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01-02-2015 | Ultrasound

Testicular microlithiasis imaging and follow-up: guidelines of the ESUR scrotal imaging subcommittee

Authors: Jonathan Richenberg, Jane Belfield, Parvati Ramchandani, Laurence Rocher, Simon Freeman, Athina C. Tsili, Faye Cuthbert, Michal Studniarek, Michele Bertolotto, Ahmet Tuncay Turgut, Vikram Dogra, Lorenzo E. Derchi

Published in: European Radiology | Issue 2/2015

Abstract

Objectives

The subcommittee on scrotal imaging, appointed by the board of the European Society of Urogenital Radiology (ESUR), have produced guidelines on imaging and follow-up in testicular microlithiasis (TML).

Methods

The authors and a superintendent university librarian independently performed a computer-assisted literature search of medical databases: MEDLINE and EMBASE. A further parallel literature search was made for the genetic conditions Klinefelter’s syndrome and McCune-Albright syndrome.

Results

Proposed guidelines are: follow-up is not advised in patients with isolated TML in the absence of risk factors (see Key Points below); annual ultrasound (US) is advised for patients with risk factors, up to the age of 55; if TML is found with a testicular mass, urgent referral to a specialist centre is advised.

Conclusion

Consensus opinion of the scrotal subcommittee of the ESUR is that the presence of TML alone in the absence of other risk factors is not an indication for regular scrotal US, further US screening or biopsy. US is recommended in the follow-up of patients at risk, where risk factors other than microlithiasis are present. Risk factors are discussed and the literature and recommended guidelines are presented in this article.

Key Points

• Follow up advised only in patients with TML and additional risk factors.

• Annual US advised for patients with risk factors up to age 55.

• If TML is found with testicular mass, urgent specialist referral advised.

• Risk factors – personal/ family history of GCT, maldescent, orchidopexy, testicular atrophy.

Available only for authorised users

De Jong BW, De Gouveia Brazao CA, Stoop H, Wolffenbuttel KP, Oosterhuis JW, Puppels GJ et al (2004) Raman spectroscopic analysis identifies testicular microlithiasis as intratubular hydroxyapatite. J Urol 171(1):92–96PubMedCrossRef

Kim B, Winter TC, Ryu JA (2003) Testicular microlithiasis: clinical significance and review of the literature. Eur Radiol 13(12):2567–2576PubMedCrossRef

Renshaw AA (1998) Testicular calcifications: incidence, histology and proposed pathological criteria for testicular microlithiasis. J Urol 160(5):1625–1628PubMedCrossRef

Drut R, Monica R (2002) Testicular microlithiasis: histologic and immunohistochemical findings in 11 pediatric cases. Pediatr Dev Pathol 5(6):544–550PubMedCrossRef

Bennett HF, Middleton WD, Bullock AO, Teefey SA (2001) Testicular microlithiasis: US follow-up. Radiology 218(2):359–363PubMedCrossRef

Backus ML, Mack LA, Middleton WD, King BF, Winter TC 3rd, True LD (1994) Testicular microlithiasis: imaging appearances and pathologic correlation. Radiology 192(3):781–785PubMedCrossRef

Jungwirth A, Diemer T, Dohle GR, Giwercman A, Kopa Z, Tournaye H, Krausz C (2013) Guidelines on male infertility: European Association of Urology. Available from: http://www.uroweb.org/gls/pdf/16_Male_Infertility_LR.pdf

Elzinga-Tinke JE, Sirre ME, Looijenga LH, van Casteren N, Wildhagen MF, Dohle GR (2010) The predictive value of testicular ultrasound abnormalities for carcinoma in situ of the testis in men at risk for testicular cancer. Int J Androl 33(4):597–603PubMed

DeCastro BJ, Peterson AC, Costabile RA (2008) A 5-year followup study of asymptomatic men with testicular microlithiasis. J Urol 179(4):1420–1403PubMedCrossRef

10.

Montgomery JS, Bloom DA (2011) The diagnosis and management of scrotal masses. Med Clin North Am 95(1):235–244PubMedCrossRef

11.

