How should we monitor boys with testicular microlithiasis?

Abstract

Testicular microlithiasis (TM), a rare condition characterized by calcification within the seminiferous tubules, is associated with benign and malignant disorders of the testis. We review current practices of following up pediatric patients diagnosed TM incidentally on scrotal ultrasonography (US). We analyzed retrospectively patient characteristics, family history, indications for US, pathological features, US findings, outcome, and follow-up. At our institution, 2875 scrotal US examinations were performed on 2477 children with various scrotal complaints from 2008 to 2015. Testicular microlithiasis was detected in 81 patients (i.e., an incidence of 3.27%). Every 6 months, each patient underwent a clinical and ultrasonographic evaluation as well as serum tumor markers determination to detect a potential malignancy. Seventy-eight patients who had undergone scrotal US at least twice were included in this study. We evaluated the US studies for the type of TM (diffuse and focal) and change in follow-up studies. Testicular microlithiasis was typically diffuse (n = 56, 71.8%) and bilateral (n = 45, 57.7%), and it was detected the most frequently in the 9-11-year age group (27 patients, 34.6%). The most common comorbid conditions included undescended testes (31 patients, 39.7%) and hydrocele (11 patients, 14.1%). We found that serum tumor markers were within normal limits both at diagnosis and upon follow-up. No testicular tumors or new abnormal symptoms developed during the clinical follow-up. There is no convincing evidence that TM alone is premalignant in a pediatric population. In terms of follow-up, we advise regular self-examinations and annual US in the absence of risk factors.

Microlitiasis testicular como factor de riesgo de Cáncer testicular - Estudio de casos y controles

“…22,23 A pesar de eso, otros autores han propuesto que esa población debería ser seguida al menos mediante el autoexamen testicular y para ello se les debería realizar un proceso de educación durante la consulta siendo eso aún más importante en caso de presentar otros posibles factores de riesgo como lo sería el tabaquismo. [24][25][26]…”

Testicular microlithiasis in a boy with X-linked adrenal hypoplasia congenita

“…The term refers to multiple, uniformly echogenic foci less than 3 mm in diameter that can be found either diffusely or segmentally located throughout the testicular parenchyma. The prevalence of TM in boys varies between 1 and 4% [ 11 , 12 ]. TM is classified with respect to the number of microliths per US field as limited or classic grade 1 to 3 [ 4 ].…”

Pediatric Testicular Microlithiasis: To Refer or Not to Refer?

“…Patient and family reassurance with the recommendation and education about regular testicular self-examination is recommended for isolated TM. 14-16 …”