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Year : 2016  |  Volume : 59  |  Issue : 2  |  Page : 245-246
Cavernous hemangioma of anterior urethra: An unusual cause of vaginal bleeding


Department of Pathology, PGIMER, Dr. RML Hospital, New Delhi, India

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Date of Web Publication9-May-2016
 

How to cite this article:
Ahuja A, Sen AK, Bhardwaj M. Cavernous hemangioma of anterior urethra: An unusual cause of vaginal bleeding. Indian J Pathol Microbiol 2016;59:245-6

How to cite this URL:
Ahuja A, Sen AK, Bhardwaj M. Cavernous hemangioma of anterior urethra: An unusual cause of vaginal bleeding. Indian J Pathol Microbiol [serial online] 2016 [cited 2020 Jun 3];59:245-6. Available from: http://www.ijpmonline.org/text.asp?2016/59/2/245/174879


Hemangioma of the urethra is a very rare cause of hematuria or urethral bleeding.[1],[2],[3],[4] There are only a few cases reported in the literature and exact incidence is still not known.[1],[2],[3],[4],[5] A few case reports and occasional series have described posterior urethral hemangioma presenting as hematuria. We are reporting a rare case of a cavernous hemangioma of the anterior urethra in a middle-aged female who presented in the gynae OPD with bleeding per vagina.

A 57-year-old female presented with complaints of bleeding per vagina and something coming out of the vagina in the gynae OPD for 20 days. There was no history of dysmenorrhea or abdominal pain. However, she emphasized that bleeding is mostly after micturition. On examination, there was a polypoidal lesion arising from the anterior urethra measuring 3 cm × 2 cm. It was soft in consistency with focal bleeding points. Rest of the pelvic organs were normal. Hematological, coagulation, and biochemical parameters were within normal limit. She was referred to urology OPD where the lesion was excised completely in the minor operation theatre.

On histopathological examination, the sections showed urothelial lining with focal squamous metaplasia and ulceration [Figure 1]. The subepithelium showed varying size thin walled dilated, congested vascular channels and mild chronic inflammatory infiltrate [Figure 2]. A diagnosis of cavernous hemangioma was made.
Figure 1: Photomicrograph showing urothelial lining with focal squamous metaplasia and ulceration (H and E, ×400)

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Figure 2: Subepithelium showing varying size thin walled dilated, congested vascular channels (H and E, ×100)

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Urethral hemangiomas are unusual benign vascular tumors, sparsely reported in the literature. The urinary tract is the uncommon site of hemangioma and described mostly in the kidney, bladder, and prostate. Urethral and ureteral hemangiomas are extremely rare. Usually, the patients present in younger age although it can be seen in all ages. Mostly urethral hemangioma has been reported in male patients and it is rare in females. They are usually congenital and develop from the embryonic rest of the unipotent angioblastic cells that fail to develop into normal blood vessels.[4] Common presentations are bloody urethral discharge and hematuria. However, in females rarely the hemangioma may present as bleeding per vagina as in the index case. Distal urethral hemangioma usually present as bloody urethral discharge and on histopathology they are cavernous hemangiomas while proximal urethral hemangiomas the presentation is with hematuria.[3],[4] The other differentials which should be kept in mind include polyp, caruncle, wart, and rarely malignancy. Treatment with laser show excellent results and preferred over open excision when the prior diagnosis has been made.[5]

To conclude, urethral hemangiomas in females can present as vaginal bleeding. Therefore, meticulous clinical examination is required to suspect this rare entity and planning the treatment strategy. Regular follow is required in these patients after treatment as these lesions tend to recur frequently.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Rohan VS, Hanji AM, Patel JJ, Tankshali RA. Female urethral hemangioma. Saudi J Kidney Dis Transpl 2008;19:647-8.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.
Parshad S, Yadav SP, Arora B. Urethral hemangioma. An unusual cause of hematuria. Urol Int 2001;66:43-5.  Back to cited text no. 2
    
3.
Efthimiou I, Kavouras D, Vasilakis P, Katsanis S. Hemangioma of penile urethra-treatment with simple transurethral excision: A case report. Cases J 2009;2:6199.  Back to cited text no. 3
    
4.
Uchida K, Fukuta F, Ando M, Miyake M. Female urethral hemangioma. J Urol 2001;166:1008.  Back to cited text no. 4
    
5.
Khaitan A, Hemal AK. Urethral hemangioma: Laser treatment. Int Urol Nephrol 2000;32:285-6.  Back to cited text no. 5
    

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Correspondence Address:
Arvind Ahuja
Department of Pathology, PGIMER, Dr. RML Hospital, New Delhi - 110 001
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.174879

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    Figures

  [Figure 1], [Figure 2]

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