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Giant penile cavernous hemangioma with intrapelvic extension
IMAGES IN CLINICAL UROLOGY
GIANT PENILE CAVERNOUS HEMANGIOMA WITH INTRAPELVIC EXTENSION MICHAEL FROEHNER, PANAGIOTIS TSATALPAS,
A
lthough hemangiomas are the most frequent congenital malformation, they are rarely observed in the genitourinary tract.1– 6 We demonstrate impressive magnetic resonance images of a penile cavernous hemangioma involving the intrapelvic space. A 39-year-old man was admitted to our hospital with erectile dysfunction due to a huge recurrence of a penile cavernous hemangioma. Shortly after birth in 1958, a cavernous hemangioma of the penile root had been removed. Local tumor recurrences were resected when the patient was 12 and 22 years old. The current lesion grew slowly during 17 years after the last operation. Clinical examination showed a subcutaneous solid mass enclosing the corpora cavernosa and reaching the symphysis pubis ventrally and the perineum dorsally. Magnetic resonance imaging revealed extensive retropubic extension of a cystic lobulated tumor separating the corpora cavernosa (Figs. 1 and 2). Partial infiltration of the cavernous bodies and of the urethra was suspected. The patient refused the recommended surgical removal of the tumor. Cavernous hemangiomas are capable of demon-
From the Department of Urology, Universitaetsklinikum “Carl Gustav Carus,” Technical University of Dresden, Dresden, Germany Reprint requests: Michael Froehner, M.D., Department of Urology, Universitaetsklinikum “Carl Gustav Carus,” Technical University of Dresden, Fetscherstrasse 74, Dresden D-01307, Germany Submitted: June 2, 1998, accepted (with revisions): July 17, 1998
414
© 1999, ELSEVIER SCIENCE INC. ALL RIGHTS RESERVED
AND
MANFRED P. WIRTH
strating an iceberg phenomenon, with unexpected deep extension.4,5 Blood group isoantigens and coagulation factor VIII related antigen are immunohistochemical markers used to verify the diagnosis of hemangiomas.7 Malignant transformation has not been reported in cavernous hemangioma.1 Nevertheless, the case reported here illustrates that incomplete removal of a penile cavernous hemangioma may result in an unfavorable course with recurrence and local progression. Early complete excision and close follow-up are required in the management of subcutaneous cavernous hemangioma. REFERENCES 1. Ferrer FA, and McKenna PH: Cavernous hemangioma of the scrotum: a rare benign genital tumor of childhood. J Urol 153: 1262–1264, 1995. 2. Mathur P, Porwal KK, Pendse AK, et al: Hemangiomatous penile horn. J Urol 155: 1738, 1996. 3. Hayashi T, Igarashi K, and Sekine H: Urethral hemangioma: case report. J Urol 158: 539 –540, 1997. 4. Suzuki Y, Kaneko H, Kubota Y, et al: Hemangioma of the bladder with extravesical extension. Urol Int 59: 125–128, 1997. 5. Jahn H, and Nissen HM: Haemangioma of the urinary tract: review of the literature. Br J Urol 68: 113–117, 1991. 6. Senoh H, Ichikawa Y, Okuyama A, et al: Cavernous hemangioma of the scrotum and penile shaft. Urol Int 41: 309 – 311, 1986. 7. Stephenson TJ, and Mills PM: Monoclonal antibodies to blood group isoantigens: an alternative marker to factor VIII related antigen for benign and malignant vascular endothelial cells. J Pathol 147: 139 –148, 1985.
UROLOGY 53: 414 – 415, 1999
• 0090-4295/99/$20.00 PII S0090-4295(98)00444-0
FIGURE 1. Native (left) and gadolinium-enhanced (right) sagittal magnetic resonance image of recurrent penile cavernous hemangioma with retropubic extension (arrows).
FIGURE 2. Penile hemangioma, visualized by transversal (left) and coronal (right) magnetic resonance imaging.
