Testicular Hemangioma: A Series of 8 Cases
Oleksandr N Kryvenko, Jonathan I Epstein. Johns Hopkins Hospital, Baltimore, MD
Background: Testicular hemangioma is a very rare neoplasm with only 25 case reports in the English literature. Such a low incidence increases the likelihood of both clinical and pathological misdiagnoses.
Design: We describe 8 cases of testicular hemangioma encountered in our institution between the years 1992 and 2012. Immunohistochemical analysis was performed in 6 cases.
Results: Clinically, a diagnosis of malignancy was entertained in all cases. Pathologycally, of the 7 consult cases, 4 favored malignancy, one a Leydig cell tumor, and 2 were recognized as hemangiomas. Patients' ages ranged from 9 to 54 years old (mean 32; median 30). Seven patients presented with self-detected palpable masses and 2 patients reported pain. Six hemangiomas involved the right testis and 2 were left-sided. Ultrasonography recognized hypervascularity in 3 cases. History of pelvic irradiation, chemotherapy, and remote scrotal trauma were present in 3 patients. The average size was 1.7 cm (median 1.8; range 0.5-3.0). Six cases were infiltrative within the testis and entrapped benign seminiferous tubules, and 3 tumors invaded the tunica albuginea. Three hemangiomas were epithelioid, 2 anastomosing, 1 cellular capillary, 1 capillary, and 1 cavernous. Mitoses were sparse in all but one case, which reached up to 5 per 10 HPF. In 6 cases, seminiferous tubules adjacent to hemangioma were atrophic without spermatogenesis. Tumors stained with CD31, CD34, FVIII-related protein, and FLI-1 but not pancytokeratin AE1/3, epithelial membrane antigen, keratin 8/18, placental alkaline phosphatase, human herpes virus 8, human chorionic gonadotropin, c-kit, melan-A, or p53. None of hemangiomas was associated with intratubular germ cell neoplasia. In one consultation case of what was eventually proven to be regressed testicular germ cell tumor associated with retroperitoneal metastases (not included in the study), we saw such marked increased vasculature between seminiferous tubules that it was initially diagnosed as capillary hemangioma. In cases with follow-up, there were no recurrences in 7 patients (mean 21 months; median 12 months; range 1 to 72 months).
Conclusions: Testicular hemangioma is rare with different morphologies having in common an infiltrative growth pattern with entrapment of seminiferous tubules, occasional tunica albuginea invasion, and often unusual cellular variants which should not be considered features of malignancy. Clinical and radiologic findings may preoperatively suggest a vascular tumor. It is also important to recognize that areas mimicking hemangioma may be seen in regressed germ cell tumors within the testes.
Category: Genitourinary (including renal tumors)
Tuesday, March 5, 2013 9:30 AM
Poster Session III # 108, Tuesday Morning