Incidental Discovery of Testicular Microlithiasis: What Is the Importance of Ultrasound Surveillance? Two Case Reports
A 33-year-old man came to our emergency department complaining of abdominal pain, vomiting, weight loss and mild jaundice. Ultrasound examination detected a large, ill-defined heterogeneous abdominal mass.\nThe patient's serum α-fetoprotein, lactate dehydrogenase, and beta subunit of human chorionic gonadotropin levels were 2.470 IU/l (normal, 90–180 IU/l), 232 ng/ml (normal, 0–7.5 ng/ml) and 3 mIU/ml (normal, <5 mIU/ml). Besides, the serum markers of cholestasis were high: conjugated bilirubin was 2 mg/100 ml (normal, <0.2 mg/100 ml), γ-glutamyl transpeptidase 70 IU/l (normal, 1–30 IU/l) and alkaline phosphates 300 IU/l (normal, <170 IU/l).\nCT and MRI examinations showed a giant retroperitoneal mass made up by multiple necrotic-colliquative fluid areas with a multilocular aspect, which dislocated the inferior vena cava anteriorly and with possible infiltrating signs; it also compressed the portal vein and the common bile duct with moderate dilatation of the intrahepatic ducts (fig. ).\nThe patient was sent to do an US to rule out the presence of a primary testicular tumor, which revealed bilateral TM without a focal hypoechoic lesion; the microcalcification pattern was quite similar to that of a past ultrasound exam that was performed when the patient was 22 years old because of a suspected varicocele.\nThe patient underwent a CT-guided biopsy and at histology, a yolk sac tumor was diagnosed.