Incidental Discovery of Testicular Microlithiasis: What Is the Importance of Ultrasound Surveillance? Two Case Reports
A 39-year-old man with a 6-month history of lumbar pain came to our hospital to perform an MRI examination in order to rule out a lumbosacral hernia. The MRI images showed no slipped disks, but we unfortunately detected a voluminous retroperitoneal solid mass. Therefore, we decided to perform a total body CT to better characterize the mass and its relationship to adjacent structures. CT images showed a large heterogeneous retroperitoneal mass with curvilinear calcifications and a marked inhomogeneous enhancement after intravenous contrast medium injection due to the presence of necrotic-colliquative areas. This lesion displaced the left renal vein cranially, the abdominal aorta anteriorly and towards the right, and infiltrated the inferior vena cava, the left renal vein, and the left psoas muscle (fig. ).\nThe patient's α-fetoprotein, lactate dehydrogenase, and beta subunit of human chorionic gonadotropin levels were 2.680 IU/l (normal, 90–180 IU/l), 279 ng/ml (normal, 0–7.5 ng/ml), and 4 mIU/ml (normal, <5 mIU/ml). We performed a scrotal ultrasonography (US) to rule out that this mass was a retroperitoneal metastasis of a primary testicular tumor: US showed bilateral classic TM (defined as more than 5 calcifications scattered throughout the testicle), without a focal lesion (fig. ). Comparing the current ultrasound images with previous US testicular images (the patient underwent a scrotal US when he was 25 years old because of a testicular trauma), we noticed that microcalcification patterns were very similar.\nThe patient underwent a CT-guided biopsy and at histology, an immature teratoma was diagnosed.