Effects of testicular microlithiasis on Doppler parameters: report of three cases
© Kutlu et al; licensee BioMed Central Ltd. 2002
Received: 19 September 2001
Accepted: 13 February 2002
Published: 13 February 2002
Testicular microlithiasis is a rare, usually asymptomatic, non-progressive disease of the testes associated with various genetic anomalies, infertility and testicular tumors. According to our literature search, there is no specific data about Doppler findings in this disease.
Doppler findings of three cases of testicular microlithiasis during last two years in our institution are presented.
Although our hypothesis was to find increased Doppler parameters due to intratesticular arterial compression, our findings suggest that there are no Doppler findings specific to testicular microlithiasis.
Testicular microlithiasis (TM) is a rare, usually asymptomatic, non-progressive disease of the testes associated with various genetic anomalies, infertility and testicular tumors [1, 2]. According to the literature that we searched, there is no study on the Doppler ultrasonography (USG) features of TM. In this report, we present our Doppler experience obtained from three cases of TM at Inonu University School of Medicine during last two years, and the ultrasonographic and clinical features of TM.
Investigated Doppler parameters of the cases.
TM is a rare, asymptomatic disease, supposed to be associated with various benign and malignant urological pathologies, and genetic anomalies, usually found incidentally on ultrasound examination performed for other reasons. There are numerous hyperechoic, small calcifications without posterior acoustic shadowing in the testicular parenchyma [1, 2].
Although the incidence is usually reported to be in the range of 0.05 to 0.6 % in the literature [3, 4], there are some reports of 1.3% and 2% incidences, and even an incidence of 15% in infertile patients [5, 6].
Histologically TM consists of laminated eosinophilic calcifications, which are thought to be the result of accumulation of cellular debris and deposition of glycoproteins, located in the seminiferous tubules [7–9]. Although these types of calcifications are present in the majority of patients with TM, they can be seen in 4% of normal prepubertal testes and in testicular torsion, cryptoorchidism, Down syndrome, Klinefelter syndrome, male pseudohermaphroditism and germ cell tumors [1, 4, 7, 8].
TM is reported to be associated mostly with cryptoorchidism; also, an association with infertility and intraepithelial germ cell tumors is also reported [2, 10]. Infertility was the most common finding in our patients and we did not encounter any testicular tumors in these 3 patients.
Although it is accepted as a benign pathology, there are no satisfactory long-term follow-up results of these patients. There are reports of TM patients gaining fertility and developing various testicular tumors [7, 14, 15]. One of our cases became fertile after his accompanying varicocele problem was solved. TM has probably benign course but follow-up of the patients are needed.
On ultrasound examination, these calcifications are seen as echogenic foci, which are distributed diffusely throughout the testicular parenchyma. They can also be seen as clusters. Although unilateral involvement is reported to be rare  two of the our cases had unilateral involvement. There are no generally accepted criteria about how many echogenic foci should be present to make the diagnosis of TM but some authors classify TM as classic if there is five or more microliths in one ultrasound image and limited TM if they do not match this criterion . The ultrasonographic findings of TM are enough to make the diagnosis just by themselves . Testicular size is normal as in our cases. Usually there is no mass in the testicular parenchyma. There are numerous echogenic foci between the sizes of 1 and 3 mm without acoustic shadowing (if it is seen it is described as having a "Comet tail" appearance) [1, 2, 4, 7, 8, 12]. Some authors call this appearance a "snow storm" . All of our three cases had fulfilled these ultrasonographic criteria. To our knowledge, there are no specific reports of Doppler findings of TM in the literature.
We assumed that the resistance indices and velocities would be higher in TM patients due to compression of the intratesticular arteries by those echogenic foci. However, that was not the case in our patients despite extensive involvement of the testes. All Doppler parameters and spectral examination findings were normal. Although larger patient series are needed to establish a firm statement, our results suggest that there are no Doppler findings specific to TM.
- Janzen DL, Mathieson JR, Marsh JI, Cooperberg PL, Del Rio P, Golding RH, Rifkin MD: Testicular microlithiasis: sonographic and clinical features. AJR. 1992, 158: 1057-1060.PubMedView Article
- Backus ML, Mack LA, Middleton WD, King BF, Winter TC, True LD: Testicular microlithiasis: imaging appearances and pathologic correlation. Radiology. 1994, 192: 781-785.PubMedView Article
- Hobarth K, Susani M, Szabo N, Kratzik C: Incidence of testicular microlithiasis. Urology. 1992, 40: 464-467. 10.1016/0090-4295(92)90467-B.PubMedView Article
- Nistal M, Paniagua R, Diez-Pardo JA: Testicular microlithiasis in two children with bilateral cryptorchidism. J Urol. 1979, 121: 535-537.PubMed
- Bar-Chama NC, Zaslou SA, Braffman B, Shapiro RB, Pasik AC: Incidence of testicular cancer and microlithiasis in male infertility. AUA Meeting. 1998
- Ganem JP, Workman KR, Shaban SF: Testicular microlithiasis is associated with testicular pathology. Urology. 1999, 53: 209-213. 10.1016/S0090-4295(98)00438-5.PubMedView Article
- Kessaris DN, Mellinger BC: Incidence and implication of testicular microlithiasis detected by scrotal Duplex sonography in a selected group of infertile men. J Urol. 1994, 152: 1560-1561.PubMed
- Smith WS, Brammer HM, Henry M, Frazier H: Testicular microlithiasis: sonographic features and pathologic correlation. AJR. 1991, 157: 1003-1004.PubMedView Article
- Renshaw AA: Testicular calcifications: Incidence, histology and proposed pathological criteria for testicular microlithiasis. J Urol. 1998, 160: 1625-1628. 10.1097/00005392-199811000-00004.PubMedView Article
- Howard RG, Roebuck DJ, Metreweli C: The association of mediastinal germ cell tumour and testicular microlithiasis. Pediatr Radiol. 1998, 28: 998-10.1007/s002470050519.PubMedView Article
- Vrachliotis TG, Neal DE: Unilateral testicular microlithiasis associated with a seminoma. J Clin Ultrasound. 1997, 25: 505-507. 10.1002/(SICI)1097-0096(199711/12)25:9<505::AID-JCU8>3.3.CO;2-#.PubMedView Article
- Patel MD, Olcott EW, Kerschmann RL, Callen PW, Gooding GA: Sonographically detected testicular microlithiasis and testicular carcinoma. J Clin Ultrasound. 1993, 21: 447-452.PubMedView Article
- Parra BL, Venable DD, Gonzales E, Eastham JA: Testicular microlithiasis as a predictor of intratubular germ cell neoplasia. Urology. 1996, 48: 797-799. 10.1016/S0090-4295(96)00304-4.PubMedView Article
- Aizenstein RI, Hibbeln JF, Sagireddy B, Wilbur AC, O'Neil HK: Klinefelter's syndrome associated with testicular microlithiasis and mediastinal germ-cell neoplasm. J Clin Ultrasound. 1997, 25: 508-510. 10.1002/(SICI)1097-0096(199711/12)25:9<508::AID-JCU9>3.0.CO;2-R.PubMedView Article
- Berger A, Brabrand K: Testicular microlithiasis a possibly premalignant condition. Report of five cases and a review of the literature. Acta Radiol. 1998, 39: 583-586.PubMed
- The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2490/2/3/prepub
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