Tan IB, Ang KK, Ching BC, Mohan C, Toh CK, Tan MH (2010) Testicular microlithiasis predicts concurrent testicular germ cell tumors and intratubular germ cell neoplasia of unclassified type in adults: a meta-analysis and systematic review. Cancer 116(19):4520–4532PubMedCrossRef

12.

Miller FN, Rosairo S, Clarke JL, Sriprasad S, Muir GH, Sidhu PS (2007) Testicular calcification and microlithiasis: association with primary intra-testicular malignancy in 3,477 patients. Eur Radiol 17(2):363–369PubMedCrossRef

13.

Manecksha RP, Fitzpatrick JM (2009) Epidemiology of testicular cancer. BJU Int 104(9 Pt B):1329–1333PubMedCrossRef

14.

Skakkebaek NE (2003) Testicular dysgenesis syndrome. Horm Res 60(Suppl 3):49PubMed

15.

Skakkebaek NE, Holm M, Hoei-Hansen C, Jorgensen N, Rajpert-De E, Mayer F et al (2003) Association between testicular dysgenesis syndrome (TDS) and testicular neoplasia: evidence from 20 adult patients with signs of maldevelopment of the testis. APMIS 111(1):1–11PubMedCrossRef

16.

Joensen UN, Jorgensen N, Rajpert-De E, Skakkebaek NE (2008) Testicular dysgenesis syndrome and Leydig cell function. Basic Clin Pharmacol Toxicol 102(2):155–161PubMedCrossRef

17.

Martin OV, Shialis T, Lester JN, Scrimshaw MD, Boobis AR, Voulvoulis N (2008) Testicular dysgenesis syndrome and the estrogen hypothesis: a quantitative meta-analysis. Environ Health Perspect 116(2):149–157PubMedCentralPubMedCrossRef

18.

Wohlfahrt-Veje C, Main KM, Skakkebaek NE (2009) Testicular dysgenesis syndrome: foetal origin of adult reproductive problems. Clin Endocrinol 71(4):459–465CrossRef

19.

James WH (2010) Further grounds for abandoning the concept of testicular dysgenesis syndrome: a response to the paper of Akre and Richiardi (2009). Hum Reprod 25(4):1084–1086PubMedCrossRef

20.

Akre O, Richiardi L (2009) Does a testicular dysgenesis syndrome exist? Hum Reprod 24(9):2053–2060PubMedCrossRef

21.

Cvancarova M, Oldenburg J, Sprauten M, Stensheim H, Fossa SD (2011) Reproduction rates prior to diagnosis of testicular cancer: does the testicular dysgenesis syndrome exist? J Clin Oncol 29(15 Suppl 1)

22.

Greene MH, Kratz CP, Mai PL, Mueller C, Peters JA, Bratslavsky G et al (2010) Familial testicular germ cell tumors in adults: 2010 summary of genetic risk factors and clinical phenotype. Endocr Relat Cancer 17(2):R109–R121PubMedCentralPubMedCrossRef

23.

Hemminki K, Chen B (2006) Familial risks in testicular cancer as aetiological clues. Int J Androl 29(1):205–210PubMedCrossRef

24.

Mai PL, Chen BE, Tucker K, Friedlander M, Phillips KA, Hogg D et al (2009) Younger age-at-diagnosis for familial malignant testicular germ cell tumor. Fam Cancer 8(4):451–456PubMedCentralPubMedCrossRef

25.

Coffey J, Huddart RA, Elliott F, Sohaib SA, Parker E, Dudakia D et al (2007) Testicular microlithiasis as a familial risk factor for testicular germ cell tumour. Br J Cancer 97(12):1701–1706PubMedCentralPubMedCrossRef

26.

Korde LA, Premkumar A, Mueller C, Rosenberg P, Soho C, Bratslavsky G et al (2008) Increased prevalence of testicular microlithiasis in men with familial testicular cancer and their relatives. Br J Cancer 99(10):1748–1753PubMedCentralPubMedCrossRef

27.

