Long-Term Follow-Up of Testicular Microlithiasis in Children and Adolescents: Multicenter Prospective Cohort Study of the Italian Society of Pediatric Urology

Abstract

Testicular microlithiasis (TM), characterized by the presence of intratubular calcifications in a single or both the gonads, is an uncommon entity with unknown etiology and outcome in pediatric and adolescent age. In this study, the results of a multicenter long-term survey are presented. From 11 units of pediatric urology/surgery, patients with TM were identified and yearly, followed up in a 7-year period, adopting a specific database. The recorded items were: age at diagnosis, presenting symptoms/associated abnormalities, ultrasonographic finding, surgery and histology at biopsy, if performed. Out of 85 patients, 81 were evaluated yearly (4 patients lost to follow-up). TM was bilateral in 66.6% of the patients. Associate genital abnormalities were present in 90%, more frequently undescended/retractile testis (23.4%) and varicocele (22.2%). TM remained unchanged at 4.7 years follow-up in 77 patients (93.8%) and was reduced in 4 patients after 1 to 5 years of inguinoscrotal surgery. Orchiectomy was performed in three patients (3.7%), one for severe testicular hypoplasia and two for seminoma (2.5%), respectively, concurrent and metachronous to diagnosis of TM. Tumorectomy with parenchymal sparing surgery was performed in a teratoma associated with TM. TM is a controversial entity, often associated with several inguinogenital features, which rarely can recover. Testicular malignancy, although present in TM, has not proven definitively associated to microliths. Proper counseling, yearly ultrasound, and self-examination are long-term recommended.

Bilateral testicular micro lithiasis in pediatrics secondary to testicular trauma

“…The appropriate recommendation in these cases is to perform an annual ultrasound and self-examination recommended as a long-term follow-up measure. 16 Although the cause and effect relationships in testicular microlithiasis are not clear, it has been seen in patients with cryptorchidism, varicocele, infertility, testicular torsion, Klinefelter syndrome, alveolar pulmonary microlithiasis, neurofibromatosis, acquired immunodeficiency syndrome, intratubular germ cell neoplasia, and most importantly, primary testicular neoplasms. 17 Micro lithiasis has been reported in testicular torsion but not in testicular trauma as in the present case.…”

Bilateral methachronous testicular germ cell tumor and testicular microlithiasis in a child: Genetic analysis and insights. A case report

“…Moreover, recent studies still underlines the statistically significant augmentation of TGCT in TML population, either in children or adults, even if they do not retain TML as a risk factor per se [22] , [23] .…”

“…Literature then suggests that dysgenesis origins in utero while TDS is promoted by environmental factors, possibly hormone-disrupting compounds affecting the mother and developing fetus, yet genetics might also play a role [20] , [21] , [22] , [28] , [29] .…”

Pediatric Testicular Microlithiasis: To Refer or Not to Refer?

“…This is because the evidence shows that there is an association of TM and testicular malignancy in the presence of testicular ultrasound indications. Reviews and studies published in multiple disciplines such as radiology, 17,18 urology, 2,13,19 and pediatric surgery 18 suggest yearly ultrasound monitoring in addition to workup for testicular malignancy indicated by risk factors and symptomology.…”