Urology Annals
About UA | Search | Ahead of print | Current Issue | Archives | Instructions | Online submissionLogin 
Urology Annals
  Editorial Board | Subscribe | Advertise | Contact
Users Online: 1052   Home Print this page  Email this page Small font size Default font size Increase font size


 
Table of Contents
CASE REPORT
Year : 2015  |  Volume : 7  |  Issue : 3  |  Page : 399-401  

Cavernous hemangioma of the glans penis


Department of Urology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India

Date of Submission12-Oct-2014
Date of Acceptance04-Nov-2014
Date of Web Publication9-Jul-2015

Correspondence Address:
Dilip Kumar Pal
Department of Urology, Institute of Post Graduate Medical Education and Research, 244, AJC Bose Road, Kolkata - 700 020, West Bengal
India
Login to access the Email id


DOI: 10.4103/0974-7796.152037

PMID: 26229337

Rights and Permissions
   Abstract 

Cavernous hemangioma of the glans penis is a very rare lesion, and only a few cases are reported in the literature. Urologists are in a dilemma to treat such lesion with cosmetic and to obtain good functional outcome. Here, we report a case of cavernous hemangioma of the glans penis in a 22-year-old boy with a successful outcome by intralesional sclerotherapy with 3% sodium tetradecyl sulfate with a review of the literature on the subject.

Keywords: Glans penis, hemangioma, sclerotherapy


How to cite this article:
Mondal S, Biswal DK, Pal DK. Cavernous hemangioma of the glans penis. Urol Ann 2015;7:399-401

How to cite this URL:
Mondal S, Biswal DK, Pal DK. Cavernous hemangioma of the glans penis. Urol Ann [serial online] 2015 [cited 2019 Apr 23];7:399-401. Available from: http://www.urologyannals.com/text.asp?2015/7/3/399/152037


   Introduction Top


Hemangioma is a benign vascular malformation and classified into capillary, cavernous, arteriovenous, venous, and mixed subtypes. [1] Cavernous and mixed varieties are most common and mostly found in the musculoskeletal system, liver, and spleen. It is rarely found in genitalia and constitutes only 1-2% of all hemangiomas. [2] In a comprehensive review, Dehner and Smith described 10 benign angiomatous lesion of the glans penis, [3] since then another 11 such lesions in the glans penis have been reported in the literature. [1],[4],[5],[6],[7],[8],[9],[10] Here, we present such a case treated by intralesional sclerotherapy with 3% sodium tetradecyl sulfate as OPD basis with successful outcome and we recommend this mode of simple and low cost treatment rather than surgical excision or laser therapy.


   Case report Top


A 22-year-old boy presented with swelling over the glans penis for last 4 years. The swelling increased in size on erection. The lesion was operated before 1-year, but it recurred within 2 months. On examination, there was an elevated irregular lesion, about 2 cm × 2 cm in its maximum dimension, on the right dorsolateral portion of the glans penis [Figure 1]. It was bluish-red in color with a smooth surface and irregular margin, compressible, nontender, and nonpulsatile. Color Doppler ultrasonography confirmed the low flow state in the lesion consistent with the diagnosis of cavernous hemangioma. There was no other lesion in the rest of the body. There was no history of trauma of bleeding from the lesion.
Figure 1: Clinical photograph of the penile lesion

Click here to view


The hemangioma was treated by instillation of sodium tetradecyl sulfate 3%. 1 ml of the sclerosant was directly instilled into the lesion with a 26G needle with a tourniquet at the base of the penis to prevent filling. Then compression was applied for about 10 min for emptying the hemangioma. Pressure dressing on the glans penis was applied for 48 h. The procedure was repeated after 1-week. In the 3 rd week, patient presented with a scab [Figure 2] which was removed spontaneously with a resultant ulcer and the lesion disappeared in 6 th week. There was no telangiectasia, scar or ulcer at 6 th week of follow-up [Figure 3]. Till 1-year of follow-up, there was no recurrence.
Figure 2: Postsclerotherapy at 3rd week

Click here to view
Figure 3: Postsclerotherapy at 6th week

Click here to view



   Discussion Top


Etiology of hemangioma is uncertain; it is believed to be abnormal proliferation of endothelial cells of dysplastic vascular channels. Mostly it is a congenital vascular anomaly, but some believe it may be due to revascularization of a previous penile hamartoma [1] or sometimes may develop after trauma. [4] It may occur at any age, and usual presentation is with bright red compressible papules, nodules or plaques when fully developed. Rarely, patient may present with pain on erection, ulceration, or hemorrhage from the lesion. Usually, they remain asymptomatic or may be noticed due to esthetic regions or may present with bleeding following trauma.

