(556) A Rare Tumor on the Glans: Preserving Form and Future Function in a Child with Epithelioid Hemangioma

Introduction Epithelioid hemangioma is a rare benign vascular tumor characterized by endothelial cells with an epithelioid morphology. While they can occur anywhere, appearances on the penis are rare, particularly in pediatric patients. They often present with non-specific symptoms that can mimic other benign conditions, such as balanitis or pyogenic granuloma, which can delay diagnosis. Objective Fewer than ten well-documented cases have been reported in the international literature. A definitive diagnosis requires histopathological and immunohistochemical studies. It is crucial to distinguish it from malignant vascular neoplasms, such as epithelioid hemangioendothelioma or angiosarcoma. This case study illustrates this rare condition in a child and highlights the associated diagnostic challenges and evidence-based management strategies. Methods A four-year-old male patient with no significant medical history presented with a lesion on the glans of the penis. The lesion had been present for four months. He had previously been treated with topical corticosteroids under a presumptive diagnosis of balanitis, but this had not improved the condition. Physical examination revealed a single, pedunculated lesion measuring approximately 3 mm in diameter. It was pink with a smooth surface and was located on the dorsal aspect of the glans adjacent to the urethral meatus. The lesion was painless and showed no signs of bleeding or ulceration. Due to the lack of response to medical treatment and the characteristics of the lesion, complete surgical excision under anesthesia was decided upon. The procedure involved resection with narrow margins, preservation of the urethral structures and careful hemostasis. The resulting defect was closed with an absorbable suture. Results Microscopic analysis of the specimen revealed a polypoid lesion covered by squamous epithelium. The stroma exhibited a well-demarcated proliferation of epithelioid endothelial cells characterized by abundant eosinophilic cytoplasm and round nuclei without atypia. Small vascular channels were observed to be forming, accompanied by a mild lymphocytic inflammatory infiltrate. No atypia, significant mitosis, necrosis or thrombosis were identified. These findings were diagnostic of epithelioid hemangioma. Follow-up at 6 and 12 months postoperatively was favorable, with no complications or evidence of recurrence. Conclusions Despite its rarity, epithelioid hemangioma of the glans should be considered in the differential diagnosis of persistent penile lesions in childhood. Histopathological confirmation is essential to rule out malignant conditions. Complete surgical resection is the primary treatment, providing a definitive diagnosis and offering a cure. Clinical follow-up is recommended to rule out late recurrences. Disclosure No