Patient's question:
The child is 9 years old and has precocious puberty. It was found that there are scattered bright spots in both testicles, with no posterior acoustic shadow. The doctor said it might be testicular microlithiasis. I heard that this condition is benign and there is no effective treatment currently. Online says this condition may cause infertility or something similar to a tumor in the future. Is that really the case? Will it disappear in the future? How can it be prevented? It can't be like a time bomb forever, always worrying. What should I do?Doctor's answer:
Clinical pediatric cases are rare, with an incidence rate of 0.6% to 20%. In male infertility, the incidence rate is 6.2%. The low incidence is related to the lack of obvious clinical symptoms of this condition, leading to fewer patient visits. Most cases in this group were incidentally discovered during ultrasound examinations for other scrotal diseases, with only one case presenting with testicular pain without accompanying symptoms. The etiology of TM is unclear, and it can be seen in patients with male infertility, cryptorchidism, undescended testes, testicular tumors, and epididymitis, among others. Cryptorchidism, testicular tumors, and male infertility are relatively closely related to this condition, especially testicular tumors, which have a significant correlation with it [4]. The cases in this group are consistent with those reported in the literature. The diagnostic criteria for TM are: (1) More than five 1–2 mm-sized punctate hyperechoic foci can be observed on each section, with no acoustic shadowing. (2) Diffusely distributed within the testicular parenchyma. The sonographic findings of testicular microlithiasis are characteristic, and ultrasound can diagnose it, making invasive puncture biopsy unnecessary.Foreign literature reports that TM has a tendency to develop testicular tumors, so it should be taken seriously. Ultrasound follow-up examinations should be performed every 6 to 12 months to detect testicular tumors in a timely manner. Children diagnosed during childhood should be followed up until adulthood. High-frequency linear transvaginal ultrasound plays an important role in diagnosis. Its repeatability and non-invasiveness make it superior in follow-up, providing more accurate and specific information for clinical diagnosis, which has significant diagnostic value.