Goede J, Hack WW, Sijstermans K, van der Voort-Doedens LM, Van der Ploeg T, Meij-de Vries A et al (2011) Normative values for testicular volume measured by ultrasonography in a normal population from infancy to adolescence. Horm Res Paediatr 76(1):56–64PubMedCrossRef

28.

Okada H, Fujioka H, Tatsumi N, Kanzaki M, Okuda Y, Fujisawa M et al (1999) Klinefelter’s syndrome in the male infertility clinic. Hum Reprod 14(4):946–952PubMedCrossRef

29.

Boyce AM, Chong WH, Shawker TH, Pinto PA, Linehan WM, Bhattacharryya N et al (2012) Characterization and management of testicular pathology in McCune-Albright syndrome. J Clin Endocrinol Metab 97(9):E1782–E1790PubMedCentralPubMedCrossRef

30.

Daneman A, Daneman D (2007) McCune-Albright syndrome. J Pediatr Endocrinol Metab 20(12):1265PubMedCrossRef

31.

Thomas K, Wood SJ, Thompson AJ, Pilling D, Lewis-Jones DI (2000) The incidence and significance of testicular microlithiasis in a subfertile population. Br J Radiol 73(869):494–497PubMedCrossRef

32.

Albers P, Albrecht W, Algaba F, Bokemeyer C, Cohn-Cedermark G, Fizazi K et al (2011) EAU guidelines on testicular cancer: 2011 update. Eur Urol 60(2):304–319PubMedCrossRef

33.

Butruille C, Marcelli F, Ghoneim T, Lemaitre L, Puech P, Leroy X et al (2012) Management of testicular lesions in a population of infertile patients. [French] Prise en charge des nodules testiculaires dans une population de patients infertiles. Prog Urol 22(1):45–52PubMedCrossRef

34.

Furness PD 3rd, Husmann DA, Brock JW 3rd, Steinhardt GF, Bukowski TP, Freedman AL et al (1998) Multi-institutional study of testicular microlithiasis in childhood: a benign or premalignant condition? J Urol 160(3 Pt 2):1151–1154, discussion 78PubMed

35.

Goede J, Hack WWM, van der Voort-Doedens LM, Sijstermans K, Pierik FH (2009) Prevalence of testicular microlithiasis in asymptomatic males 0 to 19 years old. J Urol 182(Suppl 4):1516–1520

36.

Chiang LW, Yap TL, Asiri MM, Phaik Ong CC, Low Y, Jacobsen AS (2012) Implications of incidental finding of testicular microlithiasis in paediatric patients. J Pediatr Urol 8(2):162–165PubMedCrossRef

37.

Goede J, Hack WW (2012) Clinical aspects of testicular microlithiasis in boys: a review. J Pediatr Urol 8(5):459–469PubMedCrossRef

38.

Deganello A, Svasti-Salee D, Allen P, Clarke JL, Sellars ME, Sidhu PS (2012) Scrotal calcification in a symptomatic paediatric population: prevalence, location, and appearance in a cohort of 516 patients. Clin Radiol 67(9):862–867PubMedCrossRef

39.

Hoei-Hansen CE, Olesen IA, Jorgensen N, Carlsen E, Holm M, Almstrup K et al (2007) Current approaches for detection of carcinoma in situ testis. Int J Androl 30(4):398–404, discussion 404–405PubMedCrossRef

Title: Testicular microlithiasis imaging and follow-up: guidelines of the ESUR scrotal imaging subcommittee
Authors: Jonathan Richenberg
Jane Belfield
Parvati Ramchandani
Laurence Rocher
Simon Freeman
Athina C. Tsili
Faye Cuthbert
Michal Studniarek
Michele Bertolotto
Ahmet Tuncay Turgut
Vikram Dogra
Lorenzo E. Derchi
Publication date: 01-02-2015
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 2/2015
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-014-3437-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Testicular microlithiasis imaging and follow-up: guidelines of the ESUR scrotal imaging subcommittee

Abstract

Objectives

Methods

Results

Conclusion

Key Points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusion

Key Points

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