A Rare Case of Penoscrotal Haemangioma

Haemangiomas are hamartomas of the vascular endothelium.Though they are the most common tumours of infancy, genital haemangiomas account for 1-2 percent of which penoscrotal haemangiomas are rare .Only 10 cases have been reported in the world literature so far. Penoscrotal haemangiomas commonly present as a mass or as dilated structures in scrotum . 50 percent of these haemangiomas extend into gluteal region . MR urography is imperative for diagnosis and treatment. Treatment options include steroids, alpha interferon, sclerosants,surgery or embolisation. A 5 year old boy presented with bleeding per urethra since six months of age . He was treated in various hospitals M as a case of urinary tract infection. On examination child was anaemic , had no other cutaneous haemangiomas or bleeding spots . Vitals were stable and was normally nourished . Local examination revealed two prominent tortuous veins on his penis and normal penile length . Per rectal examination was normal . Investigations revealed haemoglobin of 6.5 gm and microcytic hypochromic anaemia in peripheral smear. Coagulation profile, platelet count and renal parameters were normal . Ultrasound of the penis showed mixed echogenic lesions with multiple dilated tortuous vascular channels filling the scrotum. Dilated vessels were seen in penis and glans suggestive of vascular malformation . MR urography showed T2 hyperintensities in the penis,scrotum , glans extending into right obturator and piriformis muscle .MRI spine was normal. ECHO and CT BRAIN were normal .He was given two units of blood transfusion and haematinics . Steroids were given for 3 months as suggested by the paediatric surgeon and observed for involution. Bleeding episodes decreased considerably . Due to non involution of the haemangioma with steroid therapy child was referred to a higher centre for alpha interferon therapy or embolisation as suggested by the vascular surgeon . As the parents were unwilling to go to a higher centre , the child is on periodic follow up for spontaneous resolution and management of anaemia and other complications