Adam E. Klein, MD - West Virginia State Medical Association

| Scientific Articlehemangiomas have been describedin Klippel-Trenaunay syndrome(cutaneous port-wine hemangiomas,varicose veins, and ipsilateralsoft tissue and bony hypertrophyof the involved extremities).Scrotal hemangiomas areextremely rare lesions and lessthan 45 cases have been reportedin the literature since the first casewas reported by Boullay in 1851. 3Many cases prior to definitivediagnosis may be misinterpretedas other soft tissue masses of thescrotum. Various conditions such assebaceous cyst, midline epidemoidcyst, angiomyolipoma , varicocele,hematoma, hamartomas of thescrotum could be confused withhemangioma. Patients with scrotalhemangiomas usually present withscrotal enlargement, with or withouttenderness. Clinical examination andradiological imaging in the form ofultrasound with doppler are valuabletools used to arrive at a definitivediagnosis. Typically most of theabove mentioned clinical conditionshave subtle clinical findings thatdifferentiate them from hemangioma.Diagnosis is confirmed on ultrasoundwith doppler examination whichreveals the vascular component withits flow patterns. It is important torule out coexisting hemagiomas ofthe other system. Wide age rangehas been reported with respect topatients presenting with the scrotalhemangioma ranging from onemonth to sixth decade of life. 3,4 Thesepatients are either asymptomaticor may present with sensationof heaviness, dragging pain andoccasionally hemorrhage. 3,5,6 Thoughwide excision is a treatment of choicevarious other treatment options suchas steroid, fulguration with eithercarbon dioxide or electrocautery hasminimal to zero success. 3,5,6 Mostpatients when treated do not mandatelong term follow-up as the likelyrisk of malignant transformationis not reported but may recur fromits associated systemic nature.ConclusionScrotal septal hemangiomas arerare, thought it should be consideredin the differential diagnosis of allthe other midline masses. Diagnosisis confirmed on doppler ultrasoundwith its characteristic findings.For growing hemangiomas earlyintervention in the form of surgicalexcision is valuable and long termfollow-up is generally not required.References1. Ray B, Clark SS: Hemangioma of scrotum.Urology. 1976; 8(5): 502-5052. Pratt AG: Birthmarks in infants. ArchDermatol 1972; 67: 302-3053. Gibson TE. Hemangioma of the scrotum.Urol Cutan Rev 1937; 41: 8434. Mahoney MT: Cavernous hemangioma ofscrotal septum. J Pediatr 1956; 49:7445. Winslow ,N:Cavernous hemangioma of thescrotum, report of case, Arch. Surg. 9:829(1929)6. Cooper,T.P, Anderson RG , Chapman WH:Hemangioma of the scrotum; a casereport, review and comparison withvaricocele,ibid.112;623 (1974).helping west virginia physicians taKe the right path......in litigation, privacy and security compliance, certificate of need, medical staff and professionaldisciplinary matters, credentialing concerns, complex regulatory matters and business transactions.health care practice groupEdward C. Martin, Responsible Attorneywww.fsblaw.comCharleston | Morgantown | WheelingJuly/August 2012 | Vol. 108 27