Testicular microlithiasis in children and associated testicular cancer.
OBJECTIVE
To evaluate the prevalence of testicular microlithiasis (TM) in children who have undergone scrotal ultrasonography (US) and their association with testicular tumors.


METHODS
This HIPAA-compliant study with waiver of informed consent was approved by the institutional review board. From 2003 to 2012, all patients with scrotal US and report mentioning calcifications or microlithiasis and all patients with testicular tumors from pathology database were identified. US studies were evaluated for the type of TM (classic ≥5 microliths or limited <5 microliths in a single view) and change in follow-up studies if available. Medical charts were reviewed for US indication, underlying medical conditions, and pathologic abnormalities, when available. Fisher exact test was used to analyze the association of testicular tumors and TM.


RESULTS
A total of 3370 boys had scrotal US, 83 (2%) of whom had TM or microcalcifications in the report. TM was usually bilateral (n = 62, 75%) and classic (n = 59, 71%) type.TM was significantly less common in those younger than 2 years of age than in older age groups (0.1% vs 3.1%, P < .0001). The most common indication for US was scrotal pain (40 of 83 patients, 48%), and the most common associated medical condition was cryptorchidism (nine of 83 patients, 11%). Testicular tumor was significantly more likely in boys with TM (12% vs 0.3%, P < .01). Five (83%) of six patients with premalignant or benign tumors had a premalignant condition (cryptochydism in two and Peutz-Jeghers syndrome in three). Four patients with TM had malignant testicular tumors, all diagnosed after the age of 16 years.


CONCLUSIONS
TM has a prevalence of 2% in boys who undergo scrotal US. It is most commonly bilateral, classic type, and stable at follow-up studies. There is a significant association of TM and testicular tumors. Malignant tumors were seen only in adolescent boys.
From the Department of Radiology and Imaging Sciences (M.L.C., B.K.), Department of Urology (M.K., R.C.R.), and Department of Pathology and Laboratory Medicine (R.F.), Riley Hospital for Children, Indiana University School of Medicine, 705 Riley Hospital Dr, Room 1053, Indianapolis, IN 46202; and Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (S.G.J.).
Matthew L
ML
Cooper
Martin
M
Kaefer
Rong
R
Fan
Richard C
RC
Rink
S Gregory
SG
Jennings
Boaz
B
Karmazyn
D000293:Adolescent; D002137:Calculi / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D013733:Testicular Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D013736:Testicular Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D014463:Ultrasonography