Background. A 48-year-old, previously healthy man presented to his local urologist with several small, violaceous, indurated lesions along the shaft of his penis and glans, which caused discomfort and penile curvature. Four weeks previously, the lesions were three small painless blemishes. Peyronie disease was initially diagnosed, but the disease progressed despite steroid treatment. Following the results of a biopsy, multifocal angiosarcoma was diagnosed. CT of the chest, abdomen and pelvis was negative for metastatic disease. At this point the patient was referred to a specialist oncology center for further management. Investigations. At the specialty center, the patient underwent physical examination, additional excisional biopsies, and PET-CT. Diagnosis. Penile epithelioid hemangioendothelioma, which is a multifocal, atypical epithelioid vascular tumor. Management. Single-agent chemotherapy using liposomal doxorubicin hydrochloride for eight cycles, followed by 63 Gy of adjuvant external beam radiation therapy to the penis fractionated over 35 treatments.
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