|Year : 2021 | Volume
| Issue : 1 | Page : 21-23
Testicular microlithiasis seen in primary infertility
John Sheyin1, Nuhu D Chom2
1 Department of Radiology, Faculty of Clinical Sciences, College of Medicine, Kaduna State University, Kaduna, Nigeria
2 Department of Radiology, Ahmadu Bello Teaching Hospital, Zaria, Nigeria
|Date of Submission||20-Nov-2019|
|Date of Acceptance||18-Sep-2020|
|Date of Web Publication||22-Apr-2021|
Dr. John Sheyin
Department of Radiology, Faculty of Clinical Sciences, College of Medicine, Kaduna State University, Kaduna
Source of Support: None, Conflict of Interest: None
Testicular microlithiasis (TM) is rare and usually asymptomatic. It is usually bilateral but has been reported on single testis. TM is defined as five microliths on a single sonogram; it is divided into classical TM and limited TM. There is association between TM and neoplasm. A 34-year-old male presented with a history of primary infertility. Investigations done were normal, except for semen analysis and scrotal ultrasound. The scrotal scan showed multiple hyperechoic foci in both testes. The patient did not come for follow-up in the clinic. Ultrasound is used to diagnose TM in a case of infertility
Keywords: Hyperechoic foci, infertility, testicular microlithiasis
|How to cite this article:|
Sheyin J, Chom ND. Testicular microlithiasis seen in primary infertility. West Afr J Radiol 2021;28:21-3
| Introduction|| |
Testicular microlithiasis (TM) is rare and usually asymptomatic., It was first reported by Priebe and Garret in 1970 in a healthy 4-year-old child., With increasing pathologic awareness came the first description of its sonographic appearances by Doherty et al. in 1987.,, Sonographic TM appears as small, nonshadowing hyperechoic foci ranging in diameter from 1 to 3 mm. This occurs within the testicular parenchymal but may be distributed peripherally or segmentally. TM usually occurs bilaterally but has been reported in a single testis.,,,, The number of microliths required to define TM has been arbitrary, but the consensus now is to accept five on a single sonogram. Classification of TM is into two; the classical TM (CTM) or limited TM (LTM) which also have two definitions. CTM is defined as when there is five or more multiple hyperechoic foci in a single sonogram and LTM is when they are <5; however, Doherty and Jaramillo defined CTM as when the microliths are randomly distributed throughout the testicle while LTM is when they are limited to a part of the testicle. Its prevalence is 0.05%–18.1%,,,, There is both accrued and largely anecdotal evidence of an association between TM, intratubular germ cell neoplasia, and testicular tumor.,,,,,,,,,
| Case Report|| |
El is a 34-year-old banker who was referred from a private hospital in Kaduna to Ahmadu Bello University Teaching Hospital with a history of infertility for a period of 2 years. On examination, a young man is afebrile, anicteric, and not dehydrated.
Review of the systems yielded no additional information. They were essentially normal. Investigations ordered include full blood count and differentials, urine microscopy, culture and sensitivity (m/c/s), urea and electrolytes and random blood sugar, transrectal ultrasound, scrotal ultrasound (SUS), serum hormones, and semen analysis (SA). Except for SA and SUS, the remaining investigations were essentially normal.
The SA showed scanty spermatozoa. Their total count was <1.0 × 106 cells/ml. None was mobile. Their morphologies also showed only 20% that were in their normal form. Pus cells count was 80–82/HPF.
The SUS showed normal-sized testicles, measuring 4.0 cm × 2.0 cm and 3.9 cm × 2.2 cm in their dimensions for the right and left, respectively. There were multiple, nonshadowing hyperechoic foci seen all over in both testicles, being worst on the left side. On color interrogation, there was flow of blood in the epididymides and testicles. There was no intratesticular mass, varicocele, or hydrocele noted on either side. A radiological diagnosis of TM was made [Figure 1] and [Figure 2]. The patient absconded, i.e., was not seen again in the clinic.
| Discussion|| |
The actual cause of TM is unknown but its pathologic appearance is due to degeneration of the semiferius epithelium rubbing into the tubular lumen. The debris which has been secreted into the lumen accumulates there in the form of a glycoprotein and calcium layers and evolves into the histologically characteristic form.,, Its prevalence is 0.05%–18.1%.,,,, The number of pediatric cases is relatively smaller when compared to adults., This patient was an adult. They develop in the testicular parenchyma; however, they may show peripheral or segmentary distribution. Although they are usually bilateral, unilateral TM cases have been reported.,,, It was bilateral in this case. TM is classified into CTM in which the number of microliths is five or more and LTM in which they are <5., It was CTM in this case.
TM has been associated with the number of diseases such as inflammatory scars, granulomata, and infarction with hemorrhage. Similarly, variable testicular calcification is often seen sonographically within testicular tumor, but they do not tend to show the characteristic configuration of TM as previously described. Co-existence of much benign and malignant pathology with TM such as cryptorchidism, pulmonary alveolar, microlithiasis, male pseudohermaphroditism, Klinefelter syndrome, AIDS, germ cell tumors, Down syndrome, and infertility has been reported.,,, The index patient here presented with primary infertility. Other associations include previous radiotherapy. Testicular neoplasm is an important association. These are only association and no cause-and-effect relationship has been established. Indeed, TM may simply act as a marker of an abnormal testis affected by a range of abnormal processes, all of which may in their own right be associated with testicular malignancy. Malignancy can occur in any of TM. Only infertility was found in this patient.
The significance of an association between abdominal or thoracic teratomas and TM remains unclear; due to these associations related to TM, abdominal ultrasound, chest, and abdominal X-rays should be done to rule out their involvement, which were not done in this case. TM should be considered a premalignant condition. The use of serial ultrasound and tumor markers for monitory and biopsy may be warranted at intervals. Treatment is mainly conservative, but surgery (orchiectomy) is done when indicated.
| Summary|| |
A case of TM in a 34-year-old man has been presented. Its clinical features, radiological diagnosis, and review of the literature have also been discussed.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]