Testicular microlithiasis (TM) is a condition that has traditionally been considered uncommon, characterized at sonography by multiple microcalcifications in the testes. Currently, the correlation between TM and testicular malignancies is variable in different series. Thus, the management for incidentally discovered TM is still in debate, ranging from no follow-up to complete workups. The purpose of this study is to review our data regarding the prevalence of TM, its association with testicular malignancies, and the value of follow-up at the University of California, Davis, Medical Center. This is a retrospective study in which 3,254 testicular sonograms over a 10-year period identified 137 patients with TM. TM was divided into two groups of either classic TM or limited TM. Associations with testicular cancers and other findings were then noted, as well as the extent of follow-up with each patient; 137 (4.6%) of the 2,957 individual patients with scrotal sonograms had TM; 8 (5.8%) of the 137 patients with TM had testicular cancers. All eight patients with testicular malignancies presented with classic TM. There were nine testicular tumors in eight patients. This included three patients with bilateral classic TM, three patients with unilateral classic TM and ipsilateral malignancy, and two patients with unilateral classic TM and contralateral malignancy. In one patient with bilateral CTM there were bilateral malignancies. In the two cases with unilateral classic TM and malignancy in the contralateral testis, the tumors were very large (1.1 and 1.2 kg). None of the 30 TM patients who did not have a testicular cancer at the time of the first sonogram developed testicular malignancies on our follow-up (average follow-up time of 19 months; range 1-90 months, SD 19.7 months). We conclude that TM does not independently increase the risk of testicular malignancy; however, in patients with TM and other known risk factors for testicular cancer, follow-up is warranted. Furthermore, testicular tumors are associated with classic TM and not with limited TM.
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