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Hemangioendothelioma of the Testis
Vol. 113. Printed in
THE JOURNAL OF UROLOGY
Copyright © 1975 by The Williams & Wilkins Co.
HEMANGIOENDOTHELIOMA OF THE TESTIS JAY J. STEIN
From the Department of Surgery (Urology), University of California, Irvine, California
An hemangioendothelioma is a vascular neoplasm composed predominantly of masses of endothelial cells growing in and about vascular channels. The tumor represents an intergrade between the well differentiated hemangioma and the anacellular hemangioendotheliosarcoma. 1 There is confusion in the literature concerning the term hemangioendothelioma, since it is used to refer to the benign and the malignant endothelial tumor. Robbins suggested that the malignant counterpart be properly referred to as an hemangioendotheliosarcoma or angiosarcoma. The important cell --,~-··-··-·- for the benign and malignant tumor is endothelial cell, origirecognized in 1908. 2 The neoplasms have been mainly in the spleen, breast, skin and subcutaneous tissues, although other sites include the tonsil, stomach, intestine, omentum, ;eo'.crn,no,r, space, lung, mediastinum, heart, ovary, central nervous system, uterus, pleura, orbit and corpus cavernosum of the 'The case reported herein concerns an hemangioendothelioma of the testis and is the first, or malignant, to be in the literature. CASE REPORT
A 23-year-old white man was seen m November 1973 because of a testicular mass that had been knowingly present for 1 year. The patient had not noticed the mass to increase in asymptomatic, size and it had been He denied a history of urinary tract infections, trauma, mumps or history of carcinoma or testicular masses. Review of systems was completely non-contributory. A complete blood count, urinalysis, urine culture, human chorionic gonadotropin, test for veneral disease, chest x-ray, excretory urogram and SMA-12 were normal. Physical examination was unremarkable with the exception of a 2 2 cm, non-tender, solid mass, which did not transmit light and was thought to be within the superior, right testicular parenchyma or to be a medial extension from the globus major of the epididymis.
At inguinal exploration, with the cord doubly clamped at the internal ring, the testis delivered into the wound and the mass was lieved to be intratesticular. Radical was performed and convalescence was uneventful The testis measured 4 3 cm. and contained a fairly well circumscribed, uv,rc,uc reddish-tan tumor that displayed areas throughout. The mass was adherent to the adjacent testicular tissue and did not sheil out Sectioning of the epididymis and pedicle revealed no additional lesions. Histologically, this circumscribed tumor of a stroma containing multiple, closely lar channels and irregular spaces lined benign appearing, endothelial cells Masson and reticulum staining the cells to be endothelial, which lines vascular channels produces piled-up masses of cells vading the lumen of the vessel, as ""rn"'"'" located outside of the reticular and work, or perivascular, as toma. Focal interstitial ent. Diagnosis was adenomatoid tumor was was reviewed Dr. F. K. iWv0cvu, the tumor as an hemangioendothelioma, benign. DISCUSSION
Histologically, the hemangioendothelioma sists of masses and sheets of endothelial cells, which may grow in whorls or undifferentiated sheets, There is little in nuclear or cell size. Mitotic figures are normal and scant in number. No is present. The hemangioendotheliosarcoma or coma is a malignant vascular neoplasm charact2rized masses of endothelial cells and anaplasia. The spectrum varies mostly vascular, anaplastic but thelial cells to undifferentiated and atypical tumors that no definite blood vessels. Stout believes that there are 2 features oi· mangioendothelioma present in all cases, he believes that the malignant nature of tumors is fully confirmed their metastasize. 3 The first feature is the formation atypical endothelial cells in greater numbers are required to line the vessels with a endothelial membrane. The second feature is
Accepted for publication June 28, 1974. Robbins, S. L.: Pathology, 3rd ed. Philadelphia: W. B. Saunders 614, 1967. 2 Mallory, F. : The results of the application of special histological methods to the study of tumors. Med. Rec., 73: 63, 1908. _ 3 Stout, A. P.: Hemangio-endothelioma; a tumor of blood vessels featuring vascular endothelial cells. Ann. Surg., H8: 445, 1943. 1
201
202
STEIN
Fm. 1. A, low power magnification reveals tumor to be composed of masses of tubular channels. There is resultant pressure atrophy of involved seminiferous tubules. B, high power magnification reveals increased numbet of thin-walled, vascular channels. There is little evidence of variability in nuclear or cell size since cells appear to be benign. H & E stain.
