Is there an increased incidence of contralateral testicular cancer in patients with intratesticular microlithiasis?

OBJECTIVE. The objective of this study was to determine if there is an association between intratesticular microlithiasis and contralateral testicular cancer. MATERIALS AND METHODS. Retrospective review of a radiology database revealed 156 men who had undergone testicular sonography and orchiectomy for testicular cancer. Sonographic abnormalities were correlated with medical records and histopathology. Statistical significance was assessed using Fisher's exact test. RESULTS. Twenty-three (15%) of 156 patients with prior orchiectomy for testicular cancer had microlithiasis, and 133 (85%) did not have microlithiasis. Four of 23 patients with microlithiasis had masses, and eight had heterogeneous changes. Sonograms of 133 patients without microlithiasis revealed masses in seven and heterogeneous changes in 15 patients. Five patients with microlithiasis and six without microlithiasis underwent a second orchiectomy. Contralateral testicular cancer was confirmed in five (22%) of 23 patients with microlithiasis versus three (2%) of 133 men without microlithiasis. Microlithiasis was present in five (63%) of eight patients with bilateral testicular cancer, and microlithiasis was highly associated with confirmed bilateral testicular cancer (5/23 vs 3/133, odds ratio [OR] = 12.0, p = 0.002). Among the 34 patients who had either testicular masses or heterogeneous changes, microlithiasis had an OR of 4.5 (p = 0.10). CONCLUSION. In our study, contralateral testicular cancer was significantly associated with intratesticular microlithiasis. Nevertheless, there was not sufficient evidence that intratesticular microlithiasis adds independent diagnostic information for bilateral testicular cancer in the absence of a mass or heterogeneous changes.