Testiküler Mikrolitiyazis
Özet
Testiküler mikrolitiyazis (TM), skrotal ultrasonografide testis parankiminde saptanan, 1-3 mm boyutlarında, akustik gölgelenme göstermeyen hiperekojenik odaklar ile karakterize tesadüfi bir radyolojik bulgudur. Histolojik olarak seminifer tüp lümeninde hidroksiapatit çekirdek çevresinde kollajen ve glikojen katmanlarından oluşur. Toplumdaki gerçek insidansı tam bilinmemekle birlikte genellikle bilateral izlenir. TM'nin oluşum mekanizması kesinleşmemiş olup germ hücreli testis tümörü (GHTT), infertilite ve kriptorşidizm gibi durumlarla ilişkili olabileceğini gösteren çalışmalar mevcuttur. Radyolojik olarak, görüntüleme alanı başına beş veya daha fazla odak bulunması "klasik TM" olarak tanımlanır. Avrupa Ürogenital Radyoloji Derneği (ESUR) ve EAU kılavuzlarına göre, ilave bir risk faktörü (GHTT öyküsü, inmemiş testis, infertilite, atrofik testis vb.) taşımayan asemptomatik hastalarda biyopsi, rutin ultrason veya bilgisayarlı tomografi ile takip önerilmemekte; bu kişilere yalnızca erken teşhis amacıyla kendi kendine testis muayenesi öğretilmesi zayıf kanıt derecesiyle tavsiye edilmektedir. Buna karşılık, infertilite veya diğer risk faktörlerine sahip yüksek riskli hastalarda multidisipliner değerlendirme ile testis biyopsisi, cerrahi eksplorasyon veya orşiektomi düşünülebilir. GHTT tedavisi görecek hastalarda ise operasyon öncesi sperm kriyoprezervasyonu önerilmektedir.
Testicular microlithiasis (TM) is an incidental radiological finding characterized by multiple, 1-3 mm, non-shadowing hyperechoic foci within the testicular parenchyma during scrotal ultrasonography. Histologically, it consists of a hydroxyapatite core surrounded by concentric collagen fibers and glycogen layers within the seminiferous tube lumen. Although its true incidence in the general population remains unknown, it is typically bilateral. The exact pathogenesis of TM is not fully understood, but studies indicate associations with testicular germ cell tumors (TGCT), infertility, and cryptorchidism. Radiologically, the presence of five or more foci per viewpoint is defined as "classic TM". According to European Society of Urogenital Radiology (ESUR) and EAU guidelines, routine follow-up with biopsy, ultrasound, or CT is not recommended for asymptomatic patients without additional risk factors (such as a history of TGCT, undescended testes, infertility, or testicular atrophy); instead, teaching testicular self-examination for early detection is advised with a weak grade of recommendation. Conversely, in high-risk infertile patients or those with accompanying risk factors, testicular biopsy, surgical exploration, or orchiectomy may be considered following a multidisciplinary evaluation. Furthermore, sperm cryopreservation is recommended prior to planned orchiectomy for patients undergoing treatment for TGCT.
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