![]() Testicular Microlithiasis: What Does It Mean Clinically? BJU Int. A 5-Year Followup Study of Asymptomatic Men with Testicular Microlithiasis. Testicular Microlithiasis: Is There an Agreed Protocol? Indian J Urol. How Worrisome is Testicular Microlithiasis? Curr Opin Urol. Testicular Microlithiasis: Prevalence and Tumor Risk in a Population Referred for Scrotal Sonography. Testicular Microlithiasis Predicts Concurrent Testicular Germ Cell Tumors and Intratubular Germ Cell Neoplasia of Unclassified Type in Adults: A Meta-Analysis and Systematic Review. Tan I, Ang K, Ching B, Mohan C, Toh C, Tan M. The European Society of Urogenital Radiology (ESUR) advises annual ultrasound follow-up until age 55, only if a risk factor for malignancy is present 12 which include: Some publications advise routine self-examination rather than sonographic surveillance 5 while others recommend annual ultrasound follow up when it is accompanied by other premalignant factors 6. ![]() It is also unclear whether early detection confers any benefit over self-exam. As such, screening is unlikely to be beneficial 1,17. An ~12 fold increased risk of GCT in symptomatic testes with microlithiasis has been reported (with microlithiasis found in approximately 50% of GCT cases), however, no increased risk has been found in asymptomatic testes. A relationship with testicular tumors, in particular germ cell tumors (GCT) is controversial. Testicular microlithiasis is in itself asymptomatic and benign. It is unclear if a grading system adds prognostic value, however, relative to follow up based on known risk factors. diffuse TML: numerous microcalcifications.classic TML: greater than or equal to 5 microcalcifications per field of view.limited TML: less than 5 microcalcifications per field of view.One classification scheme used on ultrasound, suggested by ESUR scrotal imaging guidelines is 13: Microlithiasis appears as small non-shadowing hyperechoic foci ranging in diameter from 1-3 mm. These foci, often uniformly sized, occur within the testicular parenchyma and although usually distributed uniformly, may be distributed peripherally or segmentally 2. ![]() Ultrasound is the modality of choice for examining the testes. The microcalcifications are likely a marker of tubular degeneration, but not a risk factor for tubular degeneration 10. Testicular microlithiasis per se is asymptomatic and is usually found incidentally when the scrotal content is examined with ultrasound, or found in association with symptomatic conditions. ![]()
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