Testicular microlithiasis

Testicular microlithiasis (TM) is a relatively common condition that represents the deposition of multiple tiny calcifications throughout both testes

The diagnosis is only made with more than five calcifications are detected. In the vast majority of cases testicular microlithiasis is found bilaterally.


Testicular microlithiasis is seen in up to 0.6% of patients undergoing scrotal ultrasound. Some reports suggest that it may present in up to 5.6% of the general population between 17 and 35 years of age 3. Although testicular microlithiasis is present in about 50% of men with a germ cell tumour, it is very common in patients without cancer, and a direct relationship between the two is contentious. 

Clinical presentation

Testicular microlithiasis per se is asymptomatic, and is usually found incidentally when the scrotal content is examined with ultrasound, or found in association with symptomatic associated conditions. 

Known associations include:

Radiographic features


Ultrasound is the modality of choice for examining the testes. Microlithiasis appears as small non-shadowing hyperechoic foci ranging in diameter from 1-3 mm. These foci occur within the testicular parenchyma and although usually distributed uniformly, may be distributed peripherally or segmentally 2.

One grading system used on ultrasound is

  • grade I: less than 10 microcalcifications
  • grade II: 10 to 20 microcalcifications
  • grade III: more than 20 microcalcifications

Treatment and prognosis

Testicular microlithiasis is in itself asymptomatic and benign. A relationship between testicular tumours (in particular germ cell tumours (GCT)) is controversial. An ~8 fold increased risk of GCT in symptomatic testicles with microlithiasis has been reported (microlithiasis is found in approximately 50% of GCT cases), however no increased risk has been found in asymptomatic testicles. As such, screening is unlikely to be beneficial 1.

Some publications advise routine self examination rather than sonographic surveillance 5 while others recommend annual ultrasound follow up when it is accompanied by other premalignant factors 6.

The European Society of Urogenital Radiology (ESUR) advises annual ultrasound follow up until age 55, only if a risk factor is present 12.

  • personal/family history of germ cell tumour
  • maldescent
  • orchidopexy
  • testicular atrophy

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