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Testicular Microlithiasis


Presentation

  • Some reports suggest that it may present in up to 5.6% of the general population between 17 and 35 years of age 3.[radiopaedia.org]
  • Presentation This 26 YO male presented for a scrotal ultrasound as an outpatient with no specific medical history on the referral.[sonoworld.com]
  • TM usually presents bilaterally but may also present unilaterally.[journals.sagepub.com]
  • More than 20 microcalcifications were present on the cross section of both testicles. Standard laboratory blood tests were normal. Prostate-specific antigen was 1.22 ng/ml.[content.sciendo.com]
  • We report the cases of a 33- and a 39-year-old man presenting with a retroperitoneal extragonadal tumor.[karger.com]
Down Syndrome
  • Associations testicular germ cell tumor Klinefelter syndrome cryptorchidism testicular infarct testicular granulomatous disease infertility Down syndrome alveolar microlithiasis Testicular microlithiasis per se is asymptomatic and is usually found incidentally[radiopaedia.org]
  • With the exception of Down syndrome, all of these conditions were also seen in our population. The most common of these conditions in patients with TM in our series was cryptorchidism.[pubs.rsna.org]
  • ., 2015 ) and 36.0% in men with Down's syndrome (Cebeci et al ., 2015 ).[onlinelibrary.wiley.com]
  • syndrome and pulmonary alveolar microlithiasis [3].[ijri.org]
  • This is a condition of unknown etiology; however, in many cases it may be associated with cryptorchidism, Klinefelter syndrome, Down syndrome, varicocele, testicular torsion and male pseudohermaphroditism.[content.sciendo.com]
Precocious Puberty
  • The child with Leydig cell tumor presented with precocious puberty. The other three patients presented with a scrotal mass.[pubs.rsna.org]
Weight Loss
  • Case 2 A 33-year-old man came to our emergency department complaining of abdominal pain, vomiting, weight loss and mild jaundice. Ultrasound examination detected a large, ill-defined heterogeneous abdominal mass.[karger.com]
Fishing
  • 36.6 295 22.0 1.95 1.39 2.73 Fast‐food More than once a week vs. less than once a week 39 19.8 215 16.0 1.19 0.80 1.76 Meat More than 3 times a week vs. 144 73.1 966 72 1.01 0.72 1.42 Poultry More than 3 times a week vs. 55 27.9 327 24.4 1.11 0.79 1.58 Fish[onlinelibrary.wiley.com]
Pseudotumor
  • MR imaging of scrotal tumors and pseudotumors. Radiographics. 2010; 30 (3): 665-683. doi:10.1148/rg.303095049. Hellström P, Tammela T, Kontturi M, Lukkarinen O. Ethanolamine oleate as a sclerosant for testicular hydroceles and epididymal cysts.[medigraphic.com]
Abdominal Pain
  • The cause of abdominal pain, in the case of spermatocele, is often misdiagnosed in the emergency room.[medigraphic.com]
  • Case 2 A 33-year-old man came to our emergency department complaining of abdominal pain, vomiting, weight loss and mild jaundice. Ultrasound examination detected a large, ill-defined heterogeneous abdominal mass.[karger.com]
Vomiting
  • Case 2 A 33-year-old man came to our emergency department complaining of abdominal pain, vomiting, weight loss and mild jaundice. Ultrasound examination detected a large, ill-defined heterogeneous abdominal mass.[karger.com]
Jaundice
  • Case 2 A 33-year-old man came to our emergency department complaining of abdominal pain, vomiting, weight loss and mild jaundice. Ultrasound examination detected a large, ill-defined heterogeneous abdominal mass.[karger.com]
Testicular Pain
  • Testicular pain was the most frequent referral reason to US investigation, and men with TML tended more often to have testicular pain than men without.[onlinelibrary.wiley.com]
  • View larger version (282K) Fig. 1A —54-year-old man seen in emergency department for testicular pain of 6 months' duration. A, Ultrasound images show classic testicular microlithiasis in right ( A ) and left ( B ) testicles.[ajronline.org]

Workup

  • Thus, the management for incidentally discovered TM is still in debate, ranging from no follow-up to complete workups.[jim.bmj.com]
  • Reviews and studies published in multiple disciplines such as radiology, 17, 18 urology, 2, 13, 19 and pediatric surgery 18 suggest yearly ultrasound monitoring in addition to workup for testicular malignancy indicated by risk factors and symptomology[journals.sagepub.com]

