Testicular Carcinoma in a Patient with Previously Demonstrated Testicular Microlithiasis

A 21-year-old man initially presented with a history of bilateral testicular pain and hematospermia. Ultrasound revealed a normal right testis and multiple echogenic foci throughout the left testis consistent with testicular microlithiasis (part A of figure). No focal masses were identified sonographically. Symptoms resolved after treatment for epididymitis. Three years later the patient presented to the emergency department because of increasing back pain. Computerized tomography of the retroperitoneum revealed multiple pulmonary nodules and lymphadenopathy. Ultrasound demonstrated multifocal solid left testicular masses i n addition to testicular microlithiasis (part B of figure). The right testis was sonographically normal. Testicular microlithiasis, and mixed embryonal cell carcinoma and seminoma of the left testis were noted on pathological examination.