self-examinations to detect any changes in testicular size or texture 1.
From the Research
Definition and Characteristics of Testicular Microlithiasis
- Testicular microlithiasis (TM) is an uncommon condition characterized by calcium deposits within the seminiferous tubules 2.
- On ultrasound, it is seen as multiple, uniform, nonshadowing echogenic foci in the testis 2.
- The true prevalence of TM in the general population is still unknown, with reported prevalences ranging from 0.6 to 9% 2.
Association with Testicular Germ Cell Tumor
- TM is often associated with germ cell tumor (GCT) or intratubular germ cell neoplasia 2.
- The incidence of GCT in patients with TM was reported as 6-46% 2.
- However, more recent studies show a lower incidence of associated GCT and no interval development of tumor in relatively longer duration follow-up 2.
Clinical Significance and Follow-up
- The presence of TM may be a marker for testicular abnormalities, such as tubular degeneration 2.
- Follow-up is recommended for patients with TM, especially those with risk factors for testicular GCT 2, 3, 4.
- The routine use of biochemical tumor markers, abdominal and pelvic CT, or testicular biopsy is not justified 2.
- An individualized approach based on the age of the patient, presence of concurrent features of testicular dysgenesis syndrome, fertility, and ultrasound pattern is recommended 3.
- Ultrasound surveillance is not recommended for patients with TM who are at low risk for testicular cancer 5.