Yulia V. Volokhina MD, Presenter: Nothing to Disclose

John Howard Miller MD, Abstract Co-Author: Nothing to Disclose

There is a suggestion in the ultrasound (US) literature that testicular microlithiasis (TM) predicts an increased risk of testicular malignancy, especially testicular germ cell tumors (TGCT). While this association has been suggested in adult literature, only several case reports in children have been reported. We conducted a retrospective review of testicular tumor occurrence in patients with TM to asses this risk.

1225 testicular US exams performed on 1095 pediatric patients (younger than 19 years of age) in our institution from 2006 through 2011 were reviewed for presence of TM and masses. Incidence of testicular malignancy was calculated in a group of patients with TM and in a matched control group without TM. Relative risk was then calculated: [number of TM patients with TGCT/total number of TM patients] / [number of non TM patients with TGCT/total number of non TM patients].

TM was found in 57 patients out of our total of 1095.  No patients were found to have both testicular malignancy and TM. In our matched control group of 1038 patients without TM 6 had biopsy proven primary TGCT. Incidental findigns among 57 patients with TM included 1 patient with diagnosis of myxoid mesenchymal tumor and 1 patient with right paratesticular embryonal rhabdomyosarcoma.  In our 1038 patients without TM, there was 1 patient with testicular adrenal rests associated with adrenal hyperplasia, 1 with possible testicular lymphoma, 1 with precursor B cell acute lymphoblastic lymphoma/leukemia, and 1 patient with a benign testicular mass. Observed incidence of TM in our institution was 5.2%. Incidence of TGCT in TM patients was 0.0%, while incidence of TGCT in non TM patients was 0.58%.  Relative risk of TGCT in TM patients versus non TM patients was 0.

We found that there is no association between TGCT and TM in pediatric patients. The incidence of TGCT was in fact greater in non TM patients. The incidence of TM in our institution is comparable to previously reported in the literature. We had hoped to do a metanalysis of relationship between TM and TGCT, but only two studies had a sufficient case control group of non TM patients. These studies had no patients with both TM and TGCT.  

We have concluded based on our data and that previously reported data that there is no association of TM and TGCT. In fact, based on our data, there is stronger association of TGCT and non TM patients.

Volokhina, Y, Miller, J, Ultrasound Demonstration of Testicular Microlithiasis in Pediatric Patients: Is There an Association with Testicular Malignancy?.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12034503.html