Pediatric testicular microlithiasis through four clinical case studies: review of the literature and proposal of clinical guidelines

Background Testicular microlithiasis in children was defined for the first time in 1961 based on histological criteria. There should be more than 5 calcifications per testicle in order to say that the patient has testicular microlithiasis. It has three different echographic grades depending on the number of calcifications. However, this disease is uncommon, with inaccurate prevalence and no certain information about its evolution or etiology. Main body We studied 4 clinical cases of children diagnosed with testicular microlithiasis, in light of the conducted review of the literature, and we defined the characteristics of this disease and proposed a management and monitoring framework based on the clinical observations. Conclusion There is a link between testicular microlithiasis and testicular cancer. Therefore, it is recommended to make a regular follow-up of children who present testicular microlithiasis with the presence of risk factors.

Shorter anogenital distance is observed in patients with testicular microlithiasis using magnetic resonance imaging

Objective To investigate the anogenital distance in patients with and without testicular microlithiasis (TML). Methods A total of 101 patients underwent a conventional standard clinical B-mode scrotal ultrasonography and scrotal MRI. The patients were divided into two groups: patients with TML and non-TML. The latter served as control group. The anogenital distance was measured by a straight line from center of the anus to the posterior base of scrotum using MRI. Results In the TML group, mean AGD was 5.4 (± 1.07) cm (range 29–79 mm), and in non-TML 5.9 (± 1.03) cm (range 35–85 mm) (p = 0.04). Conclusion MRI is a useful tool to measure the AGD. It is easy to perform without any discomfort to patients. We found AGD to be lower in patients with TML.

Histological Features of Sporadic and Familial Testicular Germ Cell Tumors Compared and Analysis of Age-Related Changes of Histology

This study aimed to compare histological features of familial and sporadic testicular germ cell tumors (TGCTs) and surrounding parenchyma, since discriminating features might be etiologically relevant and clinically useful. The study of parenchyma was prompted by reports claiming a higher prevalence of testicular microlithiasis in familial cases. Histological features of TGCTs and surrounding parenchyma of 296 sporadic and 305 familial cases were compared. For each case, one representative hematoxylin and eosin-stained slide was available. Slides were independently scored by two expert pathologists using a semi-quantitative data abstract. Discrepancies were resolved by consensus. A logistic regression model was used to assess the ability to discriminate between sporadic and familial GCT. The histological composition of a tumor, amount of lymphocytic infiltration, amount of germ cell neoplasia in situ (GCNIS), and presence of testicular microlithiasis (TM) did not discriminate between sporadic and familial GCT (area under the curve 0.56, 95%CI 0.51–0.61). Novel observations included increasing lymphocytic infiltration and decreasing GCNIS and TM with increasing age at diagnosis. The presence of tubules with infiltrating lymphocytes was mainly associated with pure seminomas and nonseminomas with a seminoma component. Among seminomas, tubules with infiltrating lymphocytes decreased with increasing age. No discernable differences between sporadic and familial TGCTs were found. The age-related changes in the tumors and surrounding parenchyma in these groups combined are consistent with a host response building up over time predominantly affecting seminomas, the seminoma-component of nonseminomas and GCNIS. TM may gradually dissolve with age. Our hypothesis that histological differences between sporadic and familial TGCT might identify genetically distinct disease subsets was not supported.