Hindawi Publishing Corporation

Case Reports in Urology

Volume 2015, Article ID 950819, 3 pages
[Link]

Case Report
Large Genital Cavernous Hemangioma:
A Rare Surgically Correctable Entity

Goto Gangkak, Anoop Mishra, Shivam Priyadarshi, and Vinay Tomar

Department of Urology, SMS Medical College & Hospitals, Jaipur, Rajasthan 302004, India

Correspondence should be addressed to Goto Gangkak; ggoto2003@[Link]

Received 27 September 2015; Accepted 3 November 2015

Academic Editor: Tun-Chieh Chen

Copyright © 2015 Goto Gangkak et al. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

We report a case of 24-year-old male presenting with painless penoscrotal swelling for 3 years. On examination, a large soft bag of
worm-like, superficial, nonpulsatile swelling was present in scrotum and penis. Color Doppler showed dilated tortuous vessels and
on angiography no connections to corpora or vessels were seen. So a diagnosis of hemangioma was made and a surgical excision
was carried out by circumcoronal and scrotal incisions. Postop course was uneventful. At 6 months of follow-up, no recurrence was
seen and wound had healed with excellent cosmetic appearance.

1. Introduction into the scrotum (Figure 1(a)). No other similar lesions were
found elsewhere. The rest of the examination was normal.
Cavernous hemangiomas involving genitalia are a rare clin- Blood investigations were within normal limits. A color
ical entity [1]. Genital hemangiomas have been mostly Doppler revealed multiple dilated tortuous channels limited
reported in pediatric age group and much rarely reported in to skin and separate from corpora. On Doppler blood flow
adults [2, 3]. These tumors can involve glans, penile shaft, was reported in some of these channels. CT scan revealed that
scrotum, and perineum and can even extend to anterior the lesion was limited to penis and scrotum and arteriography
abdominal and pelvis [4]. Genital cavernous hemangiomas images did not reveal any feeding vessels or connections with
often pose diagnostic and treatment dilemma for the treating the arterial vessels. So a surgical excision was planned.
surgeon [5]. Various treatment options are available like
surgical excision, laser fulguration, intralesional sclerother-
apy, and cryotherapy but there is no clear consensus on its
management due to its rarity. We report here a case of large 2.1. Operative Technique. Patient was given spinal anesthesia
cavernous hemangioma involving glans, penile shaft, and and catheterized preoperatively. A circumcoronal circum-
scrotum which was successfully treated surgically and review ferential incision which is 1 cm from coronal sulcus was
of the literature of various treatment options available. made and dissection was carried deep up to bucks fascia
and the hemangiomatous tissue was carefully dissected from
buck’s fascia and skin of penile shaft (Figure 1(b)). Then
2. Case Presentation through a 6 cm long elliptical incision over the median raphe
hemangiomatous tissue was intussuscepted into scrotum.
A 24-year-old male presented with history of progressively There was no communication seen with corpora and any
increasing penoscrotal swelling for 3 years. It was associated vessel. Glanular lesion was left untreated. Finally circumci-
with dull aching pain and discomfort. There was no history of sion and primary closure of scrotal skin over a suction drain
trauma or previous surgery. No significant family history was was done (Figure 1(c)). Postop course was uneventful. On
present. On examination, a bosselated, nontender, nonpul- histopathological examination dilated channels lined with
satile, noncompressible, soft bag of worm-like mass was felt endothelium containing red blood cells (RBCs) were seen.
on glans and the penile shaft circumferentially, also extending The presence of thick fibrous tissue between the vessels was
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2 Case Reports in Urology

(a) (b) (c)

(d) (e) (f)

Figure 1: (a) Showing preoperative photograph of the hemangioma: black solid arrow showing the penile component of hemangioma and blue
solid arrow showing scrotal extension of hemangioma. (b) Showing intraoperative picture: green solid arrow showing the hemangioma tissue
dissected from penile shaft, yellow solid arrow shows glans, and white solid arrow shows the testis. (c) Final operative picture with suction
drain in situ. ((d), (e)) Postop picture at follow-up showing healed wound with an excellent cosmetic outcome. (f) Showing microscopic
picture (H&E stain) endothelium lined vascular channels with intervening thick fibrous septa (red arrow head shows thick fibrous septa
characteristic of cavernous hemangioma).

seen, which was characteristic of cavernous hemangioma and can also present with extension into perineum, anterior
(Figure 1(f)). abdominal wall, and pelvis. Some authors have also shown
concern for infertility with these lesions [4]. Rarely they can
be associated with hemangiomas at other sites like bladder
2.2. Outcome. At 1-month follow-up no recurrence was seen
and rectosigmoid [10] and can be associated with syndromes
and wound had healed well (Figures 1(d) and 1(e)). At 6-
like Fabry disease and Klippel-Trenaunay syndrome [11].
month follow-up the glanular lesion also had completely
Imaging studies are useful to identify and delineate the
resolved with an excellent cosmetic appearance.
extent of the hemangioma, as well as detection of any asso-
ciated anomalies. Color Doppler demonstrates blood flow
3. Discussion within these lesions but the absence of flow does not rule out
the presence of these lesions. Other imaging modalities like
Our case of a large cavernous hemangioma of penis and computed tomography (CT scan) and magnetic resonance
scrotum represents a very rare clinical entity. Many inves- imaging (MRI) are very useful for diagnosis and delineating
tigators consider them to be congenital vascular anomaly their relationship with adjacent structures [12].
and a benign tumor [6]. Some consider it to be a herniation Treatment decisions have to take into consideration the
of cavernosal tissue [7] and others consider it to be due to location of the lesion, size of lesion, cosmetic outcome, and
revascularization from penile hematoma [8]. cost of treatment. Among the various therapeutic options,
Since the first report by Boullay in 1851, very few cases nonsurgical treatments like laser (CO2 laser, Nd: YAG
have been reported so far [9]. The hemangiomas can be laser, and yellow-light laser) and intralesional sclerotherapy
located in glans, penile shaft, and scrotum [8]. Cavernous (Polidocanol, hypertonic saline) have been used primarily
hemangiomas may be present since birth but mostly they are for smaller glanular lesion with satisfactory outcomes [13,
noted in adolescence as penoscrotal mass or due to concern 14]. Due to risk of bleeding because of high vascularity
about the cosmetic appearance as in our case. Usually they and possibility of scar formation, surgical excision of these
are painless but can be associated with pain, ulceration, and tumors is not favored [1]. Jimenez-Cruz and Osca [14] first
bleeding [5]. The lesion usually does not involute with time described a successful Nd: YAG laser treatment of a glans
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Case Reports in Urology 3

penis hemangioma. Ulker and Esen [13] also reported good [4] M. Froehner, P. Tsatalpas, and M. P. Wirth, “Giant penile
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In our case, we decided to operate on the patient due to 1993.
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Conflict of Interests
[20] G. J. Alter, G. Trengove-Jones, and C. E. Horton Jr., “Heman-
The authors declare that they have no conflict of interests. gioma of penis and scrotum,” Urology, vol. 42, no. 2, pp. 205–
208, 1993.
[21] H. Senoh, Y. Ichikawa, A. Okuyama, M. Takaha, and T. Sonoda,
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