Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

Current management strategies for testicular microlithiasis

Nature Clinical Practice Urology volume 4, pages 492–497 (2007)Cite this article

Abstract

The association of testicular microlithiasis with testicular tumor and the management of incidentally detected testicular microlithiasis have generated a great deal of interest. We review the current literature on testicular microlithiasis with regard to its association with testicular tumor. This association seems complex. The available data suggest that men with incidental findings of testicular microlithiasis but who have otherwise normal testes are at low risk of developing testicular cancer. The only follow-up recommended is regular testicular self-examination. Testicular microlithiasis is, however, associated with a high risk of developing testicular malignancy in men with subfertility, history of contralateral testicular tumor or history of cryptorchidism. Regular testicular self-examination is recommended for follow-up of high-risk patients, but the role of surveillance with serial ultrasonography and measurement of tumor markers is still not clear.

Key Points

  • A strong association exists between testicular microlithiasis and testicular tumor, but no evidence suggests that testicular microlithiasis is premalignant in men with otherwise normal testes, who comprise a low-risk group

  • Low-risk patients with testicular microlithiasis are recommended to follow up the diagnosis with regular testicular self-examinations; serial ultrasonography, assessment of tumor markers and testicular biopsy are not warranted

  • Testicular microlithiasis in men with subfertility, history of contralateral testicular tumor and history of cryptorchidism is associated with an increased risk of having carcinoma in situ and developing testicular malignancy

  • Follow-up of patients with testicular microlithiasis, involving regular testicular self-examinations, is recommended for those at high-risk but serial ultrasonography, assessment of tumor markers and testicular biopsy do not seem to improve survival

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1: Ultrasound image of testis with microlithiasis

Similar content being viewed by others

References

  1. Priebe CJ Jr and Garret R (1970) Testicular calcification in a 4-year-old boy. Pediatrics 46: 785–788

    PubMed  Google Scholar 

  2. Doherty FJ et al. (1987) Testicular microlithiasis: a unique sonographic appearance. J Ultrasound Med 6: 389–392

    Article  CAS  Google Scholar 

  3. Bennett HF et al. (2001) Testicular microlithiasis: US follow-up. Radiology 218: 359–363

    Article  CAS  Google Scholar 

  4. Backus ML et al. (1994) Testicular microlithiasis: imaging appearances and pathologic correlation. Radiology 192: 781–785

    Article  CAS  Google Scholar 

  5. Cornud F et al. (2001) Ultrasound findings in male hypofertility and impotence. Eur Radiol 11: 2126–2136

    Article  CAS  Google Scholar 

  6. Bieger RC et al. (1965) Testicular intratubular bodies. J Clin Endocrinol Metab 25: 1340–1346

    Article  CAS  Google Scholar 

  7. Vegni-Talluri M et al. (1980) Testicular microliths: their origin and structure. J Urol 124: 105–107

    Article  CAS  Google Scholar 

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

    Article  CAS  Google Scholar 

  9. Peterson AC et al. (2001) The prevalence of testicular microlithiasis in an asymptomatic population of men 18 to 35 years old. J Urol 166: 2061–2064

    Article  CAS  Google Scholar 

  10. Derogee M et al. (2001) Testicular microlithiasis, a premalignant condition: prevalence, histopathologic findings, and relation to testicular tumor. Urology 57: 1133–1137

    Article  CAS  Google Scholar 

  11. Skyrme RJ et al. (2000) Testicular microlithiasis in a UK population: its incidence, associations and follow-up. BJU Int 86: 482–485

    Article  CAS  Google Scholar 

  12. Cast JE et al. (2000) Testicular microlithiasis: prevalence and tumor risk in a population referred for scrotal sonography. AJR Am J Roentgenol 175: 1703–1706

    Article  CAS  Google Scholar 

  13. Von Eckardstein S et al. (2001) Sonographic testicular microlithiasis as an indicator of premalignant conditions in normal and infertile men. J Androl 22: 818–824

    CAS  PubMed  Google Scholar 

  14. Leenen AS and Riebel TW (2002) Testicular microlithiasis in children: sonographic features and clinical implications. Pediatr Radiol 32: 575–579

    Article  Google Scholar 

  15. Miller NAC et al. (2007) Testicular calcification and microlithiasis: association with primary intra-testicular malignancy in 3,477 patients. Eur Radiol 17: 363–369

    Article  Google Scholar 

  16. Ikinger U et al. (1982) Microcalcifications in testicular malignancy: diagnostic tool in occult tumor? Urology 19: 525–528

