Stesura Seveso 395Archivio Italiano di Urologia e Andrologia 2014; 86, 4 CASE REPORT Capillary hemangioma of the scrotum mimicking an epididymal tumor: Case report Antonio Vavallo 1, Francesco Lafranceschina 1, Giuseppe Lucarelli 1, Carlo Bettocchi 2, Pasquale Ditonno 2, Michele Battaglia 2, Francesco Paolo Selvaggi 1 1 Casa Bianca Hospital (GVM), Cassano delle Murge, Bari, Italy; 2 Urology, Andrology and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation (DETO), University of Bari, Italy. We report a case of capillary heman- gioma of the scrotum. A 52-year-old male presented with a left scrotum swelling that had arisen suddenly two months before. Scrotal ultrasound revealed a dishomogeneous mass in the left scrotum. The mass demonstrated blood flow in the color Doppler mode. Scrotal mass excision was performed. Pathological evaluation revealed a capillary hemangioma. KEY WORDS: Capillary; Hemangioma; Scrotum. Submitted 3 October 2014; Accepted 31 October 2014 Summary No conflict of interest declared. in the lesion. The patient was diagnosed with a suspect- ed epididymal neoplasm and a left inguinal approach was performed. The mass was dissected with testicular and epididymal sparing surgery and found to be a nodu- lar, dark red conglomerate of distended blood vessels measuring 7 x 5 x 2 cm. The mass was not attached to the testis or the spermatic cord, but was adherent to the epididymis. Pathological examination identified a capil- lary hemangioma and immunohistochemical staining for CD31, actin, S100 protein and Ki67 confirming the vas- cular nature of this tumor. On the basis of the morpho- logical characteristics and immunohistochemical find- ings, the diagnosis of scrotal capillary hemangioma was rendered. At the last follow-up, 12 months after the operation, the patient was healthy without any clinical evidence of complication or recurrence. DISCUSSION Hemangiomas are benign vascular tumors, which may develop in any part of the body and they are most com- mon in the musculoskeletal system, liver and spleen. Hemangiomas are classified into capillary, cavernous, arteriovenous, venous and mixed subtypes and may be composed of vessels whose walls are abnormal and can- not be identified as arterial or venous (3). The occur- rence of capillary hemangioma in the scrotum is rare and scrotum enlargement, with or without tenderness, is the chief presenting symptom. Only a few number of articles describing intrascrotal hemangioma have been reported. An interesting point of our case is the age; our patient was a 52-year-old male and, as far as we know, this is the first case in which the patient is older than 50 years in the literature. Ultrasonography is useful for diagnosing scrotal hemangiomas, but rarely definitive. It can deter- mine the extent of the lesion, delineate its relationship with adjacent structures, demonstrate the nature of the mass and help plan therapy. In sonography, heman- giomas vary from hypoechoic to hyperechoic, or they may be heterogeneous. Color Doppler may demonstrate blood flow within these lesions but the absence of flow DOI: 10.4081/aiua.2014.4.395 Presented at 19th National Congress SIEUN, Fermo 2014 INTRODUCTION Scrotal hemangioma is a very rare benign vascular neo- plasm, mostly seen in children and young adults and comprises less than 1% of all hemangiomas (1). Malignant tumors of the epididymis constitute 25% of the tumors of this area (2). In the current study, we report a case of capillary hemangioma of the left scro- tum, which mimicked an epididymal tumor, and discuss the diagnostic and therapeutic problems. CASE REPORT A 52 years old man referred to our department for pain- less enlargement in the left hemiscrotum for two months. Personal and familiar history were unremark- able. The patient denied any history of fever, scrotal trauma or epididymitis. At physical examination, the mass was discriminated from the testis, but not from epi- didymis and spermatic cord. The patient had a normal blood cell count and urinalysis. Laboratory examina- tions, including relevant tumor markers, particularly α-fetoprotein and β-human chorionic gonadotrophin, were normal. Scrotal ultrasound revealed a dishomoge- neous mass, lying on the border between epididymal tail and lower pole of the left testis without any disruption of the architecture of the testicular parenchyma. Color Doppler sonography showed increased blood flow with- Vavallo_Stesura Seveso 16/01/15 12:01 Pagina 395 Archivio Italiano di Urologia e Andrologia 2014; 86, 4 A. Vavallo, F. Lafranceschina, G. Lucarelli, C. Bettocchi, P. Ditonno, M. Battaglia, F.P. Selvaggi 396 does not rule out the presence of the lesions. Magnetic Resonance Imaging (MRI) may provide more useful infor- mation for differentiation. When the diagnosis is estab- lished, eradication of the lesion is recommended and the lesion must be complete removed to avoid recurrence. Since it is impossible to differentiate a hemangioma from a malignant tumor before the operation, intra-operative frozen section examination may be requested as tumor enucleation with testicular and epididymal sparing sur- gery is considerate adequate. CONCLUSION In summary, capillary scrotal hemangioma is a very rare neoplasm with different morphologies having in com- mon an infiltrative growth pattern. Clinical and radio- logic findings may preoperatively suggest a vascular tumor; however any scrotal solid masses of uncertain diagnostic significance require surgical approach to define the nature by hystological examination. REFERENCES 1. Lin CY, Sun GH, Yu DS, et al. Intrascrotal hemangioma. Arch Androl. 2002; 48:259-65. 2. Dell'Atti L. Ultrasound diagnosis of unusual extratesticular mass: case report and review of the literature. Arch Ital Urol Androl. 2013; 85:41-3. 3. Rastogi R. Diffuse cavernous hemangioma of the penis, scrotum, perineum, and rectum- A rare tumor. Saudi J Kidney Dis Transpl. 2008; 19:614-8. Figure 1. Macroscopic specimen of the dissected mass, which appeared as a nodular, dark red conglomerate of distended blood vessels. Correspondence Antonio Vavallo, MD (Corresponding Author) antoniovavallo@hotmail.com Francesco Lafranceschina, MD Giuseppe Lucarelli, MD Francesco Paolo Selvaggi, MD Casa Bianca Hospital (GVM) Cassano delle Murge, Bari, Italy Carlo Bettocchi, MD Pasquale Ditonno, MD Michele Battaglia, MD Urology, Andrology and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation (DETO), University of Bari Piazza G. Cesare 11 - 70124 Bari, Italy Vavallo_Stesura Seveso 16/01/15 12:01 Pagina 396