Testicular microlithiasis: clinical significance and review of the literature

Testicular microlithiasis (TM) is an uncommon condition characterized by calcium deposits within the seminiferous tubules. On ultrasound (US), it is seen as multiple, uniform, nonshadowing echogenic foci in the testis. Although its true prevalence in the general population is still unknown, reported prevalences range from 0.6 to 9%. The TM is often associated with germ cell tumor (GCT) or intratubular germ cell neoplasia. The incidence of GCT in patients with TM was reported as 6–46%. There are several reports demonstrating interval development of GCT in patients with TM. These may suggest a premalignant nature of TM; however, more recent studies show a lower incidence of associated GCT and no interval development of tumor in relatively longer duration follow-up. Additionally, previously reported cases of interval tumor development had predisposing factors for testicular GCT. According to the recent literature, it is suggested that both TM and testicular GCT may be caused by a common defect, such as tubular degeneration, and TM may present as a marker for such abnormalities; however, because of a high incidence of association with GCT, it is prudent to follow up patients with TM with physical examination and US at least annually and to encourage self-examination. The routine use of biochemical tumor markers, abdominal and pelvic CT, or testicular biopsy does not seem to be justified.     

Testicular microlithiasis: US follow-up

PURPOSE: To determine in patients with testicular microlithiasis (TM) the short-term natural history of classic TM (CTM) and limited TM (LTM). MATERIALS AND METHODS: In 104 patients, testicular microliths were identified on ultrasonographic (US) images; 39 patients had five or more microliths on at least one US image (criterion for CTM), and 65 patients had fewer than five microliths (criterion for LTM). Attempts were made to have all patients return for follow-up US to assess for change in TM or development of tumor. RESULTS: Seven (18%) of the 39 patients with CTM and one (2%) of the 65 patients with LTM had tumor at presentation (P =.004). Among all 104 patients, follow-up US was performed in 72 patients (31 with CTM, 41 with LTM), with mean follow-up of 45 months (range, 12-90 months). None of these patients had interval development of testicular neoplasm. LTM did not progress to CTM in any patient. Progression in number of microliths was seen in two patients with CTM. CONCLUSION: Patients with LTM have a lower prevalence of associated malignancy than do patients with CTM. The risk of developing malignancy in patients with isolated TM (LTM or CTM) is low at short-term follow-up. These results raise the question of the need for routine US in this patient population.     

Dandy-Walker variant: prenatal sonographic features and clinical outcome.

The Dandy-Walker variant is a less severe posterior fossa anomaly than the classic Dandy-Walker malformation. In 17 consecutive fetuses, the Dandy-Walker variant was diagnosed at sonography, and associated defects, karyotypic anomalies, and outcomes were evaluated. Four of the 17 fetuses (24%) had mild ventriculomegaly. Eight of the 17 (47%) had concurrent non-central nervous system (CNS) anomalies. Five fetuses (29%) had an abnormal karyotype (two with trisomy 18, one each with trisomy 13, 21, and 11q+) and associated sonographic anomalies. Six of the 17 fetuses (35%) died in utero or during the neonatal period, two are severely handicapped, and the other nine are developing normally at ages 4 months to 4 years. Six of the nine normally developing infants (53%) lacked non-CNS sonographic findings. Because the prognosis is uncertain for an infant born with the prenatal diagnosis of Dandy-Walker variant, prenatal recognition of the anomaly allows for the option of fetal karyotyping and for arrangement for postnatal follow-up.     

Original report. Testicular torsion in neonates and infants: sonographic features in 30 patients

OBJECTIVE: The purpose of this study was to illustrate the spectrum of sonographic findings in testicular torsion in a large series of neonates and infants. These patterns and their evolution have, to our knowledge, not been described previously. CONCLUSION: The sonographic appearance of testicular torsion in neonates and infants can be divided into three types. We believe that the findings represent different stages in the evolution of testicular torsion.     

