Penis and scrotum
Benign tumors
Epithelioid hemangioma

Authors: Antonio Cubilla, M.D., Alcides Chaux, M.D. (see Authors page)

Revised: 23 August 2018, last major update May 2010

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PubMed Search: Epithelioid hemangioma penis

Cite this page: Cubilla, A., Chaux, A. Epithelioid hemangioma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/penscrotumepithelioidhemangioma.html. Accessed November 14th, 2018.
Definition / general
  • Very rare in the penis
Terminology
  • Also called angioblastic (lymphoid) hyperplasia with eosinophilia, angiolymphoid hyperplasia with eosinophilia, atypical / pseudopyogenic granuloma, histiocytoid hemangioma, inflammatory angiomatous nodule, intravenous atypical vascular proliferation
Epidemiology
  • Median age 45 years, range 23 - 75 years
Sites
  • Mainly penile shaft but also glans or penile root
Etiology
  • Possibly trauma related proliferation
Clinical features
  • Localized pain / tenderness
  • Tumor mass
Case reports
Gross description
  • Solitary mass in most cases
  • Preferential dorsal location
  • Tumor size 1.2 cm (range < 0.5 - 2.5 cm)
Microscopic (histologic) description
  • Tumefactive proliferation of epithelioid endothelial cells with nodular / lobular configuration formed by immature but well defined vessels (Am J Surg Pathol 2004;28:523)
  • Proliferation involves mainly superficial soft tissues and rarely deep erectile tissues
  • Epithelioid endothelial cells with abundant amphophilic / eosinophilic cytoplasm, large nuclei with open chromatin, delicate nuclear membranes and distinctive centrally located nucleoli
  • Inflammatory infiltrate with lymphocytes and eosinophils
  • Proliferation is usually associated with a small arterial segment showing intraluminal epithelioid endothelial cells and evidence of vascular damage (thrombosis, fibrointimal proliferation, duplication of internal elastic lamina or mural disruption)
  • Muscle specific actin+ myopericytic cells border endothelial cells in all cases
  • Low mitotic rate and no atypical mitoses

Atypical / exuberant type:
  • Prominent centrally located area with nests or sheet-like aggregates of epithelioid endothelial cells
  • No vessel formation in these central areas
Microscopic (histologic) images

Images hosted on other servers:

Orbit

Positive stains
Negative stains
  • AE1 / AE3 (scattered positive cells may be present)
Differential diagnosis
  • Epithelioid angiosarcoma: deep location, marked nuclear atypia, destructive growth pattern, necrosis, high mitotic rate and myxoid / hyalinized connective matrix; scarce / absent inflammatory infiltrate, not associated with arterial walls
  • Epithelioid hemangioendothelioma: more nuclear atypia, infiltrative / destructive pattern of growth, preferentially affects veins, myxoid / hyalinized connective matrix and scarce / absent inflammatory infiltrate