(152) A Case of Penile Neoplasm Masquerading as Acute Peyronie's Disease
Authors: Hassig S , Wanderling C , Gabrielsen J S 
Published: May 2023

Abstract

Introduction
Painful erections with curvature is pathognomonic for acute Peyronie’s Disease (PD). While resolution of pain and stabilization of curvature define the transition from acute to stable PD, there is high variability in the time from symptom onset to resolution. Thus, when to image and consider alternative diagnoses is poorly defined. We present a case of persistent distal penile pain and curvature with erections, initially diagnosed as acute PD, but subsequently found to be epithelioid hemangioendothelioma (EHE), a rare vascular neoplasm on the spectrum between a hemangioma and an angiosarcoma, with high probability of local recurrence and ability to metastasize.

Objective
To raise awareness that painful penile erections with curvature may not necessarily represent acute PD and foster discussion of when imaging, testing and alternative diagnoses should be considered.

Methods
Case report of a 51-year-old male seeking a third opinion for painful penile nodule with curvature of approximately four years duration.

Results
A 51-year-old male presented to our clinic complaining of an extremely painful penile nodule with curvature. He initially presented to another urologist with similar symptoms approximately 4 years previously and was diagnosed with acute PD. He had no prior history of penile trauma, erectile dysfunction, Dupuytren’s contractures or family history of PD. He was started on vitamin E, L-arginine and pentoxyphylline. He sought a second opinion about three years later when his symptoms remained unchanged and, again, was diagnosed with acute PD and told to return when his pain had resolved. His symptoms persisted and approximately 1 year later presented to our clinic for evaluation. Physical examination demonstrated a 1 cm tender nodule between the corpora cavernosa at the distal shaft. Pharmacologic erection demonstrated a 30-degree upward curvature at this site. Given the duration of his symptoms, ultrasound was obtained. A 1.4 cm circumscribed lesion with internal vascularity was identified; however, MRI identified dorsal angulation of the shaft in this area but did not visualize a mass. Due to extreme pain, the patient desired excision of the mass. Intraoperatively, a well circumscribed lesion with a vascular pedicle was identified between the corpora and the neurovascular bundle. The mass was easily excised without evidence of invasion of surrounding tissues. Final pathology demonstrated an epithelioid hemangioendothelioma with question of a positive margin. The case was discussed at a Multidisciplinary Tumor Board and given the sparsity of literature on the tumor, particularly in the penis, it was felt that excision of surrounding tissues to ensure negative margins would be best. The patient returned to the OR two weeks after his initial surgery and the surrounding corpora were excised. Final pathology demonstrated no evidence of residual malignancy. PET/CT was negative for metastatic disease.

Conclusions
While current guidelines indicate that penile angulation may rarely be due to other causes, including tumors, there are no recommendations on when alternative diagnoses should be investigated and imaging obtained. We present a case report of epithelioid hemangioendothelioma masquerading as acute PD that was identified due to abnormal duration of symptoms.

Disclosure
No