    Article  CAS  Google Scholar 

  17. Ganem JP et al. (1999) Testicular microlithiasis is associated with testicular pathology. Urology 53: 209–213

    Article  CAS  Google Scholar 

  18. Dieckmann KP et al. (1986) Bilateral testicular germ cell tumors. Report of nine cases and review of the literature. Cancer 57: 1254–1258

    Article  CAS  Google Scholar 

  19. Holm M et al. (2003) Increased risk of carcinoma in situ in patients with testicular germ cell tumor with ultrasonic microlithiasis in the contralateral testicle. J Urol 170: 1163–1167

    Article  Google Scholar 

  20. Skakkebaek NE et al. (1982) Carcinoma-in-situ of the undescended testis. Urol Clin North Am 9: 377–385

    CAS  PubMed  Google Scholar 

  21. Bach AM et al. (2003) Is there an increased incidence of contralateral testicular cancer in patients with intratesticular microlithiasis? AJR Am J Roentgenol 180: 497–500

    Article  Google Scholar 

  22. Pourbagher MA et al. (2005) Follow-up of testicular microlithiasis for subsequent testicular cancer development. Urol Int 74: 108–112

    Article  Google Scholar 

  23. Furness PD III et al. (1998) Multi-institutional study of testicular microlithiasis in childhood: a benign or premalignant condition? J Urol 160: 1151–1154

    Article  Google Scholar 

  24. McEniff N et al. (1995) Yolk sac tumor of the testis discovered on a routine annual sonogram in a boy with testicular microlithiasis. AJR Am J Roentgenol 164: 971–972

    Article  CAS  Google Scholar 

  25. Winter TC III et al. (1996) Testicular carcinoma in a patient with previously demonstrated testicular microlithiasis. J Urol 155: 648

    Article  Google Scholar 

  26. Frush DP et al. (1996) Testicular microlithiasis and subsequent development of metastatic germ cell tumor. AJR Am J Roentgenol 167: 889–890

    Article  CAS  Google Scholar 

  27. Cornford PA et al. (2001) Testicular microlithiasis needs long-term surveillance. Scand J Urol Nephrol 35: 243–244

    Article  CAS  Google Scholar 

  28. Ortiz Gorraiz MA et al. (2003) Testicular microlithiasis and testicular cancer [Spanish]. Arch Esp Urol 56: 521–524

    PubMed  Google Scholar 

  29. Lawrentschuk N et al. (2003) Testicular microlithiasis: a case report and review of the literature. ANZ J Surg 73: 364–366

    Article  Google Scholar 

  30. Thomas K et al. (2000) The incidence and significance of testicular microlithiasis in a subfertile population. Br J Radiol 73: 494–497

    Article  CAS  Google Scholar 

  31. Sasagawa I et al. (1988) Testicular microlithiasis in male infertility. Urol Int 43: 368–369

    Article  CAS  Google Scholar 

  32. Pierik FH et al. (1999) Is routine scrotal ultrasound advantageous in infertile men? J Urol 162: 1618–1620

    Article  CAS  Google Scholar 

  33. Schantz A and Milsten R (1976) Testicular microlithiasis with sterility. Fertil Steril 27: 801–805

    Article  CAS  Google Scholar 

  34. Moran JM et al. (1993) Idiopathic testicular microlithiasis: ultrastructural study. Br J Urol 72: 252–253

    Article  CAS  Google Scholar 

  35. de Gouveia Brazao CA et al. (2004) Bilateral testicular microlithiasis predicts the presence of the precursor of testicular germ cell tumors in subfertile men. J Urol 171: 158–160

    Article  CAS  Google Scholar 

  36. Husmann DA (2005) Cryptorchidism and its relationship to testicular neoplasia and microlithiasis. Urology 66: 424–426

    Article  CAS  Google Scholar 

  37. Campbell HE (1959) The incidence of malignant growth of the undescended testicle: a reply and re-evaluation. J Urol 81: 663–668

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. K Jaganathan is a Staff Grade in Urology at James Paget Hospital, Great Yarmouth, UK.,

    Kirubanand Jaganathan

  2. S Ahmed is a Clinical Fellow and A Rané is a Consultant Urologist in the Department of Urology, East Surrey Hospital, Redhill, UK.,

    Shwan Ahmed & Abhay Rané

  3. A Henderson is a Specialist Registrar in the Department of Urology at Guy's Hospital, London, UK.,

    Alastair Henderson

Authors
  1. Kirubanand Jaganathan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shwan Ahmed
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alastair Henderson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Abhay Rané
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Abhay Rané.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jaganathan, K., Ahmed, S., Henderson, A. et al. Current management strategies for testicular microlithiasis. Nat Rev Urol 4, 492–497 (2007). https://doi.org/10.1038/ncpuro0856

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ncpuro0856

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing