Case 7
History:
23 year old male with palpable right testicular lesion
Findings:
Testicular ultrasound examination showing presence of bilateral hyperechoic foci consistent with microlithiasis. A hypointense lesion is present in the left testicule. A selected CT scan image of the mid abdomen showing retroperitoneal masses consistent with metastatic nodes.
Diagnosis:
Testicular Microlithiasis
Discussion:
Testicular microlithiasis is a rare condition found in approximately 0.5% of men with calcifications present within the seminal vesicle tubules. Sonography shows multiple, scattered small hyperechoic foci diffusely throughout the testicular parenchyma which rarely shadow and occasionally show a comet tail appearance. Bilateral involvement may occur. It is an asymptomatic, non-progressive disease.
The clinical significance resides in the fact that this condition was found to be associated with co-existing primary testicular neoplasms. The microlithiasis are not pre cancerous condition. Currently, a 6 month intervals routine ultrasound to follow-up is recommended.
References:
- Dunnick NR. Textbook of Uroradiology, 2nd Edition. Williams & Wilkins, Baltimore; 1997:498-499.
- Rumack CM. Diagnostic Ultrasound, 2nd Edition. Mosby, St. Louis; 1998:806-807.
- Ariadne M. Bach, Lucy E. Hann, Orna Hadar, Weiji Shi, Hyok-Hee Yoo, Catherine S. Giess, , Joel Sheinfeld, and Howard Thaler. Testicular Microlithiasis: What Is Its Association with Testicular Cancer? Radiology. 2001;220:70-75
- James E. I. Cast1, William M. Nelson1, Alan S. Early1, Shekhar Biyani2, Graeme Cooksey2, Niall G. Warnock3 and David J. Breen1Testicular Microlithiasis. Prevalence and Tumor Risk in a Population Referred for Scrotal Sonography. AJR 2000; 175:1703-1706
