Testicular microlithiasis: A benign condition with a malignant association

Miller, Robert; Wissman, Robert D.; White, Susan; Ragosin, Robert

doi:10.1002/(sici)1097-0096(199605)24:4<197::aid-jcu6>3.0.co;2-a

Cited by 75 publications

(46 citation statements)

References 23 publications

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“…21,22 When TM is diagnosed, a coexistent tumor is present in 30 to 40% of patients. 23 In agreement with these studies, five of our patients had TM, four identified by ultrasound and one at orchiectomy.…”

Section: Discussionmentioning

confidence: 99%

Orchiectomy for suspected microscopic tumor in patients with anti-Ma2-associated encephalitis

Mathew¹,

Vandenberghe²,

García‐Merino³

et al. 2007

Neurology

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Objective: To report the presence of microscopic neoplasms of the testis in men with anti-Ma2-associated encephalitis (Ma2-encephalitis) and to discuss the clinical implications.Methods: Orchiectomy specimens were examined using immunohistochemistry with Ma2 and Oct4 antibodies.Results: Among 25 patients with Ma2-encephalitis younger than 50 years, 19 had germ-cell tumors, and 6 had no evidence of cancer. These 6 patients underwent orchiectomy because they fulfilled five criteria: 1) demonstration of anti-Ma2 antibodies in association with MRI or clinical features compatible with Ma2-encephalitis, 2) life-threatening or progressive neurologic deficits, 3) age < 50 years, 4) absence of other tumors, and 5) new testicular enlargement or risk factors for germ-cell tumors, mainly cryptorchidism or ultrasound evidence of testicular microcalcifications. All orchiectomy specimens showed intratubular-germ cell neoplasms unclassified type (IGCNU) and other abnormalities including microcalcifications, atrophy, fibrosis, inflammatory infiltrates, or hypospermatogenesis. Ma2 was expressed by neoplastic cells in three of three patients examined. Even though most patients had severe neurologic deficits at the time of orchiectomy (median progression of symptoms, 10 months), 4 had partial improvement and prolonged stabilization (8 to 84 months, median 22.5 months) and two did not improve after the procedure. Conclusions:In young men with Ma2-encephalitis, 1) the disorder should be attributed to a germcell neoplasm of the testis unless another Ma2-expressing tumor is found, 2) negative tumor markers, ultrasound, body CT, or PET do not exclude an intratubular germ-cell neoplasm of the testis, and 3) if no tumor is found, the presence of the five indicated criteria should prompt consideration of orchiectomy. Tumors involved in paraneoplastic neurologic disorders are usually small, confined to a specific organ, or detectable at the organ-draining lymph nodes. 1,2 Recent studies show that the use of CT and FDG-PET uncovers most of these tumors at symptom presentation or within the first year of the neurologic disorder. 3 Among all paraneoplastic disorders, the anti-Ma2 immune response is the most specific for limbic, diencephalic, or upper brainstem encephalitis. 4 In young men this disorder associates with testicular tumors, while in older men or women other tumors are involved. Of 25 men with anti-Ma2-associated encephalitis younger than 50 years, 19 had germ-cell tumors (18 in testis). The current study focuses on the remaining 6 patients whose tumors were not found by multiple ancillary tests or even at initial evaluation of the orchiectomy specimen. Eventually all 6 patients were found to have a microscopic intratubular germ-cell neoplasm unclassified type (IGCNU), a common precursor of most testicular cancers that takes approximately 5 years to become invasive. 5 Methods Tissues and antibodiesThe 6 patients were seen by the authors and form part of a series of 46 patients with anti-Ma2-associated encephalitis (appendix...

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Section: Discussionmentioning

confidence: 99%

Orchiectomy for suspected microscopic tumor in patients with anti-Ma2-associated encephalitis

Mathew¹,

Vandenberghe²,

García‐Merino³

et al. 2007

Neurology

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“…Literature reviews by several authors report the incidence of GCT in patients with TM as 30-35% (Table 1) [25,26,27].…”

Section: Association With Germ Cell Tumormentioning

confidence: 99%

Testicular microlithiasis: clinical significance and review of the literature

2003

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The purpose of this study was to evaluate CT findings of phytobezoar associated with small bowel obstruction. We evaluated abdominal CT of 19 patients with phytobezoar. Abdominal CT of 6 patients with small bowel feces was included for the comparison. On CT we analyzed morphological features of phytobezoars such as location, number, size, shape, and the presence or absence of an encapsulating wall. The sites of the phytobezoar were in the jejunum in 12 patients (63%) and the ileum in 7 (37%). The phytobezoars were single in number in 13 patients (68%) and multiple in 6 (32%). The mean short- and long-axis diameters of the phytobezoars measured 3.2 cm (range 2.1-5.2 cm) and 5.2 cm (range 2.2-11.0 cm), respectively. The phytobezoars were ovoid in 9 patients, round in 6, and tubular in 4. On CT, phytobezoars appeared as gas-containing masses in 17 patients (89%) and as a solid mass without gas in the remaining 2 patients (11%). An encapsulating wall was noted in 6 patients (32%). Small bowel feces were much more tubular in shape but did not have encapsulating wall on CT. The CT imaging is useful in making the diagnosis of phytobezoar associated with small bowel obstruction.

