Testicular microlithiasis. A unique sonographic appearance.

Abstract

Testicular microlithiasis, also known as intratubular tes,. ticular calcification, is a rarely encountered problem in urology. Now, with the easy availability of high-frequency real-time ultrasound scans, along with their exquisite resolution, sonographic evaluation of the scrotal contents has become an invaluable source of significant clinical information to urologists. We recently examined a patient with testicular microlithiasis; and we present here what we believe is the first report of the unique sonographic appearance of this condition. REPORT OF A CASEA 23-year-old man was evaluated because of a small right testis. The only pertinent finding in his urolOgic history was a right orchiopexy performed at age 10 for cryptorchidism. On physical examination, he had a well-healed right inguinal incision; a small, mobile, and high-riding right testis; and a normal left testis. The consistency and shape of both testes were normal to palpation, as were the remainder of the scrotal contents. A high-frequency real-time scrotal ultrasound examination was performed, which was markedly abnormal. Using a Diasonics scanner, equipped with a lO-MHz transducer, a unique appearance was encountered. Both testes were somewhat small-the right measuring 2.5 em in length, and the left Received September 17, 1985, from the Departments of ·Radiology -Ultrasound, tUrology, and tpathology, Both testes had an identical appearance that was unusual, and, indeed, unique in the experience of our laboratory. Each testis had a pattern of innumerable tiny bright echoes diffusely and uniformly scattered throughout their substance (Fig. 1). This picture was coupled with the finding of significant attenuation of the ultrasound beam. With the normal testis (Fig. 2) usually being such an excellent transmitter of ultrasound, the situation in this patient was exactly the oppo~ site, with poor penetration of the ultrasound beam through the testis, and great difficulty in imaging the architecture of the testis. The scrotal skin was not thickened, nor excessively hairy, and reapplication of scanning gel did not improve the appearance. Scanning of the adjacent thigh produced normal images; and it became obvious that it was the testicular substance itself, and not the equipment, that was interfering with our ability to evaluate the testis. The abnormal testicular pat .. tern encountered in this patient was remarkable for its bilateral, diffuse, symmetrical homogeneity, except for a small (4 mm) focal hypoechoic area in the right testis in a relatively peripheral area, which was persistently seen just before the image was attenuated.Serum tumor markers (alpha fetoprotein and beta HCG) were normal, as were serum testosterone levels. A semen analysis was not done.Since most intra testicular masses are malignant neoplasms, the hypoechoic mass in the right testis, which was seen with ultrasound, was a worrisome finding, and occult tumor had to be ruled ou1. 2 Because of this finding in this patient, who had an increased risk for testicular cancer, since he had ...

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

“…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.…”

Surveillance of Testicular Microlithiasis?: Results of an Uk-Based National Questionnaire Survey

“…But it was not until the mid 80 s when Doherty et al using a 10-MHz transducer first described ultra sonically detected testicular microlithiasis [1]. Ever since, the interest in this entity has increased, with several case reports and retrospective studies reporting an association with testicular cancer [2][3][4][5][6][7][8].…”

“…Ever since Doherty et al [1] described testicular microlithiasis on ultrasound scan in the late 80 s, the interest in this subject had been on the increase. However despite an association of testicular microlithiasis with testicular tumour [2][3][4][5][6][7][8] its aetiological role and the need for followup have remained largely unclear.…”

Prevalence of small testicular hyperechogenic foci in subgroups of 382 non‐vasectomized, azoospermic men: a retrospective cohort study

“…(1987) described a 23‐year‐old man, who at age 10 had an orchiopexy for cryptorchidism. By ultrasonography, a pattern of innumerable tiny bright echoes (‘white spots’) diffusely and uniformly scattered throughout the testis tissue was found.…”