盧昱成、李苑如
國立台灣大學醫學院附設醫院 泌尿部
Yu-Cheng Lu, Yuan-Ju Lee
Department of Urology, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
Case: A 53-year-old G1P0SA1 woman without previously known major systemic diseases presented her initial symptoms included difficulty voiding, urinary hesitancy, and a sensation of incomplete bladder emptying for a period of 1 month. Vaginal bleeding was also noted 1 week before visiting the clinic. The patient then visited our gynecology clinic for medical attention. Vaginal examination revealed a single 2- × 2- × 3-cm polypoid tumor that was continuous with the vaginal wall at 1 o'clock and protruded outside the vaginal canal. Initial diagnostic impression was that of a vaginal tumor. Preoperative magnetic resonance imaging (MRI) revealed a 2.8-cm infiltrative enhancing lesion with a high signal on T2-weighted imaging. The mass surrounded the lower urethra and involved the anterior wall of vagina. Hence, urologists were consulted for cystoscopic evaluation during the surgery. However, the urethral orifice could not be identified initially. The urethral orifice protruded and deviated downward into the vaginal canal. Because of external compression, only a 5F ureteral catheter could pass through the orifice. On further analysis, the tumor was found to be urethral in origin and protruding into the vaginal canal; as a result, it was initially misdiagnosed as a vaginal tumor. The urethral tumor was partially resected and the tissue was sent to pathology for further testing. The pathology report revealed a cavernous hemangioma.
Discussion: Hemangiomas are usually benign vascular tumors and they grow at all levels of the genitourinary system, including the kidney, ureter, bladder, prostate, and urethra. Urethral hemangiomas are extremely rare, and most cases are found in men. Cavernous hemangioma is the most common histological type. Patients with lesions located in the proximal urethra present with hematuria, hemospermia, or urinary retention. The differential diagnosis of urethral hemangioma includes wattles of the urethra, urethral prolapse, polyps, fibroids, caruncles, periurethral abscess, or malignant tumors. Treatment depends on the size and location of the tumor. Asymptomatic lesions do not require treatment, but extensive lesions may require open excision and urethral reconstruction. Treatment of urethral hemangioma includes oral corticosteroids, local injections of sclerosant or pingyangmycin, selective arterial embolization, endoscopic laser ablation or electrocautery, and open surgery. Although benign in nature, these tumors have a propensity to recur unless completely excised.