Prevalence of testicular microlithiasis in an asymptomatic population

Serter, Selim; Gümüş, Bilal; Ünlü, M. S.; Tunçyürek, Özüm; Tarhan, Serdar; Ayyildiz, Veli; Pabuşçu, Yüksel

doi:10.1080/00365590600589641

Cited by 76 publications

(40 citation statements)

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“…No study has compared TGCT cases to control subjects without suspected testicular pathology. Two studies that examined the prevalence of TM among non-symptomatic army recruits (median age at ultrasound of 18 -20 years) showed approximately 6% had TM (defined as X5 microliths) (Peterson et al, 2001;Serter et al, 2006).Although previous data suggest that TM is a risk factor for TGCT, the frequency of TM in relatives of TGCT patients has never been examined. Furthermore, the familiality of TM itself has not previously been investigated.…”

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confidence: 99%

Testicular microlithiasis as a familial risk factor for testicular germ cell tumour

et al. 2007

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Testicular microlithiasis (TM) is characterised by small intratesticular calcifications, which can be visualised by ultrasound. Men with testicular germ cell tumour (TGCT) have a higher frequency of TM than men without TGCT. To clarify the association between TGCT and TM and to investigate the relationship between TGCT susceptibility and TM, we recruited TGCT patients with and without family history of TGCT, unaffected male relatives and healthy male controls from the UK. Testicular ultrasound data were analysed from 328 men. Testicular microlithiasis was more frequent in TGCT cases than controls (36.7 vs 17.8%, age adjusted Po0.0001) and in unaffected male relatives than controls (34.5 vs 17.8%, age adjusted P ¼ 0.02). Testicular germ cell tumour case and matched relative pairs showed greater concordance for TM than would be expected by chance (P ¼ 0.05). We show that TM is present at a higher frequency in relatives of TGCT cases than expected by chance indicating that TM is a familial risk factor for TGCT. Although the familiality of TM could be due to shared exposures, it is likely that there exists a genetic susceptibility to TM that also predisposes to TGCT. We suggest that TM is an alternative manifestation of a TGCT susceptibility allele. (Forman et al, 1992;Westergaard et al, 1996;Heimdal et al, 1996a;Sonneveld et al, 1999;Hemminki and Li, 2004), a previously diagnosed germ cell tumour (Osterlind et al, 1991;Wanderas et al, 1997), a history of undescended testis (Brown et al, 1987;Swerdlow et al, 1997), infertility (Petersen et al, 1998;Moller and Skakkebaek, 1999;Jacobsen et al, 2001;Richiardi et al, 2004), atrophy (Harland et al, 1998), and gonadal dysgenesis (Verp and Simpson, 1987). In a proportion of cases (B2%), a first-degree family member is also affected with the disease (Forman et al, 1992). The relative risk to a brother of a TGCT case is 8 -10 (Forman et al, 1992;Heimdal et al, 1996b;Hemminki and Li, 2004), which is higher than for most other cancer types that rarely exceed four (Dong and Hemminki, 2001) and suggests that predisposition genes are important in this disease. However, despite intensive efforts, susceptibility genes are yet to be identified (Crockford et al, 2006). Testicular microlithiasis (TM), the presence of multiple small deposits of calcium within the testis, shows characteristic sonographic findings of multiple, intratesticular, nonshadowing echogenic foci. Since the original description of ultrasounddetected TM (Doherty et al, 1987), a number of studies have reported an association between TGCT and TM (Backus et al, 1994;Miller et al, 1996Miller et al, , 2006Cast et al, 2000;Bach et al, 2001;Bennett et al, 2001;Derogee et al, 2001;Middleton et al, 2002;Sakamoto et al, 2006). All the studies report ultrasound findings for men investigated for a suspect testicular pathology (infertility, hydrocele, varicocele or suspected tumour) and compare the rate of TM in men found to have TGCT with those that have other diagnoses, including normal testes. The studies have shown a hig...

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Testicular microlithiasis as a familial risk factor for testicular germ cell tumour

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“…In the US series, 5.6% of 1504 men showed THF (Peterson et al ., 2001) compared to 2.4% of 2179 men in the Turkish series (Serter et al ., 2006). The prevalence of THF is associated with ethnicity.…”

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confidence: 99%

“…(2010) found a pooled risk ratio for concurrent TGCN of 8.5 (95% CI: 4.5–16.1) in the presence of THF in men with risk factors for TGCN. The pooled risk ratio for IGCN seems similar to the pooled risk ratio for TGCN (Tan et al ., 2010), while the risk for TGCN and IGCN seems very low in adult asymptomatic men with THF but without risk factors (Peterson et al ., 2001 & Serter et al ., 2006). No clinical sign of testicular malignancy was observed in those 3683 men.…”

Section: Discussionmentioning

confidence: 99%

“…In the majority of cases, THF occurs bilaterally (Peterson et al ., 2001; DeGouveia Brazao et al ., 2004; Serter et al ., 2006 & Cooper et al ., 2014). …”

