Venous cavernous hemangioma of the testis

T images presented are from a 77-year-old man who was admitted to the hospital with a 1-year history of hoarseness. A recent workup revealed an advanced squamous cell carcinoma of the larynx (T3N2CM0). He was admitted to the hospital to begin his first course of neoadjuvant chemotherapy with 5-fluorouracil (5-FU) and cisplatinum. His admission genitourinary examination revealed a large solid-appearing mass of the left testicle. The patient claimed that the testicle had been enlarged for “50 years.” An ultrasound of the testis demonstrated a large inhomogeneous mass with multiple hypoechoic regions and calcific shadowing (Fig. 1). The serum beta-human chorionic gonadotropin and alfa-feto protein levels were normal. The patient underwent an inguinal exploration. The cord structures were normal. The left testicle was firm and irregularly enlarged. A left radical orchiectomy was performed. The bivalved gross specimen is seen in Figure 2. The microscopic evaluation demonstrates vascular channels consistent with a large cavernous hemangioma of the testis (Figs. 3A and B). Cavernous hemangiomas are benign vascular tumors. Only 25 cases of testicular hemangiomas have been cited previously in the literature.1 In the present case, it was believed that the mass was probably benign because it had been present for many years. The sonographic features were more suggestive of a malignant process. Thus a radical orchiectomy was performed. This lesion, while rare, should be included in the differential diagnosis of testicular masses.