[Testicular microlithiasis--are biopsy and follow-up necessary?].

Introduction: Improvement in the technology of ultrasound has made it possible to visualise small calcifications in the testes, known in the literature as testicular microlithiasis (TM). TM is described in otherwise healthy men, but is also found related to cancer and CIS. Here we will discuss the evaluation and follow up of patients with diagnosed TM.

Material And Methods: The study comprises 14 patients in whom TM was diagnosed sonographically in the period from December 1997 to May 2000.

Results: Ultrasound indicated cancer in two patients. Pathology showed germ cell cancer in both. In 12 patients, ultrasound showed only TM, no suspicion of cancer. Biopsies taken in eight of these patients were all benign.

Discussion: The prevalence of TM is still unknown, as is its aetiology. TM is somehow correlated to testicular cancer, as microliths are found much more often in testes with cancer than in those without malignancy. However, in the vast majority of patients, evidence of cancer or CIS cannot be found. Development of cancer in patients formerly diagnosed with TM is rarely described. In the case of TM and no sonographic signs of cancer, we therefore believe biopsies can be limited to patients at increased risk of testicular cancer, for instance those with retained or small atrophic testes, and also possibly to patients known to have developed TM between repeated ultrasound examinations. If a biopsy shows no signs of malignancy or CIS, we see no need for follow up. If biopsy is not indicated, we recommend a clinical check up, followed by further investigations if these are indicated.