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LOCATION: Outpatient, Hospital PATIENT: Harold Arin SURGEON: Ira Avila, MD PREOPERATIVE DIAGNOSIS: Penile mass POSTOPERATIVE DIAGNOSIS: Probable large hemangioma with vascular malformation and superficial dorsal venous complex, penis PROCEDURE PERFORMED: Resection of large penile vascular mass CLINICAL NOTE: This 23-year-old gentleman presents with a 1-month history of increased tender dorsal penile mass. Ultrasound, CT (computerized tomography), and MRI (magnetic resonance imaging) have all shown this to be a solid lesion. No flow has been documented within it, and it is suggested that it might be a sarcoma. It is fluctuant and soft, and I wonder whether it might be vascular, but this has not been confirmed on previous imaging. OPERATIVE NOTE: The patient was given a general endotracheal anesthetic, prepped, and draped in a supine position. An incision was made overlying this large dorsal penile mass at the base of the penis. Just beneath the skin, a large vein was encountered that bled and was dealt with by isolating it and ligating it with 3-0 chromic ligatures. The mass was large, approximately 10 cm (centimeter) in greatest diameter. There was extensive neovascularity, and on further dissection, it was noted that this appeared to be a large hemangioma rising from superficial veins outside Buck’s fascia. Extensive care and mobilization were undertaken. This, again, was a very vascular lesion, and I took care to identify all perforating vessels and individually ligated them with chromic ligature. Intraoperative photographs were obtained of the mass showing its extensive vascularity and its location. Frozen section of the mass was obtained that showed no malignant cells. Once the mass was resected, there was a very large cavity. Subcutaneous tissues were closed with 4-0 chromic and skin ultimately with subcuticular Dexon. Compression dressing was applied. The patient tolerated the procedure well and was transferred to the recovery room in good condition. Pathology Report Later Indicated: Benign hemangioma SERVICE CODE(S): ______________________________________ ICD-10-CM DX CODE(S): __________________________________

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