Testicular microlithiasis: prospective analysis of prevalence and associated tumor

PURPOSE: To evaluate testicular microlithiasis (TM) prospectively with modern state-of-the-art equipment. MATERIALS AND METHODS: Information concerning indication for examination, presence and degree of TM, presence of testicular tumor, and patient age was prospectively recorded for all patients referred for scrotal ultrasonography between 1996 and 1999. High-frequency linear transducers (7.5 MHz or higher) were used. TM was divided into classic (CTM) and limited (LTM) on the basis of the presence of five or more microliths on one or more images of the testes. Fisher exact tests were used for determining significant differences in proportions. RESULTS: Data in 1,079 patients were analyzed. The overall prevalence of TM was 18.1% (195 of 1,079). Forty (3.7%) patients had CTM, and 155 (14.4%) had LTM; 15 (1.4%) had tumors visible at US. Tumors were present in three (8%) of 40 patients with CTM (seminoma in two, embryonal cell in one), nine (5.8%) of 155 with LTM (seminoma in six, mixed germ cell in one, Leydig cell in two), and three (0.3%) of 884 with no TM (seminoma in two, other in one). There was no difference between CTM and LTM (P =.72) in the rate of coexisting tumor. There was a significant difference between no TM and CTM or LTM (P 相似文献   

Testicular microlithiasis in association with pseudoxanthoma elasticum

PURPOSE: To determine the presence of testicular microlithiasis in male subjects with pseudoxanthoma elasticum (PXE). MATERIALS AND METHODS: Institutional review board approval was obtained for the prospective and retrospective components of this HIPAA-compliant study. Informed consent was obtained from all patients or their parents. Testicular ultrasonography (US) was performed in eight men aged 29-56 years and in one 13-year-old boy, all with confirmed PXE. Two radiologists reviewed the US images by consensus for testicular microlithiasis, testicular masses, and additional testicular abnormalities. Testicular microlithiasis was judged to be classic when at least five microliths were seen on a single US image and to be limited when fewer than five microliths were seen on all obtained US images. Urologic physiologic examinations were performed. A history and/or symptoms of testicular disease also were recorded at the time of examination. Similarly, the testicular US images obtained in two additional men, aged 48 and 59 years, and in another 13-year-old boy were retrospectively reviewed. Histopathologic testicular analysis was performed in one autopsy case. RESULTS: Of the 12 participants, 11 (92%) had classic and one (8%) had limited testicular microlithiasis. None of the 12 participants had evidence of testicular malignancy at US or physical examination. Histopathologic analysis at autopsy revealed intratubular microlithiasis without the calcification of elastic fibers in arterial walls that is characteristic of cutaneous PXE. CONCLUSION: Study findings suggested an association between PXE and testicular microlithiasis. It is possible that the testicular microlithiasis in male subjects who have PXE is related to the underlying PXE abnormality.     

Testicular adrenal rest tissue in congenital adrenal hyperplasia: serial sonographic and clinical findings

OBJECTIVE: The purpose of this study was to describe the serial sonographic findings and clinical and laboratory data obtained during follow-up of patients with congenital adrenal hyperplasia in whom testicular adrenal rest tissue develops. MATERIALS AND METHODS: We retrospectively reviewed testicular sonography and laboratory data for 12 patients with congenital adrenal hyperplasia who also had intratesticular masses consistent with adrenal rest tissue. The studies were done during follow-up that ranged from 7 months to 10 years. RESULTS: During follow-up of 11 of the 12 patients after the initial sonographic diagnosis, the testicular adrenal rest tissue either remained stable in size (n = 1), grew larger or smaller (n = 9), disappeared (n = 4), or reappeared after disappearing (n = 3). In one patient, the testicular adrenal rest tissue grew very rapidly in a 1-month interval. Discordant changes in the testicular adrenal rest tissue were noted in 10 patients with bilateral masses. We found no relationship between the change in size of the masses and clinical control (based on 17-hydroxyprogesterone level) at the time of sonography. CONCLUSION: In patients with congenital adrenal hyperplasia who have testicular masses detected sonographically, testicular adrenal rest tissue is the most likely diagnosis. Testicular adrenal rest tissue may remain stable in size, grow larger or smaller, or disappear during sonographic follow-up. The change in size may be marked, may occur very rapidly, and, in our study cohort, was not related to short-term clinical control based on 17-hydroxyprogesterone level at the time of sonography.     

