Recurrent angiokeratoma scroti: a case report

Abstract

Introduction Angiokeratoma is a broad term that describes various conditions of asymptomatic hyperkeratotic vascular disorders with a histologic combination of hyperkeratosis and superficial dermal vascular ectasia. Here we are describing a case of recurrent angiokeratoma scroti. Case report A 34-year-old patient presented to the surgery department with multiple small papules over the scrotum with a previous history of two recurrences. They were slowly progressive, itchy and not associated with any bleeding. Examination revealed multiple soft compressible papules of 3–4 mm diameter with excoriation marks. Systemic examination and routine investigations were normal. Histologically, they were composed of numerous dilated thin walled congested capillaries mainly in the papillary dermis. Epidermis revealed variable degree of acanthosis and elongation of rete ridges and mild hyperkeratosis. Electrocauterisation of lesions was done and the follow-up period of three months was uneventful. Conclusion Although angiokeratoma scroti is not an uncommon entity, good treatment modality with minimal adverse effects in terms of complete resolution of diffuse lesions, recurrence, scarring, crusting, bleeding or cosmetic results is still not available. Introduction The term angiokeratoma is used to describe several distinct entities characterised by vascular nodules in the skin, with a histological picture of dermal vascular ectasia surmounted by hyperkeratosis of the epidermis. Angiokeratoma of the scrotum was originally described by Fordyce in 18961 reporting a case of 60-year-old man with multiple warty lesions confined to the scrotum only. Only a few cases of recurrent angiokeratoma had been reported since then. We describe here an adult male presenting with multiple papules over the scrotum with a previous history of two recurrences. Case report A 34-year-old male presented in the surgery department with moderate itching and multiple papules arranged diffusely over the scrotum. There was history of two recurrences five and three years back with the same complaints. Electrocauterisation of lesions was previously done two times, although no previous pathological reports were available. Each time, the follow-up period of four to six months had been uneventful. Even after complete post-operative healing, the patient continued to experience persistent discomfort, pruritis and psychological distress. Mere contact of the affected area with his underwear resulted in constant irritation. There was no history of trauma, episodic bleeding, similar lesions somewhere else on his body, inguinal hernia, genitourinary tumours, thrombophlebitis or varicocele. Physical examination revealed multiple, soft, bluish-red, compressible papules of 3–4 mm diameter with excoriation marks and focal thickening of skin, which might be due to previous surgical intervention. Systemic examination and routine investigations including urine examination and ultrasonography of scrotum were unremarkable. This time also, lesions were electrocauterised and excised biopsy tissue, consisting of multiple greyish white pieces of soft tissue measuring together 1.3 × 1.0 cm., was sent for histopathological examination to the pathology department. The whole tissue was processed. The biopsy submitted was stained with haematoxylin and eosin and revealed epidermis with mild hyperkeratosis, variable degree of acanthosis and elongation of rete ridges. Papillary dermis showed numerous dilated thin-walled congested capillaries in small groups separated by thin strands of connective tissue. Histology established the diagnosis of angiokeratoma of scrotum. Follow-up period of three months to assess the cosmetic result and to look for recurrences was uneventful. Discussion Patients of angiokeratoma usually present with small, bright red, vascular papules rarely larger than 3–4 mm. Angiokeratoma of scrotum are true ectasia of blood vessels. Initially, the lesions may be red, soft and compressible but later on may be firm, keratotic and sometimes warty2. These vascular lesions may be single and discrete or arranged in clusters. The most frequent symptom is a sensation of heaviness, tension in the scrotum accompanied by irritation along with bleeding of varying degree and superadded infection. Progressive worsening of symptoms, extension of the involved area, repeated episodes of cellulitis and infection cause psychological and emotional distress in the patient; sometimes requiring hospitalisation. * Corresponding author Email: drbrijeshthakur03@gmail.com NIIMS University, Jaipur, India