formation of vascular tubes with a delicate reticulum framework and a marked tendency for their lumina to anastomose. Another site of origin of hemangioendothelioma of interest to the urologist is the corpus cavernosum. This was reviewed by Waugh in 1953 and he suggested that there were benign as well as malignant hemangioendotheliomas of the corpus cavernosum. • To date approximately 30 cases of • Waugh, T. R.: Endothelioma of corpora cavemosa of penis. Arch. Path., 55: 98, 1953.
the benign and malignant hemangioendotheliomas of the corpus cavernosum have been reported. These tumors either pursued a rapid, malignant course, despite radical surgery with or without irradiation therapy, or were clinically benign, being controlled by excision only.• 5 Deutsch, M., Leen, R. L. and Mercado, R., Jr.: Hemangioendothelioma of the penis with late appearing metastases: report of a case with review of the literature. J. Surg. Oncol., 5: 27, 1973.
HEMANGIOENDOTHELIOMA OF TESTIS
203
Fm. 2. A, Masson stain reveals thin-walled vascular channels to be endothelial cells. B, reticulum stain again reveals supernumerary endothelial cells. Cells are located in and about vascular channels as opposed to hemangiopericytoma which would be perivascular. SUMMARY
A case of hemangioendothelioma of the testis is reported. Although the tumor has been reported in almost all organs and tissues, this is the first case involving the testis to be found in the literature. A
distinction is made between the benign and the malignant form of the tumor. Hemangioendothelioma of the corpus cavernosum is discussed. Dr. F. K. Mostofi reviewed the pathology.
THE JOURNAL OF UROLOGY
Copyright © 1975 by The Williams & Wilkins Co.
HEMANGIOENDOTHELIOMA OF THE TESTIS JAY J. STEIN
From the Department of Surgery (Urology), University of California, Irvine, California
An hemangioendothelioma is a vascular neoplasm composed predominantly of masses of endothelial cells growing in and about vascular channels. The tumor represents an intergrade between the well differentiated hemangioma and the anacellular hemangioendotheliosarcoma. 1 There is confusion in the literature concerning the term hemangioendothelioma, since it is used to refer to the benign and the malignant endothelial tumor. Robbins suggested that the malignant counterpart be properly referred to as an hemangioendotheliosarcoma or angiosarcoma. The important cell --,~-··-··-·- for the benign and malignant tumor is endothelial cell, origirecognized in 1908. 2 The neoplasms have been mainly in the spleen, breast, skin and subcutaneous tissues, although other sites include the tonsil, stomach, intestine, omentum, ;eo'.crn,no,r, space, lung, mediastinum, heart, ovary, central nervous system, uterus, pleura, orbit and corpus cavernosum of the 'The case reported herein concerns an hemangioendothelioma of the testis and is the first, or malignant, to be in the literature. CASE REPORT
A 23-year-old white man was seen m November 1973 because of a testicular mass that had been knowingly present for 1 year. The patient had not noticed the mass to increase in asymptomatic, size and it had been He denied a history of urinary tract infections, trauma, mumps or history of carcinoma or testicular masses. Review of systems was completely non-contributory. A complete blood count, urinalysis, urine culture, human chorionic gonadotropin, test for veneral disease, chest x-ray, excretory urogram and SMA-12 were normal. Physical examination was unremarkable with the exception of a 2 2 cm, non-tender, solid mass, which did not transmit light and was thought to be within the superior, right testicular parenchyma or to be a medial extension from the globus major of the epididymis.
