Testicular microlithiasis (TM) is a relatively common condition that represents the deposition of multiple tiny calcifications throughout both testes.
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.
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:
- testicular germ cell tumour
- Kleinfelter syndrome
- testicular infarct
- Down syndrome
- alveolar microlithiasis
Ultrasound is the modality of choice for examining the testes. Microlithiasis appears as small non-shadowing hyperechoic foci ranging in diameter from 1 to 3 mm. These foci occur within the testicular parenchyma and although usually distributed uniformly, may be distributed peripherally or segmentally 2.
In the vast majority of cases testicular microlithiasis is found bilaterally.
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 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 pre-malignant factors 6.
- 1. Tan IB, Ang KK, Ching BC et-al. Testicular microlithiasis predicts concurrent testicular germ cell tumors and intratubular germ cell neoplasia of unclassified type in adults: a meta-analysis and systematic review. 2010;doi:10.1002/cncr.25231 - Pubmed citation
- 2. Cast JE, Nelson WM, Early AS et-al. Testicular microlithiasis: prevalence and tumor risk in a population referred for scrotal sonography. AJR Am J Roentgenol. 2000;175 (6): 1703-6. AJR Am J Roentgenol (full text) - Pubmed citation
- 3. Costabile RA. How worrisome is testicular microlithiasis?. Curr Opin Urol. 2007;17 (6): 419-23. doi:10.1097/MOU.0b013e3282f0ffea - Pubmed citation
- 4. Shanmugasundaram R, Singh JC, Kekre NS. Testicular microlithiasis: Is there an agreed protocol?. Indian J Urol. 2007;23 (3): 234-9. doi:10.4103/0970-1591.33442 - Free text at pubmed - Pubmed citation
- 5. DeCastro BJ, Peterson AC, Costabile RA. A 5-year followup study of asymptomatic men with testicular microlithiasis. J. Urol. 2008;179 (4): 1420-3. doi:10.1016/j.juro.2007.11.080 - Pubmed citation
- 6. Dagash H, Mackinnon EA. Testicular microlithiasis: what does it mean clinically?. BJU Int. 2007;99 (1): 157-60. doi:10.1111/j.1464-410X.2006.06546.x - Pubmed citation
- 7. Otite U, Webb JA, Oliver RT et-al. Testicular microlithiasis: is it a benign condition with malignant potential?. Eur. Urol. 2002;40 (5): 538-42. Pubmed citation
- 8. Dell'Acqua A, Tomà P, Oddone M et-al. Testicular microlithiasis: US findings in six pediatric cases and literature review. Eur Radiol. 1999;9 (5): 940-4. Pubmed citation
- 9. Miller FN, Sidhu PS. Does testicular microlithiasis matter? A review. Clin Radiol. 2002;57 (10): 883-90. Pubmed citation
- 10. Dell'Acqua A, Tomà P, Oddone M et-al. Testicular microlithiasis: US findings in six pediatric cases and literature review. Eur Radiol. 1999;9 (5): 940-4. Pubmed citation
- 11. de Gouveia Brazao CA, Pierik FH, Oosterhuis JW et-al. Bilateral testicular microlithiasis predicts the presence of the precursor of testicular germ cell tumors in subfertile men. J. Urol. 2004;171 (1): 158-60. doi:10.1097/01.ju.0000093440.47816.88 - Pubmed citation
Synonyms & Alternative Spellings
|Synonyms or Alternative Spelling||Include in Listings?|
|Microlithiasis of the testes||✓|
|Testicular microlithiasis (TM)||✗|