Testicular microlithiasis

Testicular microlithiasis is an uncommon condition that is characterized by calcifications within the lumina of seminiferous tubules. It is usually an incidental finding on high frequency scrotal sonography. Testicular microlithiasis is a benign condition but is associated with testicular malignancies. Recent reports support this association and suggest regular follow-up in these patients.     

Testicular microlithiasis in male infertility

Testicular microlithiasis was found in a 30-year-old infertile man. The literature is reviewed and the possible influence of testicular microlithiasis on male infertility is discussed.     

Testicular microlithiasis occurring in postorchiopexy testis

Testicular microlithiasis occurring in a postorchiopexy testis is described. The histologic characteristics of this uncommon entity are presented, and its etiology and clinical significance are briefly reviewed.     

Testicular microlithiasis needs long-term surveillance

We present a case of testicular microlithiasis in which testicular biopsy failed to predict the development of a testicular tumour.     

Testicular microlithiasis and concomitant testicular intraepithelial neoplasia

We report a case of testicular microlithiasis developing during cancer follow-up in a previously normal testicle. Biopsy revealed testicular intraepithelial neoplasia which was treated with radiotherapy. We believe that especially in cancer follow-up newly developing microlithiasis must lead to biopsy to rule out otherwise undetectable germ cell neoplasia precursor.     

Testicular microlithiasis: report of 14 cases

Testicular microlithiasis (TM) is a comparatively rare condition in which calcified congelations fill the lumina of the seminiferous tubules. Using high-frequency linear transducers (10 MHz), TM is easily demonstrated as tiny punctate echogenic foci, which typically do not give an acoustic shadow, and is classified into classic type (CTM) and limited type (LTM) on the basis of the presence of five or more microliths at least on one image of the testes. Fourteen patients were found to have TM, 6 of which were LTM and 8 were CTM. In one patient with CTM, coexisting mixed germ cell tumor (seminoma, embryonal cell carcinoma) was demonstrated. Until further data are available, it seems reasonable to consider patients with TM as having an increased risk of developing a primary testicular tumor.     

睾丸微结石症52例报告

目的 探讨睾丸微结石症(testicular microlithiasis,TM)的临床特点.方法 对泌尿男科门诊患者行睾丸超声检查诊断TM 52例,患者主诉依次为不育24例(46.2%)、阴囊睾丸疼痛不适22例(42.3%)、性腺发育不良4例(7.7%)、性功能障碍和男性更年期综合征各1例;相关系统的疾病史依次为隐睾症、睾丸附睾炎、腮腺炎、肺结核病各4例(各占7.7%),睾丸外伤2例(3.8%),糖尿病、淋病各1例.结果 微结石表现为双侧睾丸同时发生者40例(76.9%),单侧者12例(23.1%)(右4、左8);结石数量5～10个17例(32.7%)、11～50个19例(36.5%)、≥51个16例(30.8%);结石呈均匀散在分布者46例(88.5%),不均匀分布者6例(11.5%);睾丸发育基本正常者32例(61.5%),伴发睾丸发育异常者20例(38.5%).精液分析42例,其中存在质量异常者37例(88.1%).37例测定生殖激素,5项指标中至少1项异常者19例(51.4%);其中11例行睾丸瘤标(β-HCG和AFP)检测均正常.对3例高度怀疑肿瘤患者进行活检病理诊断,确诊精原细胞瘤1例.结论 TM患者多因不育、阴囊睾丸疼痛不适、性腺发育不良或睾丸发育异常等就医,并经超声检查偶然获得诊断.结石特点多为双侧发生、分布均匀、数量有较大波动,对精液质量和内分泌激素水平有一定的不良影响,甚至可发生肿瘤.感染和损伤可能是其潜在病因.     

Testicular microlithiasis in 2 children with bilateral cryptorchidism.

Testicular microlithiasis, associated with bilateral cryptorchidism, is studied in 2, 6-year-old children. In case 1 autopsy revealed that 60 per cent of the seminiferous tubules contained completely calcified microliths. Similar mineralized concretions also were found in different areas of the cerebrum and cerebellum. In the testicular biopsy obtained from case 2, 30 per cent of the seminiferous tubules contained microliths showing different degrees of calcification. The study of such calcifications supports the hypothesis that the mineralization process occurs according to the following stages: 1) accumulation of cellular debris in the tubular lumen, 2) deposit of concentric rings of glycoprotein material surrounding the central core and 3) calcification of the glycoprotein lamellar material. The presence of similar concretion in the nervous system as well as the lung in other reported cases suggests that microlithiasis could be a systemic disease.     

