Testicular microlithiasis: a benign condition with a malignant association

Testicular microlithiasis (TM), which usually affects both testes, is diagnosed primarily by ultrasound. TM has been found to be associated with benign conditions but has also been reported in association with testicular cancer. Echographically, TM is manifested by diffuse, punctate, non-shadowing, hyperechoic foci within the testicular parenchyma. To date, more than 80 cases of TM have been documented sonographically or pathologically; 25 of them have demonstrated an association with pathologically proven testicular cancer (p < 0.05). Thirty-two cases were associated with infertility/subfertility (p < 0.05). We believe the finding of TM on ultrasound should heighten the radiologist's suspicion of testicular malignancy. If no malignancy is identified on initial evaluation including CT of the chest and abdomen, close clinical follow-up with periodic (every 6 to 12 months) scrotal ultrasound examination is probably indicated.