UROLOGY 53 (2), 1999
415
GIANT PENILE CAVERNOUS HEMANGIOMA WITH INTRAPELVIC EXTENSION MICHAEL FROEHNER, PANAGIOTIS TSATALPAS,
A
lthough hemangiomas are the most frequent congenital malformation, they are rarely observed in the genitourinary tract.1– 6 We demonstrate impressive magnetic resonance images of a penile cavernous hemangioma involving the intrapelvic space. A 39-year-old man was admitted to our hospital with erectile dysfunction due to a huge recurrence of a penile cavernous hemangioma. Shortly after birth in 1958, a cavernous hemangioma of the penile root had been removed. Local tumor recurrences were resected when the patient was 12 and 22 years old. The current lesion grew slowly during 17 years after the last operation. Clinical examination showed a subcutaneous solid mass enclosing the corpora cavernosa and reaching the symphysis pubis ventrally and the perineum dorsally. Magnetic resonance imaging revealed extensive retropubic extension of a cystic lobulated tumor separating the corpora cavernosa (Figs. 1 and 2). Partial infiltration of the cavernous bodies and of the urethra was suspected. The patient refused the recommended surgical removal of the tumor. Cavernous hemangiomas are capable of demon-
From the Department of Urology, Universitaetsklinikum “Carl Gustav Carus,” Technical University of Dresden, Dresden, Germany Reprint requests: Michael Froehner, M.D., Department of Urology, Universitaetsklinikum “Carl Gustav Carus,” Technical University of Dresden, Fetscherstrasse 74, Dresden D-01307, Germany Submitted: June 2, 1998, accepted (with revisions): July 17, 1998
414
© 1999, ELSEVIER SCIENCE INC. ALL RIGHTS RESERVED
AND
MANFRED P. WIRTH
strating an iceberg phenomenon, with unexpected deep extension.4,5 Blood group isoantigens and coagulation factor VIII related antigen are immunohistochemical markers used to verify the diagnosis of hemangiomas.7 Malignant transformation has not been reported in cavernous hemangioma.1 Nevertheless, the case reported here illustrates that incomplete removal of a penile cavernous hemangioma may result in an unfavorable course with recurrence and local progression. Early complete excision and close follow-up are required in the management of subcutaneous cavernous hemangioma. REFERENCES 1. Ferrer FA, and McKenna PH: Cavernous hemangioma of the scrotum: a rare benign genital tumor of childhood. J Urol 153: 1262–1264, 1995. 2. Mathur P, Porwal KK, Pendse AK, et al: Hemangiomatous penile horn. J Urol 155: 1738, 1996. 3. Hayashi T, Igarashi K, and Sekine H: Urethral hemangioma: case report. J Urol 158: 539 –540, 1997. 4. Suzuki Y, Kaneko H, Kubota Y, et al: Hemangioma of the bladder with extravesical extension. Urol Int 59: 125–128, 1997. 5. Jahn H, and Nissen HM: Haemangioma of the urinary tract: review of the literature. Br J Urol 68: 113–117, 1991. 6. Senoh H, Ichikawa Y, Okuyama A, et al: Cavernous hemangioma of the scrotum and penile shaft. Urol Int 41: 309 – 311, 1986. 7. Stephenson TJ, and Mills PM: Monoclonal antibodies to blood group isoantigens: an alternative marker to factor VIII related antigen for benign and malignant vascular endothelial cells. J Pathol 147: 139 –148, 1985.
UROLOGY 53: 414 – 415, 1999
• 0090-4295/99/$20.00 PII S0090-4295(98)00444-0
FIGURE 1. Native (left) and gadolinium-enhanced (right) sagittal magnetic resonance image of recurrent penile cavernous hemangioma with retropubic extension (arrows).
FIGURE 2. Penile hemangioma, visualized by transversal (left) and coronal (right) magnetic resonance imaging.
UROLOGY 53 (2), 1999
415