A rare neoplasm of the testis: capillary hemangioma

Abstract

Intratesticular vascular neoplasms are extremely rare tumors and mostly seen in children or young adults. We reported a case of capillary hemangioma of the testis to attract attention to testicular hemangioma and also to prevent invasive surgery of the testis. The patient was an 18-year-old boy with a testicular mass. Scrotal sonography revealed a varicocele in the left testis and a simple cyst in the left epididymis. There was a solid hypoechoic neoplastic area 75 mm in diameter in the right testis. The laboratory findings including tumor markers and serum levels of alpha-fetoprotein and beta-human chorionic gonadotrophin were normal. The patient underwent right orchiectomy and the pathology diagnosis was capillary hemangioma. Testicular neoplasms derived from connective tissue, blood vessels and musculature are uncommon and intratesticular tumors of vascular origin are extremely rare. There are only 21 cases reported in the literature. The pathologists and the surgeon have to be aware of this entity as the prognosis of the neoplasm determines the method of surgery. Capillary hemangioma of the testis can be similar to malignant testicular tumors on clinical presentation, as well as on ultrasonography and magnetic resonance imaging. Although it is impossible to differentiate a hemangioma from a seminoma before the operation, intraoperative frozen study may be helpful in the differential diagnosis. Frozen section must be performed if the neoplasm has significant vascular proliferation identified by Doppler sonography. Because of the benign nature of this lesion, conservative surgical treatment by means of tumor enucleation with preservation of the testis is possible if intraoperative frozen section examination can be performed.