title: Testicular microlithiasis and carcinoma in situ overview and proposed clinical guideline.
abstract: Testicular microlithiasis (TM) has been associated with testicular germ cell tumours (TGCTs) in adolescents and adults and with its precursor carcinoma in situ (CIS). A clear definition of TM and the need for further diagnostics and follow-up is lacking. We reviewed the literature of TM and its association with TGCT/CIS and current follow-up advises and propose a management approach based on associated risk factors for TGCT. In the literature, a wide variance of TM incidence is reported in different patient populations. A consensus concerning the malignant potential of TM has not been reached. In addition, a clear definition on TM is lacking. Although a correlation between TM and TGCT or CIS is found, precise management and follow-up schedules are absent. We suggest that all hyperechogenic foci smaller than 3 mm without shadowing should be named TM irrespective of their number. In addition, we suggest a management scheme for physicians encountering TM in daily practice. Our algorithm suggests taking a testicular biopsy in a selected patient population with at least one additional risk factor for TGCT. A long-term active follow-up schedule, including ultrasonography and physical examinations, is not indicated in the remaining patients with TM.
authors.affiliation: Department of Urology, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: N J
authors.initials: NJ
authors.lastname: van Casteren
authors.forename: L H J
authors.initials: LH
authors.lastname: Looijenga
authors.forename: G R
authors.initials: GR
authors.lastname: Dohle
mesh_terms: D000293:Adolescent; D000328:Adult; D001706:Biopsy; D002278:Carcinoma in Situ / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D018450:Disease Progression; D006801:Humans; D007150:Immunohistochemistry; D015994:Incidence; D020347:Lithiasis / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D008297:Male; D009373:Neoplasms, Germ Cell and Embryonal / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors; D013733:Testicular Diseases / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D013736:Testicular Neoplasms / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D013737:Testis / Q000000981:diagnostic imaging / Q000473:pathology*; D014463:Ultrasonography