Benign infantile hemangioma presenting as solid testicular mass
Victor Kucherov, MD(1), Kudakwashe Chikwava, MD(2), Steven Blumer, MD (3), T. Ernesto Figueroa, MD(4)
1. Department of Urology, Thomas Jefferson University Hospital, Philadelphia, PA. 2. Department of Pathology, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE. 3. Department of Radiology, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE. 4. Division of Pediatric Urology, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE.
A 3-month old boy presented with right scrotal swelling and concern by his pediatrician for right hydrocele. Examination revealed an enlarged and firm right testicle concerning for solid mass; exam was otherwise benign without signs of lymphadenopathy or intra-abdominal mass. Work-up with scrotal ultrasound (US) identified a 4 cm exophytic right testicular mass with numerous satellite lesions throughout the testicle concerning for a malignant process. Further evaluation with computed tomography (CT) of the chest, abdomen, and pelvis did not reveal any metastatic disease. Tumor markers including alpha fetoprotein (AFP) and human chorionic gonadotropin (hCG) were within normal limits. Given concern for malignancy right radical orchiectomy was performed. Gross pathologic evaluation revealed a pink/tan lobulated mass displacing the testicle inferiorly. Microscopic examination found the mass to be arising from the tunica albuginea and visceral tunica vaginalis with focal extension into the distal spermatic cord and testicular parenchyma. The cells formed numerous capillary beds. Immunohistochemistry was negative for germ cell and sex-cord stromal markers. Final diagnosis with benign infantile hemangioma. Literature review found this to be a rare tumor without association to neoplasms of other body sites. Post-operatively he was followed with scrotal US which did not reveal interval appearance of any other masses.
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