Haemangioma of the Penis: A Review and Update of the Literature

Haemangioma of the penis (HOP) is a rare benign vascular lesion which can affect the penis of males including infants, children, and adults of up to the over 80 year-olds. HOP does manifest as: asymptomatic lump or lesion on the penis; localised pain or tenderness anywhere within the penis; a tumoral mass anywhere on the penis; pain in the penis on erection; curvature of penis on erection; bright red compressible papule or papules on penis; nodules on penis; plaques on penis; ulceration on penis; haemorrhage on penis. HOP may be associated erectile dysfunction in some cases and could affect voiding if it is associated with the urethral meatus. HOP which tends to be solitary in most cases may mimic other diseases of the penis as well as may be associated with haemangioma in the scrotum and perineal region occasionally. Diagnosis can be established by the clinical features and this can be reaffirmed by radiology imaging features with the use of Doppler ultrasound scan, CT scan and MRI scan which show low-flow within the lesion. Majority of the lesions tend to be superficial and not associated with the corpora cavernosa and spongiosum. There is no consensus opinion on the best treatment options hence various treatment options for HOP have been successfully utilized including: complete surgical excision, sclerotherapy, laser treatment, cryotherapy, and other therapies. Most cases of HOP do not recur but following sclerotherapy and laser treatment of large HOPs repeat procedures tend to be required and there may be residual / recurrent lesion that may need to be treated again. Deep and large HOPs may require complete excision with insertion of tunica graft. Very large HOPs could be more effectively treated by one stage complete surgical excision but the choice of the patient is important. The diagnosis of the lesion can be confirmed by the histopathology features of the lesion and positive immunohistochemistry staining for CD31 (strong), Factor VIII, and HHF35 (myopericytes) and minimal staining for CD34. HOP needs to be carefully differentiated from epithelioid angiosarcoma of the penis and epithelioid haemangioendothelioma. A multi-centre trial of various treatment options for HOP would be required to provide treatment guidelines for HOP taking into consideration the size of the lesion and availability of the various treatment options.