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.

Carcinoma in situ, Follow-up, Microlithiasis, Testes, Ultrasonography
dx.doi.org/10.1111/j.1365-2605.2008.00937.x, hdl.handle.net/1765/27168
International Journal of Andrology
Erasmus MC: University Medical Center Rotterdam

van Casteren, N.J, Looijenga, L.H.J, & Dohle, G.R. (2009). Testicular microlithiasis and carcinoma in situ overview and proposed clinical guideline. International Journal of Andrology (Vol. 32, pp. 279–287). doi:10.1111/j.1365-2605.2008.00937.x