[PP-113]

Fordyce angiokeratoma after vasectomy

¹Ankara Education and Research Hospital, Department of Urology, Ankara, Turkey
²Ankara Education and Research Hospital, Medicine Department of Pathology, Ankara, Turkey

Fordyce Angiokeratoma After Vasectomy

İntroduction
Fordyce's angiokeratoma is one of five subtypes of angiokeratom, located in the scrotum, penis, or vulva. Our patient was fifty years old and presented with intermittent hemorrhagic, papular and hyperemic lesions in the scrotum for twelve years.Diagnosis of Fordyce's angiokeratoma was made with clinical and histopathological findings.As far as we know in the literature, there is a case report of fordyce angiokeratoma with one acute scrotal hemorrhage and many intermittent scrotal hemorrhages.Our case is differentiated and presented with the vasectomy performed before the appearance of the lesions and the subclinical varicocele cause.

Case
A 54-year-old male patient was admitted to our hospital due to bilateral scrotal lesions with spontaneous intermittent hemorrhage, which was 12 years and more frequent with trauma.Bilateral vasectomy story 12 years ago.There are 10 papillary, hyperemic and hyperkeratotic lesions approximately 1 mm in size in lateral dimension in the lateral part of the left hemiscrotum and bilateral in the scrotum on physical examination.(Picture 1).The lesions are located bilaterally in the lateral side of the hemiscrotum.
Histopathological examination revealed macroscopically an average of 0.6x0.4x0.3 mm in size and 3 subcutaneous tissues.Microscopically, papillary dermis has ectatic vein structures and in the other two, papillary dermis has smaller vessels.(Picture 2).Histopathological diagnosis of angiokeratoma was made.
Clinical varicocele was not detected in the physical examination of the patient who had intermittent left inguinal pain complaint.However, as a result of scrotal RDUS performed on the subclinically evaluated patient, the ven diameters on the left increased in resting state (4.1 mm) valsalva and reflux current on the left.Subclinical varicocele was diagnosed.

Discussion
The pathogenesis of angiokeratoma is still unknown. Fordyce angiokeratoma is more commonly found in the scrotum, rarely in the penis shaft and rarely in the penis.There is a possible connection between scrotal angiokeratoma and increased scrotal venous pressure.This theory is supported by varicocele's tension in the skin lesions after surgical operation.Scrotal angiokeratoma-related cases were identified as varicocele, hernia, prostatitis, lymphogranuloma venereum, bladder cancer, thrombophlebitis.Scrotum must be examined in terms of varicocele findings.Subclinical varicocele can not be detected by physical examination and requires ultrasonography for diagnosis.

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Resim 1

Clinical and pathologic imaging