Teaching Case

consulted the out-patient department of urology with increasing pain in his right testis. His clinical history was non relevant. There was also no history of abnormal testicular descent. On physical examination the right testis was slightly larger than the left. Ultrasound examination of both testicles was performed.

A 23-year-old man consulted the out-patient department of urology with increasing pain in his right testis. His clinical history was non relevant. There was also no history of abnormal testicular descent. On physical examination the right testis was slightly larger than the left. Ultrasound examination of both testicles was performed.

Multiple calcifications or testicular microlithiasis (TM) is an uncommon, asymptomatic, non-progressive abnormality which is usually discovered incidentally during an ultrasound examination of the testis. The sonographic image of TM is characteristic. It appears as a diffuse speckled pattern with multiple small, echogenic foci scattered throughout the testis, measuring 2mm or less in diameter. A space-occupying lesion in such testis can be easily detected. Testicular microlithiasis is usually bilateral, but it may be asymmetric. The microliths represent calcified laminated layers of collagenous material that form in the seminipherous tubules. Differential diagnosis of small hyperechoic lesions comprises isolated intraluminal calcifications or phleboliths. Processes such as focal scars, calcified granulomas and benign adematous tumors are usually larger hyperechoic and mostly solitary lesions. Hyperechoic masses in the testis may also be formed as a result of orchitis, sarcoidosis or chronic infarction. TM is associated with a number of other abnormal conditions, including cryptorchidism, delayed testicular descent, subfertility and some chromosomal abnormalities such as Klinefelter’s syndrome and Down’s syndrome. There is a strong indication of a high risk of testicular malignancy, in patients with TM. Therefore these patients should have a regular follow-up, including annual scrotal sonography.