Testicular microlithiasis: Case report and literature review

We present an interesting case of bilateral microlithiasis. Microlithiasis is usually considered a benign condition with no need for follow-up. However, when a patient with testicular microlithiasis has a positive family history of testicular cancer, such patients should be followed up closely to detect the development of testicular cancer.     

Testicular microlithiasis. Clinical significance and therapeutic implications

Testicular microlithiasis is a rare condition usually diagnosed by scrotal ultrasound and associated with pathology of the testis. We report two pediatric cases presented with acute scrotum. Testicular sonography revealed significant bilateral testicular microlithiasis. One case was diagnosed as having torsion of the right testis and the other case as orchiepididymitis. A careful review of the literature is made and a periodic follow-up of this disease is advocated.     

Testicular microlithiasis and carcinoma in situ overview and proposed clinical guideline

Testicular microlithiasis (TM) has been associated with testicular germ cell tumours (TGCTs) in adolescents and adults and with its precursor carcinoma in situ (CIS). A clear definition of TM and the need for further diagnostics and follow-up is lacking. We reviewed the literature of TM and its association with TGCT/CIS and current follow-up advises and propose a management approach based on associated risk factors for TGCT. In the literature, a wide variance of TM incidence is reported in different patient populations. A consensus concerning the malignant potential of TM has not been reached. In addition, a clear definition on TM is lacking. Although a correlation between TM and TGCT or CIS is found, precise management and follow-up schedules are absent. We suggest that all hyperechogenic foci smaller than 3 mm without shadowing should be named TM irrespective of their number. In addition, we suggest a management scheme for physicians encountering TM in daily practice. Our algorithm suggests taking a testicular biopsy in a selected patient population with at least one additional risk factor for TGCT. A long-term active follow-up schedule, including ultrasonography and physical examinations, is not indicated in the remaining patients with TM.     

Testicular ultrastructure in infertile men

The review shows typical ultrastructural alterations of germ, Sertoli, and Leydig cells in infertile men. Regardless of the cause of infertility, the disruption of the spermatogenic process usually occurs in the pachytene stage of meiotic prophase and in the stages of early spermatid maturation. The disturbances affect the cytoplasm more than the nucleus, and the synaptonemal complexes have shown significant stability even in the severely injured testes. An acrosome formation is found to be open to injury in more advanced germ cells during spermatid maturation. The manner of reaction of the Sertoli cells under different pathological conditions depends on the presence and degree of maturation of the neighboring germ cells. The appearance of immature Sertoli cells is accompanied by the loss of germ cells more advanced in their differentiation. In most pathologically altered testes, mature Sertoli cells reveal a universal manner of reaction of cell organelles. Leydig cell ultrastructure fluctuates considerably, and the alterations predominantly affect the sites of steroid synthesis, in spite of disease specificity. It becomes clear that a complex estimation of a real testicular state requires the application of new techniques as well as recognition of local control mechanisms. This will provide evidence toward elucidation of male infertility.     

Testicular microlithiasis and antisperm antibodies following testicular biopsy in boys with cryptorchidism

PURPOSE: Testicular biopsy (TBx) performed during orchiopexy in boys with cryptorchidism can help to predict future semen analyses and possibly identify patients at risk for testicular cancer. It has been theorized that TBx can be detrimental to the long-term health of the testis. We examined testicular microlithiasis (TM) and antisperm antibody (ASA) production in cryptorchid TBx. MATERIALS AND METHODS: A total of 112 males underwent fertility evaluation. These patients had previously undergone orchiopexy and bilateral TBx (mean age 8.6 years) for unilateral or bilateral undescended testis. At a mean age of 19.6 years all patients underwent physical examination and scrotal ultrasound for evaluation of testis size, echotexture and abnormalities. Of 112 patients 57 also underwent direct Immunobead(R) assay with positive controls. Moving sperm free and/or bound to IgG bead complex were counted in the preparation. RESULTS: A total of 29 patients had bilateral and 83 had unilateral undescended testis. Of the 112 patients 26 were black and 86 were white. Four black patients (15.4%) and 4 white patients (4.7%) had testicular microlithiasis. Three patients had bilateral and 5 had unilateral diffuse TM. No tunica albuginea scars or testis masses were noted. In the 57 patients who underwent direct Immunobead assay no semen sample demonstrated evidence of forming bead-sperm complex, ie none had direct ASA. CONCLUSIONS: No patient exhibited evidence of direct ASA. Prepubertal open TBx does not increase the rate of TM. We found no evidence of additive testicular damage associated with TBx at the time of orchiopexy.