Testicular Microlithiasis: Is Sonographic Surveillance Necessary? Single Centre 14 Year Experience in 442 Patients with Testicular Microlithiasis

Abstract

Purpose: Increased prevalence of germ cell tumour (GCT) is seen with testicular microlithiasis (TM) suggesting TM is a premalignant condition with US surveillance advocated. We present a cohort of patients with TM followed up in a single centre and deliberate on the value of US surveillance.

Materials and Methods: A retrospective analysis of subjects with underlying US diagnosis of TM between 1998 and 2012. One-yearly US follow-up was offered to all patients with TM and a database maintained. Any co-existing tumour at presentation with TM was recorded. TM was divided into limited (< 5 microliths/field), classical (≥ 5 microliths/field) and florid (‘snowstorm’ appearance). Patient demographics, follow-up details and the development of any scrotal abnormalities were recorded. The radiological and histological findings were documented when a testicular lesion occurred during the follow-up period.

Results: 20 224 patients were examined: 867/20 224 (4.3 %) had TM. 21/867 (2.4 %) patients had histology proven malignant tumours at presentation. All TM patients consented to follow-up with 442/867 (51.0 %) achieving this and entering into a follow-up program (mean duration 28 months, range 8 – 165 months). Two patients developed primary GCT during the follow up period. One patient (limited TM) had undergone a previous orchiectomy for contralateral GCT and developed a palpable mass at follow up month 21. The other (limited TM) had an atrophic testis; a tumour was found on US at follow up month 62.

Conclusion: Two patients of 442 (0.5 %) followed up for all forms of TM in a single centre developed a GCT over a mean duration of 28 months, both had independent risk factors for the development of GCT. These findings suggest that US surveillance is not required when TM is the only abnormality in the absence of any clinical risk factors for the development of GCT.

Zusammenfassung

Ziel: Testikuläre Mikrolithiasis (TM) geht mit einer höheren Prävalenz von germinalen Tumoren (GCT) einher. Dies legt nahe, dass TM eine vormaligne Erkrankung ist, bei der eine US-Überwachung angezeigt ist. Wir stellen eine Patientenkohorte mit TM unter monozentrischer Nachverfolgung vor und diskutieren den Wert der US-Kontrolle.

Material und Methoden: Retrospektive Analyse von Patienten mit sonografisch diagnostizierter TM von 1998 bis 2012. Einjährige US-Follow-ups wurden allen Patienten mit TM angeboten und dokumentiert. Alle bei Aufnahme bestehenden Tumore mit TM wurden registriert. Die TM wurde in limitiert (5 Microliths/Feld), klassisch (≥ 5 Microliths/Feld) und floride („Sternenhimmelphänomen“) eingeteilt. Patientendemografie, Details der Nachkontrollen und Auftreten aller neuen skrotalen Anomalien wurden registriert. Sobald eine testikuläre Läsion in der Kontrollperiode auftrat, wurden die radiologischen und histologischen Befunde dokumentiert.

Ergebnisse: Initial wurden 20 224 Patienten untersucht: 867/20 224 (4,3 %) hatten TM, davon hatten 21/867 (2,4 %) bei Aufnahme einen histologisch bestätigten malignen Tumor. Alle TM-Patienten stimmten dem Follow-up zu, wobei 442/867 (51,0 %) daran teilnahmen (mittlere Dauer 28 Monate, 8 – 165 Monate). Währenddessen entwickelten zwei Patienten einen primären GCT während der Kontrollperiode. Ein Patient (limitierte TM) hatte wegen eines kontralateralen GCT bereits einer Orchiektomie und entwickelte eine tastbare Raumforderung im Follow-up nach 21 Monaten. Der andere Patient (limiterte TM) zeigte einen atrophischen Hoden; ein Tumor wurde im der US-Follow-up nach 62 Monaten entdeckt.

Schlussfolgerung: Nur zwei von 442 (0,5 %) Patienten mit allen Formen einer TM, die monozentrisch nachverfolgt wurden, entwickelten nach 28 Monaten (mittlere Dauer) einen GCT; beide hatten unabhängige Risikofaktoren für die GCTs. Dies legt nahe, dass eine US-Überwachung nicht erforderlich ist, solange die TM die einzige Anomalie ist und weitere klinische Risikofaktoren für GCTs fehlen.

Key words

Testis - Microlithiasis - Tumor

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