At inguinal exploration, with the cord doubly clamped at the internal ring, the testis delivered into the wound and the mass was lieved to be intratesticular. Radical was performed and convalescence was uneventful The testis measured 4 3 cm. and contained a fairly well circumscribed, uv,rc,uc reddish-tan tumor that displayed areas throughout. The mass was adherent to the adjacent testicular tissue and did not sheil out Sectioning of the epididymis and pedicle revealed no additional lesions. Histologically, this circumscribed tumor of a stroma containing multiple, closely lar channels and irregular spaces lined benign appearing, endothelial cells Masson and reticulum staining the cells to be endothelial, which lines vascular channels produces piled-up masses of cells vading the lumen of the vessel, as ""rn"'"'" located outside of the reticular and work, or perivascular, as toma. Focal interstitial ent. Diagnosis was adenomatoid tumor was was reviewed Dr. F. K. iWv0cvu, the tumor as an hemangioendothelioma, benign. DISCUSSION
Histologically, the hemangioendothelioma sists of masses and sheets of endothelial cells, which may grow in whorls or undifferentiated sheets, There is little in nuclear or cell size. Mitotic figures are normal and scant in number. No is present. The hemangioendotheliosarcoma or coma is a malignant vascular neoplasm charact2rized masses of endothelial cells and anaplasia. The spectrum varies mostly vascular, anaplastic but thelial cells to undifferentiated and atypical tumors that no definite blood vessels. Stout believes that there are 2 features oi· mangioendothelioma present in all cases, he believes that the malignant nature of tumors is fully confirmed their metastasize. 3 The first feature is the formation atypical endothelial cells in greater numbers are required to line the vessels with a endothelial membrane. The second feature is
Accepted for publication June 28, 1974. Robbins, S. L.: Pathology, 3rd ed. Philadelphia: W. B. Saunders 614, 1967. 2 Mallory, F. : The results of the application of special histological methods to the study of tumors. Med. Rec., 73: 63, 1908. _ 3 Stout, A. P.: Hemangio-endothelioma; a tumor of blood vessels featuring vascular endothelial cells. Ann. Surg., H8: 445, 1943. 1
201
202
STEIN
Fm. 1. A, low power magnification reveals tumor to be composed of masses of tubular channels. There is resultant pressure atrophy of involved seminiferous tubules. B, high power magnification reveals increased numbet of thin-walled, vascular channels. There is little evidence of variability in nuclear or cell size since cells appear to be benign. H & E stain.
formation of vascular tubes with a delicate reticulum framework and a marked tendency for their lumina to anastomose. Another site of origin of hemangioendothelioma of interest to the urologist is the corpus cavernosum. This was reviewed by Waugh in 1953 and he suggested that there were benign as well as malignant hemangioendotheliomas of the corpus cavernosum. • To date approximately 30 cases of • Waugh, T. R.: Endothelioma of corpora cavemosa of penis. Arch. Path., 55: 98, 1953.
the benign and malignant hemangioendotheliomas of the corpus cavernosum have been reported. These tumors either pursued a rapid, malignant course, despite radical surgery with or without irradiation therapy, or were clinically benign, being controlled by excision only.• 5 Deutsch, M., Leen, R. L. and Mercado, R., Jr.: Hemangioendothelioma of the penis with late appearing metastases: report of a case with review of the literature. J. Surg. Oncol., 5: 27, 1973.
HEMANGIOENDOTHELIOMA OF TESTIS
203
Fm. 2. A, Masson stain reveals thin-walled vascular channels to be endothelial cells. B, reticulum stain again reveals supernumerary endothelial cells. Cells are located in and about vascular channels as opposed to hemangiopericytoma which would be perivascular. SUMMARY
A case of hemangioendothelioma of the testis is reported. Although the tumor has been reported in almost all organs and tissues, this is the first case involving the testis to be found in the literature. A
distinction is made between the benign and the malignant form of the tumor. Hemangioendothelioma of the corpus cavernosum is discussed. Dr. F. K. Mostofi reviewed the pathology.