1003
Case
..
#{149}
‘
Testicular Pathologic American Journal of Roentgenology 1991.157:1003-1004.
Report
W. Sean
Smith,1
Microlithiasis: Correlation Harry
M. Brammer,1’2
Sonographic
Michael
Henry,3
Testicular microlithiasis is a rare abnormality that histologically consists of concretions within the seminiferous tubules [1]. On sonograms,
affected
testes
have small diffuse
echoic foci [2, 3]. We report a case that highlights sonographic appearance. firmed the calcific nature
hyper-
this unique
A radiograph of the scrotum of the hyperechoic foci.
con-
Case Report The patient pain
is a 36-year-old by
antibiotics
man
with
a 4-month
history
or antiinflammatory
of testicular
medications.
Re-
suits of scrotal examination were normal. Sonography with an Acuson 128 unit and a 7.5-MHz transducer showed both testes to be of size and echogenicity. Diftusely scattered were small homogeneous, nonshadowing,
throughout hyperechoic
both foci
1 A). A radiograph of the scrotum made on a General Electric Sonographic 500T mammographic unit with a phototimed exposure of 25 kVp showed diffuse, homogeneous, 12-mm calcifications scattered throughout both testes (Fig. 1 B). Because of persistent (Fig.
to
symptoms, performed.
exploratory On histologic
surgery and examination,
biopsies of both testes were the parenchyma of the testes
was normal except for laminated microcalcifications scattered randomly throughout. These calcifications were located in the tubular lumen or beneath the epithelium under a thin layer of connective tissue. The tubules containing the microliths had a variable loss of cellularity
(Fig. 1C). One year after biopsy,
matic and findings on a follow-up
sonogram
the patient
was asympto-
were unchanged.
with
Harold
Discussion Although uncommon, testicular calcification usually is dystrophic and caused by previous infections, trauma, or tumor [4]. The presence of calcification in the lumen of seminiferous tubules, as in the case reported here, is unusual [2, 3]. Microlithiasis has been reported in males of all ages, in both cryptorchid and scrotal testes and in testes with normal and dystrophic spermatogenesis [1 -3]. In our case, the testes
were normal with normal
unrelieved
normal testes
and
Features
spermatogenesis.
A case of micro-
lithiasis in a nonfunctioning testis is illustrated for comparison (Figs. 2A and 2B). Intratubular microcalcifications result from formation of microliths from degenerating cells within the seminiferous tubule [1 ]. Formation of microliths appears to be a primary process and not a sequel of a more basic underlying process. Our
cases
underscore
this point
because
the patients
testicular architecture graph of the scrotum
and echogenicity were normal. A radioshowed the calcifications that had been
seen on the sonogram and histologic section. diffuse, uniform appearance of the calcifications
testicular degenerative
microlithiasis breast
and not unlike disease
such
November
1991 0361 -803X/91/1
575-1003
The
as sclerosing
small,
is typical
the appearance
Received May 7, 1 991 : accepted after revision June 26, 1991. The opinions and assertions expressed herein are those of the authors and are not to be construed as reflecting the views of the Department I Department of Radiology, National Naval Medical Center, Bethesda, MD 20889-5000. 2 Deportment of Radiology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd., Bethesda, MD 20889-5000. 3 Department of Pathology, National Naval Medical Center, Bethesda, MD 20889-5000. 4 Department of Urology, National Naval Medical Center, Bethesda, MD 20889-5000. AJR 157:1003-1004,
had no
history of inflammation, infection, trauma, or infarction. Sonographically, testicular microlithiasis has bilateral, diffusely scattered, intraparenchymal hyperechoic foci [2, 3]. In our cases, no significant beam attenuation occurred, and
adenosis.
of Defense.
of
of
SMITH
1004
ET AL.
AJR:157,
American Journal of Roentgenology 1991.157:1003-1004.
Fig. 1.-A, Longitudinal sonogram of right testicle shows multiple hyperechogenic foci caused by microlithiasis. B, Radiograph of scrotum shows diffuse nature of testicular calcifications. C, Histologic section shows microlith beneath an attenuated epithelium and surrounded by a layer of connective
tissue.
