背景:睾丸微石症(TM)与良性和恶性疾病的确切相关性仍然未知,尤其是在儿科人群中。TM与成年睾丸恶性肿瘤的潜在关联已引起有关管理和随访的争议。
目的:确定TM在儿童中与睾丸恶性肿瘤或不育风险相关的预后重要性,并比较儿科和成人人群之间的差异。
方法:我们对Medline进行了文献综述,根据系统评价和荟萃分析(PRISMA)声明的首选报告项目,截至2020年11月的Embase和Cochrane对照试验数据库。分析中包括26种出版物。
结果:在595名TM患儿的随访中,只有一名TM患儿在青春期发展为睾丸恶性肿瘤。在其他594例中,没有发现睾丸恶性肿瘤,即使存在风险因素。在成年人口中,在有隐睾病史的患者中发现TM存在睾丸恶性肿瘤的风险增加(6%vs0%),与无TM相比,睾丸恶性肿瘤(22%vs2%)或亚/不孕症(11-23%vs1.7%)。儿童和成年人之间的差异可能是由于随访时间短,六个月到三年不等。平均年龄为10岁,预计睾丸恶性肿瘤将从青春期开始发展,睾丸恶性肿瘤可能尚未发展。
结论:TM是一种常见的偶然发现,在儿童时期似乎与睾丸恶性肿瘤无关,但在成人人群中存在与睾丸恶性肿瘤相关的危险因素。建议从青春期开始有危险因素的儿童每月进行睾丸常规自我检查。当TM在过渡到成年期间仍然存在时,可以考虑进行更深入的随访。
BACKGROUND: The exact correlation of testicular microlithiasis (TM) with benign and malignant conditions remains unknown, especially in the paediatric population. The potential association of TM with testicular malignancy in adulthood has led to controversy regarding management and follow-up.
OBJECTIVE: To determine the prognostic importance of TM in children in correlation to the risk of testicular malignancy or infertility and compare the differences between the paediatric and adult population.
METHODS: We performed a literature review of the Medline, Embase and Cochrane controlled trials databases until November 2020 according to the Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) Statement. Twenty-six publications were included in the analysis.
RESULTS: During the follow-up of 595 children with TM only one patient with TM developed a testicular malignancy during puberty. In the other 594 no testicular malignancy was found, even in the presence of risk factors. In the adult population, an increased risk for testicular malignancy in the presence of TM was found in patients with history of cryptorchidism (6% vs 0%), testicular malignancy (22% vs 2%) or sub/infertility (11-23% vs 1.7%) compared to TM-free. The difference between paediatric and adult population might be explained by the short duration of follow-up, varying between six months and three years. With an average age at inclusion of 10 years and testicular malignancies are expected to develop from puberty on, testicular malignancies might not yet have developed.
CONCLUSIONS: TM is a common incidental finding that does not seem to be associated with testicular malignancy during childhood, but in the presence of risk factors is associated with testicular malignancy in the adult population. Routine monthly self-examination of the testes is recommended in children with contributing risk factors from puberty onwards. When TM is still present during transition to adulthood a more intensive follow-up could be considered.