Testicular microlithiasis: prevalence and risk of concurrent and interval development of testicular tumor in a referred population.
ABSTRACT To identify prevalence of testicular microlithiasis on ultrasound in a referred population and risk of concurrent and interval testicular tumor development.
Retrospective review of our radiology database revealed 4363 scrotal ultrasounds were performed over a six-year period. Ultrasound findings were correlated with our hospital pathological database. The association of intratesticular microlithiasis and confirmed testicular cancers were assessed by means of a Fisher exact test.
Testicular microlithiasis was identified in 32 of the 4259 patients (0.75% of screened population). In the same time period 83 testicular tumors were identified on initial scanning (2.00% of screened population). Three patients with tumor had coexisting microlithiasis (9.4% incidence), whilst a further two had interval development of tumor. The follow-up of the microlithiasis patients ranged from 3 to 72 months (mean 33.9 months, median 40 months).
Interval development of testicular tumor is a documented phenomenon. As the incidence in detection of microlithiasis increases secondary to advances in ultrasound technology, follow-up becomes financially prohibitive. We advocate regular self-examination as the primary follow-up of otherwise well patients with testicular microlithiasis.
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ABSTRACT: Study Type - Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? In some individuals with disorders of sex development (DSD), gonadal tumour risk is increased. The individual risk is estimated based on the molecular diagnosis and the age and approaches 30% in the high-risk group. In the past, early gonadectomy has been advised for all individuals with 46XY DSD. Gonadectomy clearly represents an overtreatment for many individuals with 46XY DSD. Thus, further clinical indicators of individual tumour risk are urgently needed. The present study provides a comprehensive description of gonadal morphology, as seen during laparoscopy. For the first time, laparoscopic features, molecular diagnosis and histopathological findings are presented in a comprehensive context. The present study adds a detailed morphological description of the variability found in different subgroups of 46XY DSD. As three of four detected tumours were microscopic, early diagnosis by inspection appears unfeasible. Biopsy, gonadopexy and precise localisation of the gonad will potentially allow for gonadal preservation in well-defined clinical situations. OBJECTIVE: • To investigate the role of laparoscopy for the early detection of gonadal tumours, with emphasis on gonadal preservation, in patients with 46XY disorders of sex development (DSD). In patients with DSD, gonadectomy is frequently recommended and depending on the age and the molecular diagnosis, an increased gonadal tumour risk exists and undesired hormone effects may arise. However, gonadectomy is irreversible and impacts considerably on body image. It represents an overtreatment for some patients and should be considered after a comprehensive diagnostic evaluation. Laparoscopy is an important technique, because it is able to retrieve small gonads and allows guided biopsies. PATIENTS AND METHODS: • We performed laparoscopic assessment of the gonads in 40 patients with various 46XY DSD. • In all, 77 gonads were evaluated, images were analysed and compared with histological findings. • Laparoscopic procedures included gonadectomy, biopsy, laparoscopic orchidolysis or the Fowler-Stephens procedure as well as the removal or splitting of uterine remnants. RESULTS: • In all, 19 patients underwent gonadectomy and tumours were discovered in four. • Three patients had only microscopic evidence of tumour, in one the tumour was diagnosed intraoperatively. • In 21 patients, biopsies were taken and the gonads preserved. • Laparoscopic biopsy and gonadopexy was performed in six patients with complete androgen insensitivity syndrome (CAIS). CONCLUSION: • Laparoscopy and biopsy detected three microscopic tumours, one tumour was macroscopically evident. • In CAIS, gonadopexy improved the visibility of the gonads on postoperative ultrasonography. This procedure facilitated the examination of the gonad at follow-up. • In complete gonadal dysgenesis, a highly variable morphology of the gonads was found. Laparoscopy improved exposure of gonads and Müllerian structures, and facilitated biopsies and organ-preserving procedures.BJU International 04/2012; · 3.05 Impact Factor
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ABSTRACT: Ultrasound surveillance of patients with testicular microlithiasis (TM) has been advocated following the reported association with testicular cancer. The aim of this study was to assess the evidence base supporting such surveillance. Formal literature review identified cohort studies comprising at least 15 patients followed up for at least 24 months. Combining an institutional audit with the identified studies in a pooled analysis the incidence of new cancers during the surveillance period was evaluated. Literature review identified eight studies. Our institutional audit comprised 2,656 men referred for scrotal ultrasound. Fifty-one men (1.92 %) with TM were identified, none of whom developed testicular cancer (mean follow-up: 33.3 months). In a combined population of 389 men testicular cancer developed in 4. Excluding 3 who had additional risk factors, only 1 of 386 developed testicular cancer during follow-up (95 % CI 0.05-1.45 %). Ultrasound surveillance is unlikely to benefit patients with TM in the absence of other risk factors. In the presence of additional risk factors (previous testicular cancer, a history of maldescent or testicular atrophy) patients are likely to be under surveillance; nonetheless monthly self-examination should be encouraged, and open access to ultrasound and formal annual surveillance should be offered. KEY POINTS : • The literature reports a high association between testicular microlithiasis and testicular cancer. • Our study and meta-analysis suggest no causal link between microlithiasis and cancer. • In the absence of additional risk factors surveillance is not advocated. • In the presence of additional risk factors surveillance is recommended. • Such surveillance is primarily aimed at engaging patients in regular follow-up.European Radiology 06/2012; 22(11):2540-6. · 4.34 Impact Factor
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ABSTRACT: Bij drie jongens van respectievelijk 15, 9 en 10 jaar werd door middel van echografie de diagnose testiculaire microlithiasis (TM) gesteld. Twee van hen hadden geen klachten, één klaagde over pijn in de testis. TM wordt gekenmerkt door meerdere echorijke foci in de tubuli seminiferi zonder slagschaduw. De oorzaak is grotendeels onbekend. Bij volwassenen bedraagt de prevalentie tussen de 0,2 en 29%, bij jongens tussen de 0,1 en 11,7%. Er zijn aanwijzingen dat TM geassocieerd is met maligne aandoeningen van de testis. Alhoewel er bij volwassenen geen eensluidende richtlijn voor follow-up bestaat, wordt veelal jaarlijkse follow-up geadviseerd. Voor jongens bestaan vrijwel geen richtlijnen. Een driemaandelijks zelfonderzoek gecombineerd met jaarlijks lichamelijk onderzoek en echografie is raadzaam, vooral bij jongens met een al verhoogd risico op testismaligniteiten zoals jongens met een niet-scrotale testis. De prognose, evenzeer ten aanzien van de fertiliteit, is grotendeels onbekend. In three boys aged 15, 9, and 10 years respectively scrotal ultrasound revealed testicular microlithiasis (TM). Two boys were free of symptoms and one suffered from testicular pain. TM is characterized by multiple echogenic foci within the seminiferous tubules with no acoustic shadowing. The pathophysiology is largely unknown. In adult men, TM prevalence has been reported to range from 0.2 to 29%. In boys the prevalence rate varies from 0.1 to 11.7%. There are indications that TM might be associated with malignant conditions of the testes. Although in adult men the method of follow-up is controversial, annual follow-up is usually recommended. In pediatric patients virtually no follow-up guidelines exist. Testicular self-examination, for example three monthly, and annual ultrasound in addition to physical examination might be warranted especially in boys with undescended testis who are already at risk for malignant transformation in the cryptorchid testis. Prognosis, as well as with regard to fertility, is largely unknown.Tijdschrift voor kindergeneeskunde 01/2008; 76(1):34-38.