Sonographic testicular microlithiasis as an indicator of premalignant conditions in normal and infertile men

Sonographic detection of multiple, small hyperechogenic lesions in the test is (testicular microlithiasis; TM) can indicate germ cell tumors. However, it has not been well established whether this finding signifies a risk fact or for development of testicular neoplasm in all cases or whether it indica tes premalignant changes only in those men with additional risk factors for germ cell cancer, such as infertility, a history of testicular maldescent, or the presence of an atrophic testis. In a retrospective analysis of 1701 consecutively performed scrotal sonographies of patients with (n=1399) and without (n=219) infertility or with contralateral testicular tumors (n=83) , the prevalence of TM was compared with that in 198 healthy men who volunt eered for different clinical trials. TM was equally frequent in all groups (2.3% [32/1399] of infertile patients, 2.3% [5/219] of other patients witho ut infertility, and 1.5% [3/198] of healthy men). Results of testicular bio psies were available for a subgroup of infertile men. Carcinoma in situ (CI S) was present only in cases with TM (2/11). In addition, sonographic follo w-up examinations were performed in another 14 men with TM. Testicular tumo rs had developed in 2 patients, one whom was infertile and one in the contr ol group. None of these patients had a history of testicular maldescent but all testes affected either by CIS or tumors were reduced in volume. We con clude that diagnosis of TM, especially if it is present in an atrophic test is, demands a diagnostic biopsy or at least sonographic follow-up examinati ons.