Testicular adrenal rest tumours in postpubertal males with congenital adrenal hyperplasia: sonographic and MR features

The purpose of this study was to investigate the prevalence of testicular adrenal rest tumours in patients with congenital adrenal hyperplasia (CAH), and to describe sonographic and MR features of these lesions. Seventeen postpubertal male CAH patients underwent scrotal sonography, with colour Doppler, and in 16 of them pre- and postcontrast enhanced T1- and T2-weighted MR images of the testes were obtained. Ultrasound revealed lesions in 16 of 17 patients (94%), bilateral in 10 patients and unilateral in 6 patients. The lesions were typically located adjacent to the mediastinum testis. The maximal diameter of the lesions varied from 2 to 40 mm. Margins were blurred in 11 of 31 lesions. Seventeen of the 20 lesions smaller than 2 cm in diameter were hypoechoic, whereas all 11 lesions larger than 2 cm showed hyperechoic reflections. On MR all lesions were isointense on T1- and hypointense on T2-weighted images and lesion margins were clearly defined. Enhancement of the lesions after intravenous contrast was seen in 13 of 15 patients. In our series the prevalence of testicular adrenal rest tumours in postpubertal CAH patients is much higher than in other reported studies. The lesions may develop from some small, hypoechoic, and multifocal nodules and coalesce to large hypoechoic lesions with hyperechoic reflections on ultrasound. As our results suggest that ultrasonography and MR show the lesions equally well, ultrasonography should be the method of first choice for detection and follow-up of these lesions, because it is the cheapest and quickest imaging technique. In case of a partial orchiectomy, MR is recommended because it shows lesion margins optimally.     

临床型肾结核的超声声像图特征分析

目的探讨临床型肾结核的超声声像图特征。方法回顾分析42例50个病肾肾结核住院患者的病例资料,总结肾结核的超声声像图特征。结果超声诊断符合率62%。主要超声声像图特征:(1)肾实质内单发或多发低回声或无回声结构31个肾,占62%;(2)肾盂肾盏扩张27个肾,占54%;(3)合并输尿管结核18例,21个肾,占42%;(4)肾萎缩并钙化3个肾,占6%。结论临床型肾结核超声表现呈多样性,但仍有一定特征,结合临床可作出初步诊断。     

Testicular microlithiasis: US findings in six pediatric cases and literature review