Section: Introductionmentioning

confidence: 99%

“…Using the definition of >5 THF per transducer field, prevalences of many abnormal THF in healthy young men have been found to be 2.4–5.6% (Peterson et al ., 2001 & Serter et al ., 2006) depending on ethnicity and geographical origin of USA, showing the highest prevalence in black men and men from southeastern states. In the majority of cases, THF occurs bilaterally (Peterson et al ., 2001; DeGouveia Brazao et al ., 2004; Serter et al ., 2006 & Cooper et al ., 2014).…”

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confidence: 99%

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Prevalence of small testicular hyperechogenic foci in subgroups of 382 non‐vasectomized, azoospermic men: a retrospective cohort study

Fedder

2017

Andrology

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SummaryTesticular hyperechogenic foci (THF) are associated with Klinefelter's syndrome, cryptorchidism, infertility, and testicular germ cell neoplasia. The aims of the study were to evaluate THF in relation to etiology of azoospermia and to Sertoli cell dysfunction. The structures inside the scrotum of consecutive non‐vasectomized, azoospermic were examined by ultrasonography, and hormone (FSH, LH, testosterone, and prolactin), and genetic analyses (karyotype, Y microdeletions, and CFTR mutations) were performed. At testicular ultrasonography, patients were graduated into: pronounced THF (>7 THF per transducer field), distributed universally (uTHF) or collected in plaques (pTHF), borderline THF (bTHF; 3–7 THF per transducer field), or no THF (<3 THF per transducer field). Diagnostic testicular biopsy was taken open or with TruCut needle (14G). THF status was sufficiently described in 382 of 449 potential participants, and testicular histology was available in 300 cases. Presence of ultrasonographically detectable THF was compared to presence of testicular microlithiasis (TM) detected histologically. Sertoli cell dysfunction was investigated in a subgroup using a three‐stage immunoperoxidase technique for detection of cytokeratin‐18 (CK‐18). The prevalence of THF was 13.4%. uTHF was found in 11 men (2.9%), the pattern was bilateral in four while other four had bTHF in the other testis. pTHF was detected in eight cases (2.1%), and except for one case with Klinefelter's syndrome, pTHF was in all cases occurring unilaterally. bTHF was detected in 32 cases (8.4%), bilaterally in 17 (53%). Pronounced THF was significantly associated with testicular malignancy. CK‐18 was detected in more azoospermic men with sperm production in ≤50% seminiferous tubules than in azoospermic men with spermatogenesis in ≥90% of seminiferous tubules and normal controls (p < 0.05). Unfortunately, TM detected histologically was not detected in any patient expressing THF, and neither THF nor TM was detected in any of the patients examined for CK‐18. Sertoli cell dysfunction was not associated with testicular microlithiasis or hyperechogenic foci.

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Testicular microlithiasis predicts concurrent testicular germ cell tumors and intratubular germ cell neoplasia of unclassified type in adults

Tan

Ang

Ching

et al. 2010

Cancer

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BACKGROUND:There is an increasing body of literature associating testicular microlithiasis (TM), a common finding on testicular ultrasound, with testicular germ cell tumor (TGCT) and intratubular germ cell neoplasia of unclassified type (ITGCNU). Determining these associations is pertinent both clinically and biologically. To the authors' knowledge, no previous systematic review or meta-analysis has been performed. METHODS: A comprehensive systematic literature review was performed without language restrictions through July 2009 and included an exhaustive search of electronic databases and article references. Two reviewers extracted data independently. Studies were categorized according to the clinical context in which sonography was performed. The primary study outcomes were concurrent diagnoses of TGCT or ITGCNU, with TM. In addition, studies with prospective follow-up of patients with TM were reviewed. RESULTS: Thirty-three studies met inclusion criteria. TM was not associated with an increased risk of TGCT in asymptomatic men. However, in referral populations, TM was associated overall with a risk ratio of 8.5 (95% confidence interval [CI], 4.5-16.1; P < .001) for a concurrent diagnosis of TGCT and 10.5 (95% CI, 5.3-20.8; P < .0001) for ITGCNU. Seventeen observational studies were identified in which the interval development of TGCT in patients with TM was reported; however, the majority of those studies did not report the follow-up of a control arm and could not be summarized. CONCLUSIONS: In the presence of risk factors, TM was associated with a substantially elevated risk of a concurrent diagnosis of TGCT and ITGCNU. The authors suggest modifications to recently proposed guidelines for the management of TM. Cancer 2010;116:4520-32.

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Prevalence of testicular microlithiasis in an asymptomatic population

Abstract: Our results suggest that there is no significant association between TM and testicular cancer, although it is difficult to rule out such an association without further studies with a longer follow-up period.

Cited by 76 publications

References 20 publications

Testicular microlithiasis as a familial risk factor for testicular germ cell tumour

Testicular microlithiasis as a familial risk factor for testicular germ cell tumour

Prevalence of small testicular hyperechogenic foci in subgroups of 382 non‐vasectomized, azoospermic men: a retrospective cohort study

Testicular microlithiasis predicts concurrent testicular germ cell tumors and intratubular germ cell neoplasia of unclassified type in adults

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