From the Guidelines
Testicular microcalcifications are generally benign and do not require treatment, but their presence may indicate an increased risk of testicular cancer, particularly in men with other risk factors. When five or more microcalcifications are found in a single ultrasound image, a condition known as testicular microlithiasis, there may be an increased risk of developing testicular cancer, especially in men with other risk factors such as cryptorchidism, family history of testicular cancer, or personal history of testicular cancer in the opposite testicle 1. Some key points to consider include:
- Testicular microlithiasis in the absence of a solid mass or other risk factors for germ cell tumor (GCT) does not confer an increased risk of malignant neoplasm and does not require further evaluation or follow-up 1.
- For men with incidental microcalcifications but no other risk factors, routine self-examination is generally sufficient, but those with multiple risk factors may benefit from regular ultrasound monitoring every 6-12 months 1.
- Microcalcifications form when calcium salts deposit within the seminiferous tubules, possibly due to cellular degeneration or abnormal metabolism within the testicle, and while their presence alone doesn't warrant invasive procedures, they should prompt appropriate follow-up based on individual risk assessment 1.
- The role of testicular microlithiasis in the carcinogenesis of testicular cancer remains controversial, with more recent literature suggesting it only increases the chance of testicular malignancy in patients with other known risk factors of GCT 1. In summary, the presence of testicular microcalcifications should prompt a thorough evaluation of individual risk factors and may warrant regular follow-up, but generally does not require immediate treatment. Some additional considerations include:
- Scrotal ultrasound with Doppler should be obtained in patients with a unilateral or bilateral scrotal mass suspicious for neoplasm 1.
- Serum tumor markers, including alpha-fetoprotein, human chorionic gonadotropin, and lactate dehydrogenase, should be measured prior to any treatment, including orchiectomy 1.
- Patients with normal serum tumor markers and indeterminate findings on physical exam or testicular ultrasound for testicular neoplasm should undergo repeat imaging in 6-8 weeks 1.
From the Research
Significance of Microcalcifications in the Testicle
The presence of microcalcifications in the testicle, also known as testicular microlithiasis, has been a topic of interest in the medical community due to its potential association with testicular cancer.
- Testicular microlithiasis is present in approximately 5.6% of the male population between 17 and 35 years of age, with a higher prevalence in African Americans (14.1%) 2.
- While microcalcifications are found in roughly 50% of germ cell tumors, the majority of men with testicular microlithiasis will not develop testicular cancer 2.
- A study found that the presence of testicular microlithiasis is not related to the prognosis of the disease or any of the comorbidities and clinical data analyzed 3.
Association with Testicular Cancer
The relationship between testicular microlithiasis and testicular cancer is still being researched.
- Some studies suggest that testicular microlithiasis may be associated with an increased risk of germ cell neoplasia, but the evidence is indirect 4.
- A review of the current literature found that the clinical consequences of testicular microlithiasis depend on the co-occurrence of specific risk factors, and that the presence of testicular microlithiasis alone is not an indication for further investigation 5.
- However, another study reported a series of 6 patients with predetermined testicular macrocalcification who developed malignancy on follow-up ultrasonography, suggesting that testicular macrocalcification may be a risk factor for malignancy 6.
Recommendations for Follow-up
The recommendations for follow-up in cases of testicular microlithiasis vary.
- Some studies suggest that increased emphasis on testicular examination is the recommended follow-up for men identified with testicular microlithiasis 2.
- Others recommend follow-up ultrasonography examinations for patients with macrocalcification, potentially in a similar manner as for those with testicular microlithiasis 6.
- A review of the literature found that follow-up is only recommended where risk factors of testicular cancer other than testicular microlithiasis are present 5.