The aim of this article is to report on six pediatric cases of testicular microlithiasis (TM) and to review literature reports, in order to schedule US and/or other control examinations, particularly when concomitant focal or diffuse alterations of the testicular parenchymal structure are present, considering the possible association of TM with testicular tumors. Six patients (age range 4–12 years) underwent US examination for scrotal trauma (two cases) unilateral cryptorchidism (one case) follow-up after orchidopexy for bilateral cryptorchidism (one case), and varicocele (two cases). Five examinations were performed with high-frequency probes (10/13 MHz) and seven with 5/7.5-MHz frequency transducers. Follow-up US examinations were performed at different times depending on initial clinical indications, presence of underlying disease, and initial US findings. Two of the six patients underwent three US examinations, two patients underwent two US examinations, and the remaining two patients underwent only one US examination. The patients underwent a total of 12 US examinations. Microliths were bilateral in four patients and unilateral in two patients. In these two latter cases, the contralateral testis was, in one case, cryptorchid and could not be evaluated by US; in the other case it was small and hyperechogenic with orchidopexy sequelae. In three cases microliths were distributed throughout the testis. In the remaining three cases they were present in limited areas of parenchyma. As to the importance of microliths, it was defined as mild in three cases and moderate/severe in three cases. Intratubular testicular microlithiasis is a well-proved histological finding (biopsy or autopsy). More recent is the US demonstration of TM with consequent definition of its pattern: usually bilateral hyperechogenic multiple small foci without acoustic shadows with complete or partial extension to the parenchyma. Testicular microlithiasis is a rare finding. Moreover, the pediatric cases reported in the literature are very few. However, the use of high-frequency US transducers (10–13 MHz) has recently allowed an easier demonstration of this disease also in children. Of particular interest is the study of the still-debated association of microliths with other diseases such as neoplasms. Some aspects need further investigation, namely the real incidence of microliths in the healthy population, the incidence of tumors in patients with microliths, the differences between adults and children, and the different types of follow-up at different ages. In pediatric age, if TM represents an isolated sign, patients need non-invasive US follow-up until adult age. Only if TM is in association with focal lesions of testis parenchyma is it mandatory to perform biopsy or surgical treatment. Received: 17 June 1998; Revision received: 26 August 1998; Accepted: 21 September 1998     

Testicular microlithiasis: what is its association with testicular cancer?

PURPOSE: To determine the prevalence of testicular microlithiasis in patients who were referred for scrotal ultrasonography (US) at a tertiary care cancer center and to evaluate the association between microlithiasis and cancer. MATERIALS AND METHODS: Testicular sonograms obtained in 528 men were retrospectively reviewed to identify patients with US findings suggestive of microlithiasis, intratesticular masses, and intratesticular heterogeneous changes. The association of US findings with medical records and with histopathologic findings that were available in 95 patients was evaluated. Statistical analysis was performed to determine the relationship of testicular cancer, intratesticular mass, and microlithiasis. RESULTS: Forty-eight (9%) of the 528 patients had microlithiasis; 13 of these (27%) had testicular cancers. Of the 480 patients without microlithiasis, 38 (8%) had testicular cancer. Ninety patients had an intratesticular mass, of whom 23 (26%) had microlithiasis. Forty-three (12 with microlithiasis) patients with a mass had testicular cancer, 43 (10 with microlithiasis) had benign findings or nontesticular malignant histopathologic findings, and four (one with microlithiasis) had no pathologic findings. CONCLUSION: Intratesticular microlithiasis is highly associated with confirmed testicular cancer, as well as with US evidence of testicular mass.     

Fat necrosis of the breast: clinical, mammographic and sonographic features

OBJECTIVE: the purpose of this study was to describe and quantitate the clinical, mammographic and sonographic (US) features and to evaluate the evolution of fat necrosis in the breast. MATERIALS AND METHODS: a retrospective review of the clinical, mammographic and US findings of 126 fat necrosis lesions in 94 patients, diagnosed between 1989 and 1999, was done. All the cases included in the study had at least 3 years follow-up mammograms. In addition, 48 patients with a total of 62 fat necrosis lesions, also had an US follow-up. Fat necrosis was diagnosed on the basis of histologic (n=25) and initial or follow-up imaging (n=69) findings. RESULTS: the predominant mammographic features of the 114 lesions apparent on mammograms were radiolucent oil cyst (n=34, 26.9%), round opacity (n=16, 12.6%), asymmetrical opacity or heterogenicity of the subcutaneous tissues (n=20, 15.8%), dystrophic calcifications (n=34, 26.9%), clustered pleomorphic microcalcifications (n=5, 3.9%), and suspicious speculated mass (n=5, 3.9%). In five patients with 12 (9.5%) palpable masses, mammograms were normal. The predominant US features of the 112 lesions apparent on sonograms were solid (n=18, 14.2%), anechoic with posterior acoustic enhancement (n=21, 16.6%), anechoic with posterior acoustic shadowing (n=20, 15.8%), cystic with internal echoes (n=14, 11.1%), cystic with mural nodule (n=5, 3.9%) and increased echogenicity of the subcutaneous tissues (n=34, 26.9%). In five patients with 14 (11.1%) lesions, sonographic examination was normal. Mammographic follow-up showed that five of the radiolucent oil cysts developed curvilinear calcifications, six of the round opacities decreased in size and density, and another two disappeared. Eleven of the dystrophic calcifications became even more coarse. Six of the asymmetrical opacities became vague and one developed an oil cyst and coarse calcifications. The only nonoperated speculated mass developed a typical small radiolucent oil cyst in the centre. US follow-up showed that 18 of the 29 increased subcutaneous tissue echogenicity turned back to normal, while in the remaining 11 small cysts formed. In 19 solid appearing masses, 15 showed decrease in size, while four remained stable (biopsy disclosed fat necrosis). The four complex masses in two patients showed increase in size and appeared more cystic (FNAB was consistent with fat necrosis). CONCLUSION: a spectrum of imaging findings is associated with fat necrosis. Knowledge of the mammographic and US appearance and evolution of these patterns may enable imaging follow-up of these lesions, reducing the number of unnecessary biopsies.     

