Differential Diagnosis for Severe Punctuate Calcification in Testicles

• Single Most Likely Diagnosis
  • Testicular microlithiasis: This condition is characterized by the presence of small calcifications within the testicles, which can be detected by ultrasound. It is often associated with testicular cancer, particularly germ cell tumors, but can also be found in individuals without cancer.
• Other Likely Diagnoses
  • Testicular cancer (e.g., germ cell tumors): While not all testicular cancers present with calcifications, the presence of severe punctuate calcification increases the suspicion for malignancy, particularly in the context of testicular microlithiasis.
  • Epididymal calcifications: Calcifications can also occur in the epididymis, which is a tube at the back of the testicle that stores and carries sperm. These calcifications might be visible on imaging studies and could be mistaken for testicular calcifications.
• Do Not Miss Diagnoses
  • Testicular torsion with calcified hematomas: Although less common, in cases of testicular torsion, subsequent hemorrhage and calcification can occur. Missing this diagnosis could lead to loss of the testicle.
  • Metastatic disease to the testes: While rare, metastases to the testes from other primary cancers can occur and might present with calcifications, especially if the primary tumor is known to produce calcified metastases.
• Rare Diagnoses
  • Sarcoidosis: This autoimmune disease can affect multiple organs, including the testes, and might present with calcifications, although this is exceedingly rare.
  • Tuberculosis: Testicular tuberculosis is a rare condition that can cause calcifications within the testes, usually as part of a larger systemic infection.