Testicular microlithiasis in the early diagnosis of testicular neoplasms

Purpose: Testicular microlithiasis is a rare condition characterized by mul tiple scattered echogenic foci visible in high frequency scrotal ultrasound . We report 4 cases with testicular microlithiasis. The association with ma lignant and nonmalignant conditions and the indications for biopsy are disc ussed. Patients and methods: 350 testicular ultrasound examinations with a high-fr equency transducer (7.5 MHz) were done between 08/1999 and 05/2000. In 4 pa tients (aged 34 to 55 years), testicular microlithiasis was diagnosed. In a ll cases a biopsy was performed because of cancer-suspicious findings or fo r further evaluation of infertility. Results: in a 34-year-old male, seminoma (stage I) was diagnosed. Bilateral testicular biopsies of a 40-year-old man with painless adenopathy revealed high-grade (stage IV) malignant non-Hodgkin's lymphoma with a testicular m anifestation. Subsequent to aggressive polychemotherapy (mega-CHOEP) and co mplete regression (for more than 1 year now), ultrasound controls showed a persistence of the testicular microcalcifications. In the 2 other cases, bi opsies showed regular testicular tissue without evidence of intraepithelial germ cell neoplasia (TIN) or malignancy. Conclusion: We recommend clinical and ultrasound surveillance with control of testicular tumor markers every 6 to 12 months. Furthermore, the patient should be educated in careful self-examination of his testicles. In cases o f increased risk of testicular cancer (maldescensus testis, infertility, at rophic testis, contralateral testicular cancer), biopsy should be performed .