Testicular hemangioma: a series of 8 cases

Testicular hemangioma is a very rare neoplasm with only 25 cases reported in the English literature. We describe 8 cases of testicular hemangioma encountered at our institution between 1992 and 2012. Of the 7 consult cases, 4 were malignant, 1 a Leydig cell tumor, and 2 were recognized as hemangiomas. The patients' ages ranged from 9 to 54 years (mean 32; median 30). Seven patients presented with self-detected palpable masses, and 2 patients reported pain. Six hemangiomas involved the right testis, and 2 were left sided. Ultrasonography recognized hypervascularity in 3 cases. History of pelvic irradiation, chemotherapy, and remote scrotal trauma was present in 3 patients. Preoperative serum tumor markers were negative (2/2 cases). The average size was 1.7 cm (median 1.8; range, 0.5 to 3.0). Six cases were infiltrative within the testis and entrapped benign seminiferous tubules, and 3 tumors invaded the tunica albuginea. Three hemangiomas were epithelioid, 2 anastomosing, 1 cellular capillary, 1 capillary, and 1 cavernous. Mitoses were sparse in all but 1 case, which reached up to 5 per 10 HPF. In 6 cases, seminiferous tubules adjacent to the hemangioma were atrophic without spermatogenesis. Immunohistochemical analysis was performed in 6 cases, and tumors stained with CD31, CD34, FVIII-related protein, and FLI-1 but not with pancytokeratin AE1/3, epithelial membrane antigen, keratin 8/18, placental alkaline phosphatase, human herpes virus 8, human chorionic gonadotropin, c-kit, melan-A, or p53. In cases with follow-up, there were no recurrences in 7 patients (mean 21 mo; median 12 mo; range, 1 to 72 mo). In summary, testicular hemangioma is a rare neoplasm with different morphologies having in common an infiltrative growth pattern with entrapment of seminiferous tubules, which should not be considered a feature of malignancy. Clinical and radiologic findings may preoperatively suggest a vascular tumor.