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Penis and scrotum
Benign tumors
Epithelioid hemangioma
Editors: Antonio Cubilla, M.D. and Alcides Chaux, M.D. (see Author/Reviewers page)
Revised: 12 May 2010, last major update May 2010
Copyright: (c) 2002-2010, PathologyOutlines.com, Inc.
Definition
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● Very rare in the penis
Terminology
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● Also called atypical/pseudopyogenic granuloma, inflammatory angiomatous nodule, angioblastic (lymphoid) hyperplasia with eosinophilia, angiolymphoid hyperplasia with eosinophilia, intravenous atypical vascular proliferation and histiocytoid hemangioma
Epidemiology
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● Median age 45 years, range 23-75 years
Sites
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● Mainly penile shaft but also glans or penile root
Etiology
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● Possibly trauma-related proliferation
Clinical features
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● Localized pain/tenderness
● Tumor mass
Case reports
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● Series of 19 cases (Am J Surg Pathol 2004;28:523)
● Two cases (Arch Pathol Lab Med 1985;109:51)
Gross description (Macroscopy)
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● Solitary mass in most cases
● Preferential dorsal location
● Tumor size 1.2 cm (range <0.5-2.5 cm)
Micro description (Histopathology)
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● Tumefactive proliferation of epithelioid endothelial cells with nodular/lobular configuration formed by immature but well-defined vessels
● 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
Micro images
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Colon Orbit Skin: H&E and CD31
Positive stains
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● CD31 (strong), Factor VIII, HHF-35 (myopericytes)
● Minimal for CD34
Negative stains
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● AE1/AE3 (scattered positive cells may be present)
Differential Diagnosis
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● Epithelioid hemangioendothelioma: more nuclear atypia, infiltrative/destructive pattern of growth, preferentially affects veins, myxoid/hyalinized connective matrix, scarce/absent inflammatory infiltrate
● Epithelioid angiosarcoma: deep location, marked nuclear atypia, destructive growth pattern, necrosis, high mitotic rate, myxoid/hyalinized connective matrix; scarce/absent inflammatory infiltrate, not associated with arterial walls
End of Penis and scrotum > Benign tumors > Epithelioid hemangioma
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