Treatment

  • TM has been reported to be associated with carcinoma in situ (CIS) and the development of second testicular germ cell tumor (TGCT) after contralateral orchiectomy treatment for primary TGCT; however, no prospective studies have investigated the relationship[ascopubs.org]
  • Treatment and prognosis Testicular microlithiasis is in itself asymptomatic and benign. A relationship with testicular tumors, in particular germ cell tumors (GCT) is controversial.[radiopaedia.org]
  • You can help by adding to it. ( February 2019 ) Testicular ultrasound Management [ edit ] There is no cure or treatment for testicular microlithiasis, however, patients may be monitored via ultrasound to make sure that other conditions do not develop.[en.wikipedia.org]
  • Surgical treatment is reserved for patients with large or symptomatic epididymal cysts. 25,28-30 CONCLUSION A genitourinary examination should be part of every well child or adolescent visit, even in patients without complaints.[consultant360.com]

Prognosis

  • Treatment and prognosis Testicular microlithiasis is in itself asymptomatic and benign. A relationship with testicular tumors, in particular germ cell tumors (GCT) is controversial.[radiopaedia.org]
  • These are useful serum markers in the diagnosis, prognosis, and follow-up of patients with germ cell tumors [ 5 ]. The majority of the EGCTs occur in men, except benign mature teratoma, which occurs with equal frequency in men and women.[karger.com]

Etiology

  • Journals El Residente Year 2017, Issue 1 García-Yánez AR, Arboleda MS Epididymal cyst as abdominal pain etiology and ultrasound diagnostic of testicular microlithiasis.[medigraphic.com]
  • Familial testicular germ cell tumors (FTGCT) — Overview of a multidisciplinary etiologic study. Andrology. 2015;3:47. Pedersen MR, et al. Testicular microlithiasis and testicular cancer: Review of the literature.[mayoclinic.org]
  • Indian J Urol 2007;23:234-9 Testicular microlithiasis (TM) is an entity of unknown etiology that results in formation of intratubular calcifications. It is often detected incidentally when scrotal ultrasonogram is done for various indications.[indianjurol.com]
  • The etiology of our patient’s enlarged scrotum was unclear but was unlikely related to the epididymal cysts or testicular microlithiasis.[consultant360.com]
  • This is a condition of unknown etiology; however, in many cases it may be associated with cryptorchidism, Klinefelter syndrome, Down syndrome, varicocele, testicular torsion and male pseudohermaphroditism.[content.sciendo.com]

Epidemiology

  • Epidemiology of and risk factors for testicular germ cell tumors. . Accessed Aug. 4, 2016. Greene MH, et al. Familial testicular germ cell tumors (FTGCT) — Overview of a multidisciplinary etiologic study. Andrology. 2015;3:47. Pedersen MR, et al.[mayoclinic.org]
  • Google Scholar 18 Surveillance, Epidemiology, and End Results Cancer Incidence Public-Use Database, 1973–1997. Washington. D.C. : United States Department of Health and Human Services, National Cancer Institute August 1999.[auajournals.org]
  • Genetics Team, Section of Cancer Genetics, Institute of Cancer Research, Sutton, Surrey, UK J Coffey, D Dudakia, J L Pugh, M R Stratton & E A Rapley Academic Radiotherapy Unit, Institute of Cancer Research, Sutton, Surrey, UK R A Huddart Section of Epidemiology[nature.com]
  • Meta-analysis of observational studies in epidemiology: a proposal for reporting. JAMA. (2000) 283:2008–12. doi: 10.1001/jama.283.15.2008 PubMed Abstract CrossRef Full Text Google Scholar 31.[frontiersin.org]
Sex distribution
Age distribution

Prevention

  • Screening for testicular cancer: an evidence review for the US Preventive Services Task Force. Ann Intern Med. 2010 ;153: 396 - 399. doi: 10.7326/0003-4819-153-6-201009210-00007. Google Scholar Crossref Medline ISI 21.[journals.sagepub.com]
  • Preventive Services Task Force. Ann Intern Med 2010; 153:396–399 [Google Scholar] 38. Ilic D, Misso ML. Screening for testicular cancer. Cochrane Database Syst Rev 2011; (2):CD007853 [Google Scholar] 40. Winter TC. Ultrasonography of the scrotum.[ajronline.org]
  • Performing Preventive Services: A Bright Futures Handbook. 1st ed. Elk Grove Village, IL: American Academy of Pediatrics; 2010. 31. Jaganathan K, Ahmed S, Henderson A, Rane A. Current management strategies for testicular microlithiasis.[consultant360.com]
  • Preventive Services Task Force. Ann Intern Med 2010 ;153(6):396–399. Crossref, Medline, Google Scholar Received February 14, 2013; revision requested March 27; revision received July 22; accepted August 6; final version accepted August 14.[pubs.rsna.org]
  • The vaccines would prevent Lyme disease and human granulocytic anaplasmosis, the two most common tick-borne infections in the United States.[radiology.vcu.edu]

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