Hemangioma News

Epithelioid hemangioma (EH) is an uncommon benign vascular tumor.It is usually located in the subcutaneous tissues of the head and the distal portions of the extremities, especially the digits. It generally presents as a tender nodule that slowly enlarges with time.The size at excision has ranged from 0.5 to 2.5 cm in greatest dimension. The mean time between the first appearance and its excision was 4.5 months, ranging from a few days to 1 year.It has the following features.

First, most cases of EH develop in the head (in the distribution zone of the superficial temporal artery) and in the distal portion of the extremities.Only very rarely has this tumor been described to affect the penis, with fewer than 30 cases reported. In some patients, the association between EH and penile trauma has been identified.We know from published studies that the reference standard for treatment of EH is local excision. External beam radiotherapy to the surgical margins is seldom performed.In only 1 case of atypical EH, did local recurrence develop 6 cm distal to the previous excision. At long-term follow-up (20 years at the most), nearly all patients remained free of disease. Neither lymph node involvement nor distant metastasis has been reported.

Second, the elapsed time between the initial diagnosis and the excision of the lesion in previously reported cases of EH was 1 year at the most.In contrast, in our patient, the interval was exceptional at 4 years. This could have been because of the greater depth of the lesion at the root of the corpus cavernosum and the increase in size that was slower than formerly described.Ultrasound time-elapsed measurements of the lesion demonstrated that, after 4 years, the greatest dimension had only increased by 3 mm. Therefore, in our case the’atypical’ variant of EH was not associated with rapid growth of the lesion.

Third, this lesion was initially misdiagnosed as PD, and ECD ultrasonography was essential to the clinical diagnosis of EH.Ultrasonography showed a well-circum-scribed hypoechoic PD-like nodule with a slightly irregular internal structure, in association with the tunica albuginea. PD nodules can have different ultrasound patterns, depending on their age and activity (normally hypoechogenic in recent nodules, isoechogenic in fibrotic nodules, and hyperechogenic in calcific nodules). However, in some cases, even with the clinical presentation of PD, no significant alterations can be detected on ultrasonography.Nevertheless, vascularization assessment with penile ECD ultrasonography will help to establish the correct clinical diagnosis: PD nodules feature low or absent vascularization, usually surrounded by distorted vessels.In contrast, in the present case, ECD ultrasonography demonstrated a highly vascularized lesion with both arterial and venous fiow. To our knowledge, no ECD examination of EH has previously been performed at other anatomic sites.

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