title: Relationship Between the Pathologic Subtype/Initial Stage and Microliths in Testicular Germ Cell Tumors.
abstract: OBJECTIVE
  To investigate the relationship between microliths and germ cell tumor histologic subtypes and determine whether microliths correlate with tumor stage at diagnosis.
  
  
  METHODS
  A total of 1249 patients with testicular cancer seen between 1999 and 2013 were evaluated; 346 of 1249 patients (28%) with primary testicular tumors and sonographic imaging of unaffected testicular tissue formed the analytic cohort. Age, ethnicity, tumor histologic subtype, and stage at diagnosis were extracted from the medical record. Two examiners concurrently recorded the highest number of microliths per image of unaffected testicular tissue.
  
  
  RESULTS
  A total of 175 of 346 patients (51%) had 1 or more microliths; 69 of 346 (20%) had more than 5 microliths per image. The histologic percentage of seminomas positively correlated with the microlith count (rs = 0.12; P = .036); the histologic percentage of embryonal components negatively correlated with the microlith count (rs = -0.15; P = .007). A higher microlith count was associated with a lower stage at diagnosis (P = .0243). Subgroup analysis of pure seminomas suggested a trend toward a higher microlith count in patients with lower-stage disease at diagnosis (P= .07). No association was found between the tumor stage at diagnosis and microlith count in patients with greater than 50% embryonal components of tumors (P= .55). No association was found between microliths and age, tumor size, and presence of lymphovascular/rete testis invasion (P = .120, .500, .629, and .155, respectively).
  
  
  CONCLUSIONS
  Patients with testicular cancer who have microliths may be more likely to have a higher percentage of seminomas and a lower percentage of embryonal components in their primary tumors. Microliths also showed an association with earlier stages of disease at diagnosis.
authors.affiliation: Department of Imaging, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts USA (F.S., M.H.R., S.H.T., S.A.H.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts USA (F.S., M.H.R., S.H.T., S.A.H.); Harvard Medical School, Boston, Massachusetts USA (M.J.W.); and Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts USA (C.S.).
authors.forename: Farhana
authors.initials: F
authors.lastname: Sharmeen
authors.affiliation: Department of Imaging, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts USA (F.S., M.H.R., S.H.T., S.A.H.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts USA (F.S., M.H.R., S.H.T., S.A.H.); Harvard Medical School, Boston, Massachusetts USA (M.J.W.); and Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts USA (C.S.).
authors.forename: Michael H
authors.initials: MH
authors.lastname: Rosenthal
authors.affiliation: Department of Imaging, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts USA (F.S., M.H.R., S.H.T., S.A.H.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts USA (F.S., M.H.R., S.H.T., S.A.H.); Harvard Medical School, Boston, Massachusetts USA (M.J.W.); and Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts USA (C.S.). monicajwood@post.harvard.edu.
authors.forename: Monica J
authors.initials: MJ
authors.lastname: Wood
authors.affiliation: Department of Imaging, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts USA (F.S., M.H.R., S.H.T., S.A.H.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts USA (F.S., M.H.R., S.H.T., S.A.H.); Harvard Medical School, Boston, Massachusetts USA (M.J.W.); and Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts USA (C.S.).
authors.forename: Sree Harsha
authors.initials: SH
authors.lastname: Tirumani
authors.affiliation: Department of Imaging, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts USA (F.S., M.H.R., S.H.T., S.A.H.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts USA (F.S., M.H.R., S.H.T., S.A.H.); Harvard Medical School, Boston, Massachusetts USA (M.J.W.); and Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts USA (C.S.).
authors.forename: Christopher
authors.initials: C
authors.lastname: Sweeney
authors.affiliation: Department of Imaging, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts USA (F.S., M.H.R., S.H.T., S.A.H.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts USA (F.S., M.H.R., S.H.T., S.A.H.); Harvard Medical School, Boston, Massachusetts USA (M.J.W.); and Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts USA (C.S.).
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Howard
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002137:Calculi / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology*; D013223:Statistics as Topic; D013736:Testicular Neoplasms / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology*; D014463:Ultrasonography / Q000379:methods*; D055815:Young Adult
keywords: embryonal carcinoma; genitourinary ultrasound; microlithiasis; seminoma; testicular germ cell tumor; testicular sonography