Testicular Microlithiasis

Testicular microlithiasis is an infrequent incidental finding on scrotal ultrasound. An association between testicular microlithiasis and germ cell tumors and testicular carcinoma in situ has been reported. Testicular microlithiasis has also been suggested as a feature of the testicular dysgenesis syndrome, which is thought to be related to subfertility, testicular atrophy, cryptorchidism, germ cell tumors, and other abnormalities of sexual development.

Management of patients with testicular microlithiasis has varied across institutions. A recent review in Nature Reviews: Urology makes the following suggestions:

• Initial evaluation of all patients with testicular microlithiasis: Search for personal and family history of testicular dysgenesis syndrome (e.g., symptoms of subfertility, cryptorchidism, testicular atrophy and germ cell tumors). Obtain a baseline chest radiograph and abdominal ultrasound.
• Asymptomatic and healthy patients 13 to 39 years of age and no features of testicular dysgenesis syndrome: Initial evaluation as above. Monitor with testicular self-examination.
• One or more features of testicular dysgenesis syndrome: Initial evaluation as above plus serum tumor markers. Testicular biopsy for testicular carcinoma in situ may be considered. Annual follow-up with scrotal ultrasound and serum tumor markers.

References

Tan MH, Eng C. Testicular microlithiasis: recent advances in understanding and management. Nat Rev Urol. 2011 Mar;8(3):153-63.