Testicular microlithiasis and testicular tumor: a review of the literature

Abstract

IntroductionThere are numerous scientific publications on testicular microlithiasis (TML) detected during ultrasound (US) examination. We wished to update the data.MethodsPubMed was used to identify original articles published between 1998 and May 2017 describing the association between TML and testicular tumor. Studies were only included if TML was diagnosed by US. Studies were then classified into subgroups according to the following criteria: asymptomatic, symptomatic, infertility, cryptorchidism, family or personal history of testicular cancer, and “no given reason for US”. A Z-Test was used to identify differences within these subgroups. In addition, we identified prospective cohorts of TML patients. Numbers, duration of follow-up, and occurrence of the “testicular tumor” event were recorded for each of them.ResultsOne hundred and seventy-five articles were identified, 40 of which were included. Our review has not showed a clear evidence that cryptorchidism associated with TML is a risk factor for testicular tumor. However, there seems to be a correlation between infertility associated with TML and a higher tumor risk. There were not enough studies to confirm a relationship between family or personal history associated with TML and the tumor risk. There was also a correlation with a higher tumor risk for symptomatic associated with TML and “no given reason for US” plus TML groups. However, these groups are assumed to contain bias and caution must be taken regarding conclusions. Regarding the prospective cohort studies, 16 testicular tumors appeared in the follow-up of patients with TML, 13 patients had risk factors.ConclusionIn cases of TML incidental finding by US with the presence of risk factors (personal history of testicular cancer, testicular atrophy, infertility, cryptorchidism) a consultation with a specialist should be considered. In the absence of risk factors, the occurrence of testicular cancer in patients with TML is similar to the risk of the general population.

Identification and Analysis of a Novel NR0B1 Mutation in Late-Onset Adrenal Hypoplasia Congenita and Hypogonadism

“…This is the first description, so far as we know, of an apparently rare case of late-onset X-linked AHC with testicular microlithiasis. Since testicular microlithiasis with male infertility is known to be associated with testicular malignancy [ 36 , 37 ], regular medical follow-up is essential for this patient.…”

The prognostic value of testicular microlithiasis as an incidental finding for the risk of testicular malignancy in children and the adult population: A systematic review. On behalf of the EAU pediatric urology guidelines panel

“…A systematic review and meta-analysis was published in 2019 by Yu et al [36], also investigating the association between TM and testicular tumours in children. They included 10 follow-up studies with 296 children.…”

Imaging of childhood urologic cancers: current approaches and new advances

“…However, correlation does not necessarily prove causation, and limitations of retrospective studies with potential selection bias make the formulation of recommendations difficult. To date, surveillance strategies in adults have not been especially productive or cost-effective (39,40) in a disease with a very high cure rate, leading many experts in adult testicular cancer to recommend that the isolated finding of testicular microlithiasis without other risk features may not warrant additional evaluation other than recommendations for monthly testicular self-examination (41)(42)(43). Given the absence of prospective studies to better characterize incidence and benefit of follow-up, the true risk of developing testicular cancer in pediatric patients after discovery of isolated microlithiasis is unknown.…”