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Optimal follow-up unclear for testicular microlithiasis patients.

CARMEL, CALIF. -- The classic form of testicular microlithiasis is strongly associated with subsequent testicular malignancy, Diana Lam reported at the Western regional meeting of the American Federation for Medical Research.

But it remains unclear what the optimum follow-up care is for patients with testicular microlithiasis, which is characterized at sonography by multiple microcalcifications in the testes.

"Follow up may be needed [for] patients with classic testicular microlithiasis and other risk factors," said Ms. Lam, a second-year medical student at the University of California, Davis. "We recommend testicular self-examination as an inexpensive way for early detection of malignancy."

She and her associates in the department of radiology at the university evaluated testicular sonograms performed on 2,957 patients over a 10-year period. Overall, 137 patients with testicular microlithiasis were identified, for an incidence of 4.6%.

The researchers divided those 137 patients into two groups: those with classic testicular microlithiasis, defined as having five or more calcifications per image, and those with limited testicular microlithiasis, defined as having fewer than five calcifications per image.

They also randomly selected a group of 137 patients who did not have testicular microlithiasis to serve as a control group.

Of the 137 patients with testicular microlithiasis, 8 (5.8%) patients later developed testicular malignancy. Ms. Lam reported that all eight patients had presented with classic testicular microhthiasis. Meanwhile, only one patient in the control group (0.7%) had a testicular malignancy.

Subset analysis of 30 patients with limited testicular microlithiasis who did not have a testicular cancer at the time of first ultrasound revealed that none developed subsequent testicular malignancies during an average follow-up of 19 months.

"We think the most prudent use of resources for early detection of malignancy would be that all patients with classic testicular microlithiasis perform testicular self-examinations and follow-up be limited to a subgroup of patients with classic testicular microlithiasis and other risk factors," the researchers wrote in their abstract.

Those risk factors include testicular swelling, testicular pain, and the presence of a mass on the testes, Ms. Lam said at the meeting.

The prevalence of testicular microlithiasis is believed to range from 0.6% to 9%.

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Title Annotation:Clinical Rounds
Author:Brunk, Doug
Publication:Family Practice News
Article Type:Disease/Disorder overview
Date:Mar 1, 2007
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