Abdominal lymphadenopathy in intravenous drug addicts: sonographic features and clinical significance

The sonographic features of abdominal lymphadenopathy in 35 patients with history of intravenous drug addiction were analyzed to assess their clinical significance. Of the 28 proven cases, 15 were due to reactive hyperplasia, 10 to infections, and three to neoplasms. Sonography was helpful in assessing the pathologic nature of these nodes. Most nodes attributable to reactive hyperplasia were small (less than or equal to 1.5 cm diam) and showed a characteristic distribution in the porta hepatis, celiac axis, and peripancreatic regions. Hypoechoic nodes were always pathologic, due either to tuberculosis or to neoplasm. Nodes larger than 1.5 cm in diameter and primarily involving the lower retroperitoneum, splenic hilum, and mesentery are highly suspicious for pathologic nodes, and appropriate biopsies are indicated for diagnosis.     

Comparison of tuberculous and pyogenic epididymal abscesses: clinical, gray-scale sonographic, and color Doppler sonographic features

OBJECTIVE: The purpose of this study was to evaluate the capability of clinical, gray-scale sonographic, and color Doppler sonographic features for differentiating tuberculous and pyogenic epididymal abscesses. MATERIALS AND METHODS: Retrospective analysis was performed in 10 cases of tuberculous epididymal abscess and in 13 cases of pyogenic epididymal abscess. The following clinical, gray-scale sonographic, and color Doppler sonographic features were analyzed: patient's age; duration of symptoms; scrotal tenderness; presence of sinus tract; concurrent tuberculosis in other organs; location, size, and echogenicity of the abscess; hyperechoic rim; testicular involvement; hydrocele; and blood flow in the epididymal lesion. RESULTS: Tuberculous epididymal abscess had a longer duration of symptoms (p = 0.0001) and a lower frequency of scrotal tenderness (p = 0.0048) than pyogenic epididymal abscess. The size of the abscess was larger in tuberculous epididymal abscess than in pyogenic epididymal abscess (p = 0.0002). The degree of blood flow in the peripheral portion of the abscess was lower in tuberculous epididymal abscess (p = 0.001). The patient's age, location and echogeninicity of the abscess, presence of sinus tract, hyperechoic rim, testicular involvement, and hydrocele did not differ between the tuberculous and pyogenic epididymal abscesses. CONCLUSION: Some clinical findings, gray-scale sonography, and color Doppler sonography were useful in differentiating tuberculous epididymal abscess from pyogenic epididymal abscess. The presence of long-term scrotal swelling without tenderness and a lower degree of blood flow in the peripheral portion of a large abscess are suggestive of tuberculous epididymal abscess.