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Pelvis » Scrotum And Testicles
Testicular Microlithiasis
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Presentation This 26 YO male presented for a scrotal ultrasound as an outpatient with no specific medical history on the referral. On questioning he stated that one side of his abdomen was harder and more prominent, and that he had had a CT and biopsy of an abdominal mass and that the doctors thought there would be a testicular mass on ultrasound.
Caption: Transverse both testicles
Description: Both testicles exhibit the "starry night" pattern of extensive microlithiasis.
Caption: Sagittal left testicle
Description: Blood flow appears to be normal and there are no masses or structural abnormality other than the microlithiasis.
Caption:  Sagittal right testicle
Description: Findings are the same as in the left testicle, normal blood flow, no structural abnormality or masses.
Caption: Transverse abdomen
Description: The aorta is elevated from the spine and is surrounded by a large hypoechoic mass suggesting the presence of enlarged paraaortic lymph nodes.
Differential Diagnosis The histopathology report of the biopsy of the right para-aortic lymph nodes was positive for seminoma markers & negative for lymphoma markers and other germ cell tumour markers. The path report continued "Metastatic germ cell tumour with morphologic and immunophenotypic features favouring metastatic seminoma. Given the site of the biopsy, a testicular primary is most likely, if clinical examination is negative, other primary germ cell tumour sites should be investigated.

On U/S of his testes, testicular microlithiasis was the only finding.
Final Diagnosis Testicular Microlithiasis

Discussion This 26 YO male presented for a scrotal ultrasound.  He seemed a little pale & clammy – but he blamed the weather.   When asked what caused him to visit his doctor he mentioned that he was slouching on his sofa and noticed his right side of his abdomen was harder & more prominent than his left and that he had since been for a CT & biopsy of the “mass”.  They suspected a testicular tumour from the results but his clinical examination didn’t reveal any mass – so he was sent for an ultrasound.  The ultrasound revealed a striking case of bilateral testicular microlithiasis of the "starry night" pattern in which a large number of varying size deposits of echogenic material are seen throughout the testicle, which was otherwise normal.  Testicular microlithiasis is defined as 5 or more microcalcifications within a testicle.  See for a detailed discussion of the prognostic value of testicul microlithiasis.  In this case, although there was microlithiasis of both testicles, no secific tumour mass could be identified in the testicles.

Technical Details ATL 5000  with a Linear 12MHz transducer
Follow Up Following chemotherapy the patient had a CT which demonstrated marked reduction in the retro-crural, retro-peritoneal, pre-tracheal and mesenteric root adenopathy.   Subsequent PET study indicated post chemotherapy marrow changes but no active disease.

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