Diagnosis of such entity is entirely clinical. Color Doppler ultrasonography may show low flow state in cavernous hemangioma as in our case. Magnetic resonance imaging or computed tomography is unable to show any clear demarcation between cavernous body and the angiomatous malformation. [1] However, cavernosography is helpful to locate the extension of the angiomatous lesion into the corpora cavernosa. [1]

Various modes of management have been described in the literature like laser therapy, [1],[6] surgical excision. [5],[10] and sclerotherapy with sodium tetradecyl sulfate, [4] 30% hypertonic saline [7] and 2% polidocanol. [8],[9] Sclerotherapy has been proposed to act by disruption of vascular endothelium with resultant of thrombus formation in the vessel lumen with subsequent fibrosis and sclerosis. Later, histiocytic digestion leads to disappearance of the treated lesion over a period. [9] Surgical excision may lead to excessive bleeding with sexual dysfunction due to pain and scar formation as an additional complication. [1] Laser therapy though currently advocated, may need multiple procedures for complete removal, but it is costly. [5] Comparatively sclerotherapy is less expensive and easily available, but sometimes it may also lead to necrosis of adjacent tissue, ulceration, and hyperpigmentation. [1],[5] In developing countries, sclerotherapy may prove to be cost effective and safe and with reproducible showing satisfactory results. The exact dose, method, and duration are still under evaluation as the incidences are very rare.

 
   References Top

1.
Cheng G, Song N, Hua L, Yang J, Xu B, Li P, et al. Surgical treatment of hemangioma on the dorsum of the penis. J Androl 2012;33:921-6.  Back to cited text no. 1
    
2.
Alter GJ, Trengove-Jones G, Horton CE Jr. Hemangioma of penis and scrotum. Urology 1993;42:205-8.  Back to cited text no. 2
    
3.
Dehner LP, Smith BH. Soft tissue tumors of the penis. A clinicopathologic study of 46 cases. Cancer 1970;25:1431-47.  Back to cited text no. 3
[PUBMED]    
4.
Sharma G. Hemangioma of glans penis. Internet J Urol 2004;3:1.  Back to cited text no. 4
    
5.
Lee JM, Wang JH, Kim JS. Multiple cavernous hemangiomas of the glans penis, penis and scrotum. Korean J Urol 2008;49:92-4.  Back to cited text no. 5
    
6.
Jimenez-Cruz JF, Osca JM. Laser treatment of glans penis hemangioma. Eur Urol 1993;24:81-3.  Back to cited text no. 6
    
7.
Senoh K, Miyazaki T, Kikuchi I, Sumiyoshi A, Kohga A. Angiomatous lesions of glans penis. Urology 1981;17:194-6.  Back to cited text no. 7
[PUBMED]    
8.
Hemal AK, Aron M, Wadhwa SN. Intralesional sclerotherapy in the management of hemangiomas of the glans penis. J Urol 1998;159:415-7.  Back to cited text no. 8
    
9.
Tsujii T, Iwai T, Inoue Y, Kubota T, Kihara K, Oshima H. Cutaneous hemangioma of the penis successfully treated with sclerotherapy and ligation. Int J Urol 1998;5:396-7.  Back to cited text no. 9
    
10.
Savoca G, De Stefani S, Buttazzi L, Gattuccio I, Trombetta C, Belgrano E. Sclerotherapy of hemangioma of the glans penis. Urology 2000;56:153.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
   Introduction
   Case report
   Discussion
    References
    Article Figures

 Article Access Statistics
    Viewed7248    
    Printed56    
    Emailed0    
    PDF Downloaded231    
    Comments [Add]    

Recommend this journal