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Urethral hemangioma
IMAGES IN CLINICAL UROLOGY
URETHRAL HEMANGIOMA A. R. RAO
AND
H. MOTIWALA
A
26-year-old woman, 28 weeks pregnant, presented with dysuria and perineal discomfort. She had no previous history of urinary tract infection or urethral instrumentation. Per vaginal examination revealed a soft-tissue mass arising from the urethral meatus that was partially compressible (Fig. 1). A diagnosis of hemangioma was made, and we decided on excision. Cystourethroscopy did not show any intraurethral proximal extension. Excision with primary closure was done. Histologic examination revealed a cavernous hemangioma with no malignancy. Hemangioma is an abnormal proliferation of blood vessels that may occur in any vascularized tissue. Debate exists as to whether these lesions are neoplasms, hamartomas, or vascular malformations.1,2 Urethral hemangiomas are extremely rare and most often reported in men.3 Clinical presentations include hematuria, lower urinary tract symptoms, a urethral mass, or urethral discharge. Although cystourethroscopy may be able to define the extent of the lesion, magnetic resonance imaging is the preferred method of investigation.4 The differential diagnosis includes urethral caruncle, prolapse, polyp, granuloma gravidarum, and leiomyoma, which are known to increase in size during pregnancy.5 Malignant tumors include squamous and transitional cell carcinoma, sarcoma, and malignant melanoma. Although female urethral hemangioma has been described, our case is the first with rapid enlargement during pregnancy.4 Other than surgical excision, hemangioFrom the Department of Urology, Wexham Park Hospital, Slough, United Kingdom Reprint requests: Amrith Raj Rao, M.S., D.N.B., F.R.C.S.Ed., Department of Urology, Wexham Park Hospital, Slough SL2 4HL, United Kingdom. E-mail: [email protected] Submitted: December 20, 2004, accepted (with revisions): January 31, 2005
© 2005 ELSEVIER INC. 1000
ALL RIGHTS RESERVED
FIGURE 1. Soft-tissue mass arising from urethra.
mas have been successfully treated with electrofulguration and laser coagulation.6 REFERENCES 1. Mulliken JB: Cutaneous vascular anomalies, in McCarthy JG, May JW Jr, Littler JW (Eds): Plastic Surgery: Tumors of the Head and Neck and Skin. Philadelphia, WB Saunders, 1990, pp 3191–3223. 2. Goidanich IF, and Campanacci M: Vascular hamartomata and infantile angioectatic osteohyperplasia of the extremities: a study of 94 cases. J Bone Joint Surg 44A: 815– 842, 1962. 3. Jahn H, and Nissen HM: Haemangioma of the urinary tract: review of the literature. Br J Urol 68: 113–117, 1991. 4. Uchida K, Fukuta F, Ando M, et al: Female urethral hemangioma. J Urol 166: 1008, 2001. 5. Kesari D, Gemer O, Segal S, et al: Estrogen receptors in a urethral leiomyoma presenting in pregnancy. Int J Gynaecol Obstet 47: 59 – 60, 1994. 6. Tabibian L, and Ginsberg DA: Thrombosed urethral hemangioma. J Urol 170: 1942, 2003.
UROLOGY 65: 1000, 2005
• 0090-4295/05/$30.00 doi:10.1016/j.urology.2005.01.062
URETHRAL HEMANGIOMA A. R. RAO
AND
H. MOTIWALA
A
26-year-old woman, 28 weeks pregnant, presented with dysuria and perineal discomfort. She had no previous history of urinary tract infection or urethral instrumentation. Per vaginal examination revealed a soft-tissue mass arising from the urethral meatus that was partially compressible (Fig. 1). A diagnosis of hemangioma was made, and we decided on excision. Cystourethroscopy did not show any intraurethral proximal extension. Excision with primary closure was done. Histologic examination revealed a cavernous hemangioma with no malignancy. Hemangioma is an abnormal proliferation of blood vessels that may occur in any vascularized tissue. Debate exists as to whether these lesions are neoplasms, hamartomas, or vascular malformations.1,2 Urethral hemangiomas are extremely rare and most often reported in men.3 Clinical presentations include hematuria, lower urinary tract symptoms, a urethral mass, or urethral discharge. Although cystourethroscopy may be able to define the extent of the lesion, magnetic resonance imaging is the preferred method of investigation.4 The differential diagnosis includes urethral caruncle, prolapse, polyp, granuloma gravidarum, and leiomyoma, which are known to increase in size during pregnancy.5 Malignant tumors include squamous and transitional cell carcinoma, sarcoma, and malignant melanoma. Although female urethral hemangioma has been described, our case is the first with rapid enlargement during pregnancy.4 Other than surgical excision, hemangioFrom the Department of Urology, Wexham Park Hospital, Slough, United Kingdom Reprint requests: Amrith Raj Rao, M.S., D.N.B., F.R.C.S.Ed., Department of Urology, Wexham Park Hospital, Slough SL2 4HL, United Kingdom. E-mail: [email protected] Submitted: December 20, 2004, accepted (with revisions): January 31, 2005
© 2005 ELSEVIER INC. 1000
ALL RIGHTS RESERVED
FIGURE 1. Soft-tissue mass arising from urethra.
mas have been successfully treated with electrofulguration and laser coagulation.6 REFERENCES 1. Mulliken JB: Cutaneous vascular anomalies, in McCarthy JG, May JW Jr, Littler JW (Eds): Plastic Surgery: Tumors of the Head and Neck and Skin. Philadelphia, WB Saunders, 1990, pp 3191–3223. 2. Goidanich IF, and Campanacci M: Vascular hamartomata and infantile angioectatic osteohyperplasia of the extremities: a study of 94 cases. J Bone Joint Surg 44A: 815– 842, 1962. 3. Jahn H, and Nissen HM: Haemangioma of the urinary tract: review of the literature. Br J Urol 68: 113–117, 1991. 4. Uchida K, Fukuta F, Ando M, et al: Female urethral hemangioma. J Urol 166: 1008, 2001. 5. Kesari D, Gemer O, Segal S, et al: Estrogen receptors in a urethral leiomyoma presenting in pregnancy. Int J Gynaecol Obstet 47: 59 – 60, 1994. 6. Tabibian L, and Ginsberg DA: Thrombosed urethral hemangioma. J Urol 170: 1942, 2003.
UROLOGY 65: 1000, 2005
• 0090-4295/05/$30.00 doi:10.1016/j.urology.2005.01.062