Haemangioma of the Testis: A Review and Update of the Literature
Less than 60 cases of haemangiomas of the testis (HOTs) have been reported sporadically in different parts of the world in diverse age groups including in children and adults even though it has been more commonly reported in individuals who are younger than 20 years. HOTs may present with lump/mass in testis/scrotum, scrotal enlargement with or without associated pain/discomfort. The results of serum germ cell tumour marker levels tend to be normal always. The clinical examination does reveal a discrete lump/mass in the testis which may or may not be tender. Radiology imaging does illustrate a discrete mass which usually tends to be well-demarcated but at times the lesion could be abutting the tunica albuginea testis. Doppler scan would tend to show increased vascularity and blood flow within the lesion which may also contain calcifications and at times radiology imaging could illustrate some degree of mild contrast enhancement and these features at times may suggest the possibility of benign disease but malignancy cannot be excluded. An incidental lesion of HOT was identified incidentally in radiology imaging in the absence of a palpable mass/lump. The ideal treatment for HOT is testis-sparing partial orchidectomy which has been undertaken in about a third of cases of HOT reported and radical orchidectomy has been undertaken in two-thirds of cases of HOT under a provisional diagnosis of malignant testicular tumour and the final diagnosis has been based upon the post-operative pathology reports. Diagnosis of HOT tends to be based upon the histopathology examination findings of small tubules with red blood cells that are lined by mesothelial like cells that have uniform vesicular nuclei but they can have focally infiltrative growth pattern with entrapment of seminiferous tubules. Immunohistochemistry staining studies of HOTs do show positive staining for Factor VIII, CD31, CD34, and FLI1 but negative staining for Pancytokeratin AE1/AE3, Keratin 8 / 18, EMA, placental herpesvirus 8, human chorionic gonadotrophin, c-kit, and p53. No recurrence has been reported following either testis-sparing partial orchidectomy after frozen section pathology examination or after radical orchidectomy. If urologist and radiologists have a high index of suspicion for the disease, and intraoperative frozen section excision biopsies are undertaken in all cases of testicular tumours in all age groups with the knowledge of normal levels of germ cell tumour markers then testis-preserving surgery can be undertaken and unnecessary radical orchidectomy can be avoided.