Testis
November
is otherwise
1991
normal.
Fig. 2.-A, Sonogram of right testicle shows multiple hyperechoic foci in otherwise normalappearing parenchyma. B, Histologic section shows calcification in a sclerotic tubule without germ cells, surrounded by nonspecific fibrosis (arrow) and Leydig cell hyperplasia (arrowhead).
The distinctive
microcalcifications
of testicular
microlithiasis
REFERENCES
separate them from the microcalcifications associated with tumor, inflammation, or scar, which tend to be solitary, focal, and frequently associated with a mass [5, 6]. If all the criteria for testicular microlithiasis are present, the diagnosis can be made without further clinical or surgical evaluation [3, 7]. If the characteristic sonographic findings are not present, further evaluation
is warranted
as clinically
indicated
[2].
ACKNOWLEDGMENTS The authors
thank
Sudhir
Sover for their contributions.
Arora,
Paul Christenson,
and
Eric
R.
1 . Vegni-Talluri M, Bigliardi E, Vanni MG, Tota G. Testicular microliths: their origin and structure. J Urol 1980:124:105-107 2. Jaramillo D, Perez-Atayde A, Teele RL. Sonography of testicular microlithiasis. Urol Radio! 1989:1 1 : 55-57 3. Doherty FJ, Mullins TL, Sant GR, Drinkwater MA, Ucci AA. Testicular microlithiasis: a unique sonographic appearance. J Ultrasound Med
1987:6:389-392 4. Krone KD, Carroll BA. Scrotal ultrasound. Radio! Clin North Am 1985:23: 121 -1 39 5. Ikinger U, Wurster K, Terwey B, MOhring K. Microcalcifications in testicular malignancy: diagnostic tool in occult tumor? Urology 1982:19:525-528 6. Martin B, Tubiana JM. Significance of scrotal calcifications detected by sonography. JCU 1988:16:545-552 7. Bieger RC, Passarge E, McAdams AJ. Testicular intratubular bodies. J Clin Endocrinol 1965:25:1340-1346
Case
..
#{149}
‘
Testicular Pathologic American Journal of Roentgenology 1991.157:1003-1004.
Report
W. Sean
Smith,1
Microlithiasis: Correlation Harry
M. Brammer,1’2
Sonographic
Michael
Henry,3
Testicular microlithiasis is a rare abnormality that histologically consists of concretions within the seminiferous tubules [1]. On sonograms,
affected
testes
have small diffuse
echoic foci [2, 3]. We report a case that highlights sonographic appearance. firmed the calcific nature
hyper-
this unique
A radiograph of the scrotum of the hyperechoic foci.
con-
Case Report The patient pain
is a 36-year-old by
antibiotics
man
with
a 4-month
history
or antiinflammatory
of testicular
medications.
Re-
suits of scrotal examination were normal. Sonography with an Acuson 128 unit and a 7.5-MHz transducer showed both testes to be of size and echogenicity. Diftusely scattered were small homogeneous, nonshadowing,
throughout hyperechoic
both foci
1 A). A radiograph of the scrotum made on a General Electric Sonographic 500T mammographic unit with a phototimed exposure of 25 kVp showed diffuse, homogeneous, 12-mm calcifications scattered throughout both testes (Fig. 1 B). Because of persistent (Fig.
to
symptoms, performed.
exploratory On histologic
surgery and examination,
biopsies of both testes were the parenchyma of the testes
was normal except for laminated microcalcifications scattered randomly throughout. These calcifications were located in the tubular lumen or beneath the epithelium under a thin layer of connective tissue. The tubules containing the microliths had a variable loss of cellularity
(Fig. 1C). One year after biopsy,
matic and findings on a follow-up
sonogram
the patient
was asympto-
were unchanged.
with
Harold
Discussion Although uncommon, testicular calcification usually is dystrophic and caused by previous infections, trauma, or tumor [4]. The presence of calcification in the lumen of seminiferous tubules, as in the case reported here, is unusual [2, 3]. Microlithiasis has been reported in males of all ages, in both cryptorchid and scrotal testes and in testes with normal and dystrophic spermatogenesis [1 -3]. In our case, the testes
were normal with normal
unrelieved
normal testes
and
Features
spermatogenesis.
