53 Archivio Italiano di Urologia e Andrologia 2020; 92, 1 CASE REPORT Surgical treatment of large hemangioma of the scrotum in a young adult male Massimo Iafrate 1 , Nicolò Leone 1 , Cesare Tiengo 2 , Filiberto Zattoni 1 1 Università degli studi di Padova, Dipartimento di Scienze Oncologiche Chirurgiche e Gastroenterologiche, Clinica Urologica, Padova, Italy; 2 Università degli studi di Padova, Dipartimento di Neuroscienze, Chirurgia Plastica Ricostruttiva ed Estetica, Padova, Italy. A 24-year-old male came to our clinic for a volumetric increase of a suspected scrotal hemangioma with thrombosis episodes. The ultrasound rose the suspicion of hemangioma and the Magnetic Resonance (MR) of the scrotum confirmed the suspicion. The mass was surgically removed and histopathology described a heman- gioma cavernous. The postoperative course was regular and no subsequent relapse was shown in 5 months follow-up. KEY WORDS: Andrology; Hemangioma; Scrotum; Scrotal surgery; Scrotal mass. Submitted 3 February 2020; Accepted 29 February 2020 Summary No conflict of interest declared. DOI: 10.4081/aiua.2020.1.53 INTRODUCTION Hemangiomas are the most common vascular neoplasms in children with an incidence in the first year of age ranging from 3 to 10%. The most frequent localizations are head, neck, trunk, and extremities. Hemangiomas of the scrotum are rare conditions in adult. Many researchers consider them benign neoplasms originating from a congenital vascular anomaly (1). CASE REPORT After a written informed consent was obtained from the participant for the publication of this case report, we present a 24-year-old student male with a history of sus- pected scrotal hemangioma known from the age of 14 progressively growing over the past 12 months. In the previous 36 months, he went to the emergency room three times for hemangioma thrombosis which was con- servatively treated. In medical history, he reported the removal of a lipoma in the sacral region and no previous traumas of genitalia. No significant family history was present. The physical examination showed a soft vascu- lar mass of about 3 x 7 cm positioned in the middle part of the scrotum (Figure 1). The testicles with their funicu- lum were completely independent from the vascular mass. The remaining physical examination did not show any other significant finding. Hematology, biochemistry, renal, liver function and hormonal panel were in range. MRI of the scrotum documented the presence of a lesion of 6 x 7 x 7 cm made of venous structures dilated devel- oping in the context of the inferior-internal wall of the right scrotum containing some phlebolites, compatible with hemangioma. The lesion was in close contact with the right cavernous body but did not infiltrate Buck's fascia. Surgical excision was therefore planned. In gener- al anesthesia, a diamond-shaped incision was made in the scrotal skin. With the dissection of the subcutaneous tissue, we identified the hemangioma inside the scro- tum. After careful isolation of the neoplasm from the funicular structures and the testicles, we identified the site of origin at the perineal level on the Buck’s fascia. The vessels were then tied to the site of origin with sutures, followed by complete removal of the heman- gioma and sent to histological examination (Figure 2). A scrotal drainage in extraction and a bladder catheter were placed. Subcutaneous and skin have been sutured with detached points and a compressive dressing has been applied. The drainage and the catheter were removed the next day. The postoperative course was uneventful. Histopathological examination showed the presence of skin and subcutaneous tissue with vascular proliferation consisting of ectasic vessels with thin walls compatible with scrotal hemangioma. After 5 month, at the follow-up visit, the scar was nearly unrecognizable and there were no signs of recurrence (Figure 3). DISCUSSION Cavernous hemangiomas of the scrotum are usually present since birth but come to the attention of the physician only during adolescence due to their unaes- thetic aspect. Generally, they are painless masses but sometimes they can be associated with symptoms (pain and bleeding). The imaging helps to characterize the lesion, to assess the extent of the hemangioma, and to detect associated anomalies. Scrotal ultrasonography, however, is frequently not diriment for the diagnostic characterization. A hemangioma may be hypo or hyper- echoic. The most typical finding is a mass of soft tissue containing phlebolites (small calcifications). The pres- ence of phlebolites is characteristic of cavernous heman- gioma. CT and MRI provide a simple and non-invasive method for the diagnosis and the determination of the extent of these lesions as well as their relationship with adjacent structures. For such reasons, these imaging techniques are considered mandatory before a surgical program (2). The therapeutic choice must take into account different aspects, from the size and the location of the neoplasm to the esthetic outcome. In the litera-