Testicular microlithiasis: clinical significance and review of the literature

Testicular microlithiasis (TM) is an uncommon condition characterized by calcium deposits within the seminiferous tubules. On ultrasound (US), it is seen as multiple, uniform, nonshadowing echogenic foci in the testis. Although its true prevalence in the general population is still unknown, reported prevalences range from 0.6 to 9%. The TM is often associated with germ cell tumor (GCT) or intratubular germ cell neoplasia. The incidence of GCT in patients with TM was reported as 6–46%. There are several reports demonstrating interval development of GCT in patients with TM. These may suggest a premalignant nature of TM; however, more recent studies show a lower incidence of associated GCT and no interval development of tumor in relatively longer duration follow-up. Additionally, previously reported cases of interval tumor development had predisposing factors for testicular GCT. According to the recent literature, it is suggested that both TM and testicular GCT may be caused by a common defect, such as tubular degeneration, and TM may present as a marker for such abnormalities; however, because of a high incidence of association with GCT, it is prudent to follow up patients with TM with physical examination and US at least annually and to encourage self-examination. The routine use of biochemical tumor markers, abdominal and pelvic CT, or testicular biopsy does not seem to be justified.