A case of micro-
lithiasis in a nonfunctioning testis is illustrated for comparison (Figs. 2A and 2B). Intratubular microcalcifications result from formation of microliths from degenerating cells within the seminiferous tubule [1 ]. Formation of microliths appears to be a primary process and not a sequel of a more basic underlying process. Our
cases
underscore
this point
because
the patients
testicular architecture graph of the scrotum
and echogenicity were normal. A radioshowed the calcifications that had been
seen on the sonogram and histologic section. diffuse, uniform appearance of the calcifications
testicular degenerative
microlithiasis breast
and not unlike disease
such
November
1991 0361 -803X/91/1
575-1003
The
as sclerosing
small,
is typical
the appearance
Received May 7, 1 991 : accepted after revision June 26, 1991. The opinions and assertions expressed herein are those of the authors and are not to be construed as reflecting the views of the Department I Department of Radiology, National Naval Medical Center, Bethesda, MD 20889-5000. 2 Deportment of Radiology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd., Bethesda, MD 20889-5000. 3 Department of Pathology, National Naval Medical Center, Bethesda, MD 20889-5000. 4 Department of Urology, National Naval Medical Center, Bethesda, MD 20889-5000. AJR 157:1003-1004,
had no
history of inflammation, infection, trauma, or infarction. Sonographically, testicular microlithiasis has bilateral, diffusely scattered, intraparenchymal hyperechoic foci [2, 3]. In our cases, no significant beam attenuation occurred, and
adenosis.
of Defense.
of
of
SMITH
1004
ET AL.
AJR:157,
American Journal of Roentgenology 1991.157:1003-1004.
Fig. 1.-A, Longitudinal sonogram of right testicle shows multiple hyperechogenic foci caused by microlithiasis. B, Radiograph of scrotum shows diffuse nature of testicular calcifications. C, Histologic section shows microlith beneath an attenuated epithelium and surrounded by a layer of connective
tissue.
Testis
November
is otherwise
1991
normal.
Fig. 2.-A, Sonogram of right testicle shows multiple hyperechoic foci in otherwise normalappearing parenchyma. B, Histologic section shows calcification in a sclerotic tubule without germ cells, surrounded by nonspecific fibrosis (arrow) and Leydig cell hyperplasia (arrowhead).
The distinctive
microcalcifications
of testicular
microlithiasis
REFERENCES
separate them from the microcalcifications associated with tumor, inflammation, or scar, which tend to be solitary, focal, and frequently associated with a mass [5, 6]. If all the criteria for testicular microlithiasis are present, the diagnosis can be made without further clinical or surgical evaluation [3, 7]. If the characteristic sonographic findings are not present, further evaluation
is warranted
as clinically
indicated
[2].
ACKNOWLEDGMENTS The authors
thank
Sudhir
Sover for their contributions.
Arora,
Paul Christenson,
and
Eric
R.
1 . Vegni-Talluri M, Bigliardi E, Vanni MG, Tota G. Testicular microliths: their origin and structure. J Urol 1980:124:105-107 2. Jaramillo D, Perez-Atayde A, Teele RL. Sonography of testicular microlithiasis. Urol Radio! 1989:1 1 : 55-57 3. Doherty FJ, Mullins TL, Sant GR, Drinkwater MA, Ucci AA. Testicular microlithiasis: a unique sonographic appearance. J Ultrasound Med
1987:6:389-392 4. Krone KD, Carroll BA. Scrotal ultrasound. Radio! Clin North Am 1985:23: 121 -1 39 5. Ikinger U, Wurster K, Terwey B, MOhring K. Microcalcifications in testicular malignancy: diagnostic tool in occult tumor? Urology 1982:19:525-528 6. Martin B, Tubiana JM. Significance of scrotal calcifications detected by sonography. JCU 1988:16:545-552 7. Bieger RC, Passarge E, McAdams AJ. Testicular intratubular bodies. J Clin Endocrinol 1965:25:1340-1346
