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Year : 2006  |  Volume : 16  |  Issue : 4  |  Page : 885-886
Testicular microlithiasis - a case report


Dept of Radiodiagnosis, NSCB Medical College, Jabalpur, Madhya Pradesh, India

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Date of Submission03-Oct-2005
Date of Acceptance30-Nov-2006
 

Keywords: Testicular microlithiasis , scrotal USG.

How to cite this article:
Pande S, Agrawal R, Mehta V, Sharma A. Testicular microlithiasis - a case report. Indian J Radiol Imaging 2006;16:885-6

How to cite this URL:
Pande S, Agrawal R, Mehta V, Sharma A. Testicular microlithiasis - a case report. Indian J Radiol Imaging [serial online] 2006 [cited 2019 Aug 22];16:885-6. Available from: http://www.ijri.org/text.asp?2006/16/4/885/32375

   Introduction Top


Testicular microlithiasis (TM) is a rare disease with a reported frequency between 0.6% and 9% [1],[2] as detected by ultrasonography (USG). The widespread use of high resolution USG in the evaluation of scrotal diseases has resulted in an increase in the number of TM cases.


   Case report Top


A twenty three year old male was referred to the department for an ultrasound of the scrotum for complaints of scrotal heaviness. There was no history of any trauma.

On ultrasound evaluation with a multifrequency 5-10 mHz linear transducer both the testicles were seen to be normal in size, shape and revealed multiple tiny 1-2 mm sized echogenic non shadowing foci scattered within the testicular parenchyma on either side.[Fig 1,2 3 .]Few of the foci also showed comet tail artifacts posteriorly. No mass lesion in either testis was seen. Both the epididymis were also normal. No hernia or varicocele was identified. Mild hydrocoele was noted bilaterally.

Based on these findings a diagnosis of bilateral mild hydrocoele with incidentally noted testicular microlithiasis was given.


   Discussion Top


Although usually an incidental finding during the investigation of testicular symptoms, TM has been found in association with benign tumours and malignant germ cell tumours of the testis and with various medical conditions including infertility, cryptorchidism, Down's syndrome and pulmonary alveolar microlithiasis[3]. The natural history of incidentally discovered TM and the possible association between TM and testicular malignancy is as yet undefined.

In USG examination, TM is seen as echogenicities smaller than 1-3 mm, without any acoustic shadowing. (if it is seen it is described as having a comet tail appearance) [4]. They develop in the testicular parenchyma, however, they may show peripheral or segmentary distribution. Although they are usually bilateral, unilateral TM cases have been reported as well [5].

Today, the number of microliths to reach the TM diagnosis is agreed upon to be five and above for each sonographic plane [1]. However, the cases with a smaller number of microliths are associated with malignancy and therefore classification according to the number of microliths may not be practical [6].

Testicular size is normal and USG findings of TM are enough to make the diagnosis just by themselves.

At histopathologic analysis, the microcalcifications appear as laminated concretions within the lumen of the seminiferous tubules.  Sertoli cells More Details are responsible for the phagocytosis of degenerated intratubular debris, and microcalcifications are believed to result from a defect in this activity [7].Some authors suggest that microliths result from Sertoli cell dysfunction in connection with abnormal gonadal embryogenesis [8].

The best method for diagnosis and management of microlithiasis is undecided. The options include serial scrotal ultra-sonography, serial physical examinations, serial tumor marker screening and biopsy.

 
   References Top

1.Hφbarth K, Susani M, Szabo N, et al. Incidence of testicular microlithiasis. Urology 1992; 40:464-467.   Back to cited text no. 1    
2.Ikinger U, Wurster K, Terwey B, Mohring K. Microcalcifications in testicular malignancy: diagnostic tool in occult tumor? Urology 1982; 19:525-528.   Back to cited text no. 2    
3.L H Bushby, , F N A C Miller, S Rosairo, J L Clarke, and P S Sidhu. Scrotal calcification: ultrasound appearances, distribution and aetiology. British Journal of Radiology 2002; 75:283-288.  Back to cited text no. 3    
4.Backus ML, Mack LA, Middleton WD, King BF, Winter TC, True LD. Testicular microlithiasis: imaging appearances and pathologic correlation. Radiology 1994; 192:781-785.  Back to cited text no. 4    
5.Vrachliotis TG, Neal DE: Unilateral testicular microlithiasis associated with a seminoma. J Clan Ultrasound 1997; 25:505-507.  Back to cited text no. 5    
6.Parka BL, Venable DD, Gonzalez E, Eastham JA. Testicular microlithiasis as a predictor of intratubular germ cell neoplasia. Urology 1996; 48:797-799.   Back to cited text no. 6    
7.Vegni-Talluri M, Bigliardi E, Vanni MG, Tota G. Testicular microliths: their origin and structure. J Roll 1980; 124:105-107.  Back to cited text no. 7    
8.Drut R, Drut RM. Testicular microlithiasis: histologic and immunohistochemical findings in 11 pediatric cases. Pediatr Dev Pathol 2002; 5:544-550.  Back to cited text no. 8    

Top
Correspondence Address:
S Pande
Dept of Radiodiagnosis, NSCB Medical College, Jabalpur, Madhya Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-3026.32375

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  [Figure - 1], [Figure - 2], [Figure - 3]



 

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