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泌尿科臨床個案探討

泌尿科臨床個案探討. 孫紀征醫師提供. Abstract.

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泌尿科臨床個案探討

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  1. 泌尿科臨床個案探討 孫紀征醫師提供

  2. Abstract • We reported 3 cases of genital hemangioma, one located over scrotum and the other two over penile shaft. The first case is a 12-year-old boy presented with painful sensation of lower middle part of scrotum and orchitis was told by local clinic. A rubbery mass, sized about 27x12mm, was identified by phyical examination and the ultrasound disclosed a hypo-echoic nodule between bilateral testes. Surgical excision was performed and the pathology revealed cavernous hermangioma. The other two cases are 38-year-old and 19-year-old males with rubbery nodules, size about 20x5mm and 12x5mm respectively, over sulcus glandularis. There was no discomfort or interference of sexual intercourse, though the lesion was found for more than three months. Excision biopsies were suggested and the pathology disclosed capillary hemangioma. Since hemangioma of genitalia is extremely rare, we herein discuss the clinical significance of these tumors and literature review.

  3. Scrotal cavernous hemangioma • 姓名：陳小弟 • 年齡：12歲 • 病史：Scrotal mass over lower medial raphe with tenderness for about 1~2 weeks. But no history of scrotal trauma was noted recently. He was taken to GU OPD on 2000-6-27.身體檢查：A soft tissue nodule, sized about 15x15mm, located over lower medial part of scrotum. Mild tenderness and a few small petachiae were found around the nodule.

  4. 超音波 • 2000-6-29: Ultrasonography: normal bilateral testes; a homogenous hypo-echoic nodule, sized about 27x12mm, in size, found between bilateral testes; Normal echogenicity of bilateral kidneys were noted.

  5. 實驗室檢查 • b-hCG<0.5mIU/ml; AFP=0.788ng/ml;BUN/Cr=9/0.8; Glu=96; ALT/AST=5/28; Na/K=142/3.65;CBC: WBC 5830; N/L=58.1%/22.5%; RBC 4820000; Hgb 13.4; Hct 39.2%; MCV 81.3 fl; MCH 27.8 pg; MCHC 34.2g/dl; Plt 377000; Eosinophil 11.3%; Baso 0.9%;

  6. 術前診斷：Scrotal tumor, nature ? • 手術：2000-7-4: Excision biopsy under general anesthesia; • 病理：Cavernous hemangioma Gross: The specimen consists of one piece of gray white and brown soft tissue, measuring 15x15x10mm

  7. Microscopic • The sections show irregular dilated venous vascular spaces lined by flat endothelial cells and fibromuscular walls. The lumina have erythrocytes and blood clots. No evidence of malignancy is identified in the specimen examined.

  8. Penile capillary hemangioma

  9. Case #1 • 姓名：廖先生年齡：39歲病史：A rubbery nodule over sulcus glandularis without tenderness was noted for more than half a year. He visited our GU OPD on 2000-8-1.身體檢查：A rubbery nodule, sized about 20x5mm, located over right dorsal aspect of sulcus glandularis of penis. Movable, without tenderness.

  10. 術前診斷：Penile tumor, nature ? • 手術：2000-8-1: Excision biopsy under local anesthesia; • 病理：Capillary hemangioma: Gross: red in color, 20x5x3mm in size.

  11. Microscopic: picture of capillary hemangioma with proliferation of endothelial cells and numerous capillary lumina. No evidence of malignancy.

  12. 文獻回顧

  13. Introduction • Classification of hemangioma • Capillary, Cavernous, Arteriovenous, Venous, Mixed type • Most common: cavernous & mixed • The most common tumor of childhood • Site of involvement • Musculoskeletal system, Liver, Spleen • Most masses present within the first 2 decades of life and instead of involuting, may enlarged as the child grows.(2)

  14. Etiology • CongenitalVascular neoplasiaTrauma (5, 6,7)

  15. Differential diagnosis • Benign and malignant testicular lesionsSpermatic cord lesionsEpididymal lesionsAtheromatous cystsDermoidsTeratomasLipomasInguinal hernia

  16. Scrotal and penile (genital) hemangioma are unusual anomalies • 1~2% of all hemangioma involved genitalia.(1)In 1851 Robert reported the first case and less than 45 cases have been reported in the literature. (2)Klippel-Trenaunay syndrome (2)Cutaneous hemangioma, varicose vein, ipsilateral soft tissue and body hypertrophy.

  17. Treatment • Surgical excision: recommended because of the possibility of traumatic rupture and massive hemorrhage. (2)Vessels ligation. (2)Subcutaneous / intravenous steroids. (2)Orchiectomy. (2)Radiation.(2)Electrofulguration(4)Cryosurgery(4)Pulse dye laser(10) • Prognosis: good

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