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“…Testicular microlithiasis (TM), the presence of multiple small deposits of calcium within the testis, shows characteristic sonographic findings of multiple, intratesticular, nonshadowing echogenic foci. Since the original description of ultrasounddetected TM (Doherty et al, 1987), a number of studies have reported an association between TGCT and TM (Backus et al, 1994;Miller et al, 1996Miller et al, , 2006Cast et al, 2000;Bach et al, 2001;Bennett et al, 2001;Derogee et al, 2001;Middleton et al, 2002;Sakamoto et al, 2006). All the studies report ultrasound findings for men investigated for a suspect testicular pathology (infertility, hydrocele, varicocele or suspected tumour) and compare the rate of TM in men found to have TGCT with those that have other diagnoses, including normal testes.…”

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Testicular microlithiasis as a familial risk factor for testicular germ cell tumour

et al. 2007

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Testicular microlithiasis (TM) is characterised by small intratesticular calcifications, which can be visualised by ultrasound. Men with testicular germ cell tumour (TGCT) have a higher frequency of TM than men without TGCT. To clarify the association between TGCT and TM and to investigate the relationship between TGCT susceptibility and TM, we recruited TGCT patients with and without family history of TGCT, unaffected male relatives and healthy male controls from the UK. Testicular ultrasound data were analysed from 328 men. Testicular microlithiasis was more frequent in TGCT cases than controls (36.7 vs 17.8%, age adjusted Po0.0001) and in unaffected male relatives than controls (34.5 vs 17.8%, age adjusted P ¼ 0.02). Testicular germ cell tumour case and matched relative pairs showed greater concordance for TM than would be expected by chance (P ¼ 0.05). We show that TM is present at a higher frequency in relatives of TGCT cases than expected by chance indicating that TM is a familial risk factor for TGCT. Although the familiality of TM could be due to shared exposures, it is likely that there exists a genetic susceptibility to TM that also predisposes to TGCT. We suggest that TM is an alternative manifestation of a TGCT susceptibility allele. (Forman et al, 1992;Westergaard et al, 1996;Heimdal et al, 1996a;Sonneveld et al, 1999;Hemminki and Li, 2004), a previously diagnosed germ cell tumour (Osterlind et al, 1991;Wanderas et al, 1997), a history of undescended testis (Brown et al, 1987;Swerdlow et al, 1997), infertility (Petersen et al, 1998;Moller and Skakkebaek, 1999;Jacobsen et al, 2001;Richiardi et al, 2004), atrophy (Harland et al, 1998), and gonadal dysgenesis (Verp and Simpson, 1987). In a proportion of cases (B2%), a first-degree family member is also affected with the disease (Forman et al, 1992). The relative risk to a brother of a TGCT case is 8 -10 (Forman et al, 1992;Heimdal et al, 1996b;Hemminki and Li, 2004), which is higher than for most other cancer types that rarely exceed four (Dong and Hemminki, 2001) and suggests that predisposition genes are important in this disease. However, despite intensive efforts, susceptibility genes are yet to be identified (Crockford et al, 2006). Testicular microlithiasis (TM), the presence of multiple small deposits of calcium within the testis, shows characteristic sonographic findings of multiple, intratesticular, nonshadowing echogenic foci. Since the original description of ultrasounddetected TM (Doherty et al, 1987), a number of studies have reported an association between TGCT and TM (Backus et al, 1994;Miller et al, 1996Miller et al, , 2006Cast et al, 2000;Bach et al, 2001;Bennett et al, 2001;Derogee et al, 2001;Middleton et al, 2002;Sakamoto et al, 2006). All the studies report ultrasound findings for men investigated for a suspect testicular pathology (infertility, hydrocele, varicocele or suspected tumour) and compare the rate of TM in men found to have TGCT with those that have other diagnoses, including normal testes. The studies have shown a hig...

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Testicular microlithiasis: A benign condition with a malignant association

Cited by 75 publications

References 23 publications

Orchiectomy for suspected microscopic tumor in patients with anti-Ma2-associated encephalitis

Orchiectomy for suspected microscopic tumor in patients with anti-Ma2-associated encephalitis

Testicular microlithiasis: clinical significance and review of the literature

Testicular microlithiasis as a familial risk factor for testicular germ cell tumour

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