From the Guidelines
Testicular microlithiasis is a condition characterized by the presence of small, echogenic, non-shadowing foci within the testicles, typically more than 5 in number.
Key Characteristics
- It is often incidentally detected on scrotal ultrasound [ 1, 1 ]
- Testicular microlithiasis in the absence of a solid mass or other risk factors for germ cell tumors (GCT) does not confer an increased risk of malignant neoplasm and does not require further evaluation or follow-up [ 1, 1 ]
Risk Factors and Associations
- The role of testicular microlithiasis in the carcinogenesis of testicular cancer remains controversial, with recent literature suggesting it only increases the chance of testicular malignancy in patients with other known risk factors of GCT 1
- Risk factors for GCT include cryptorchidism, hypospadias, inguinal hernia, and other birth-related factors 1
Diagnosis and Management
- Scrotal ultrasound with Doppler is recommended for patients with a unilateral or bilateral scrotal mass suspicious for neoplasm 1
- Testicular microlithiasis is diagnosed on ultrasound as more than 5 small echogenic non-shadowing foci 1
- Men with incidentally detected microlithiasis should not undergo further evaluation unless other risk factors are present 1
From the Research
Definition and Prevalence of Testicular Microlithiasis
- Testicular microlithiasis is a condition characterized by the presence of small, calcified deposits within the testicles, typically detected by ultrasound 2, 3, 4.
- The prevalence of testicular microlithiasis varies, with studies reporting it to be present in 5.6% of the male population between 17 and 35 years of age, with higher rates in African Americans (14.1%) 3.
Association with Testicular Cancer
- Testicular microlithiasis has been associated with an increased risk of testicular cancer, particularly in men with additional risk factors such as contralateral testicular cancer, testicular atrophy, inhomogeneous parenchyma, infertility, or a history of maldescensus 2, 5, 4, 6.
- However, the majority of men with testicular microlithiasis will not develop testicular cancer, and the condition is not considered premalignant in itself 2, 3.
Management and Follow-up
- Proposed management strategies for testicular microlithiasis range from benign neglect to regular follow-up with ultrasonography and testicular self-examination 2, 6.
- Men with testicular microlithiasis and additional risk factors may be offered a testicular biopsy to rule out carcinoma in situ (CIS) or testicular cancer 5.
- Regular testicular self-examination is recommended for follow-up of high-risk patients, while the role of surveillance with serial ultrasonography and measurement of tumor markers is still unclear 6.