62例阴茎鳞状细胞癌治疗的临床分析

目的:提高阴茎鳞状细胞癌的治疗水平,寻求鳞状细胞癌合理有效的治疗方法。方法:回顾分析62例病理活检证实阴茎鳞状细胞癌治疗的临床资料。结果:除8例拒绝手术治疗外,其余54例均行手术治疗。45例行阴茎部分切除术,9例行阴茎全切加会阴部尿道造口术治疗,腹股沟淋巴结活检术31例,腹股沟淋巴结病理阳性9例,总活检阳性率为29.0%,行腹股沟淋巴结清扫术。5例行阴茎部分切除者3年内复发,再行阴茎全切除并尿道会阴部造口术及髂腹股沟淋巴清扫术。高分化鳞癌43例,中分化鳞癌7例,低分化鳞癌4例;9例术前淋巴结活检有癌转移,腹股沟淋巴结清扫均有转移,盆腔淋巴结转移4例,淋巴结清扫发现转移2例。按照Jackson分期:I期29例;II期13例;III期8例;V期4例。本组62例患者中44例获定期随访2-7年,随访率70.9%。3年、5年生存率分别为90.9%、75%。非手术治疗5年生存率仅为50%。结论:外科手术治疗是目前治疗阴茎鳞状细胞癌的有效方法,淋巴结清扫根据临床分级具体处理,手术联合术后化、放疗是否可减少复发及提高生存率,还需进一步研究。     

Verruciform xanthoma of the penis in a young male masquerading as squamous cell carcinoma: Case Report

Verruciform xanthoma (VX) is a relatively rare benign lesion of unknown etiology with a predilection for oral mucosa. Penis is an uncommon location and to date only 17 cases of VX of penis have been reported. The lesion assumes importance as it can be easily mistaken for verrucous carcinoma or squamous cell carcinoma. We present herein a case of penile VX in a 25-year-old man who was referred to our institute with a histopathologic diagnosis of squamous cell carcinoma reported elsewhere. On microscopy the lesion demonstrated florid verruciform hyperplasia of the epidermis with hyperkeratosis, parakeratosis and acanthosis. There was a dense infiltrate of foam cells in the papillary dermis (a hallmark of VX), which were positive for CD68 and negative for S-100 protein. We present this case to highlight the significance of recognizing VX in extra oral location. An awareness of this entity is crucial to prevent misdiagnosis and halt inappropriate therapeutic intervention. Keywords: penis, squamous cell carcinoma, verruciform xanthoma, verrucous carcinoma.     

Pathological and clinical analysis of 102 cases of lip carcinoma

102 cases (103 tumors) of lip carcinoma treated by surgery are analyzed. There were 37 (35.9%) verrucous carcinoma and 66 (64.1%) squamous cell carcinoma which included grade I 29 cases, grade II 21, grade III 14 and grade IV 2. Of the 66 squamous cell carcinomas, six lesions co-existing with verrucous carcinoma were derived from the latter. This fact demonstrated that anaplastic transformation of verrucous carcinoma could occur in patients without radiotherapy. This study suggests that the enlarged neck lymph nodes need not be dissected prophylactically for patients with squamous cell carcinoma grade I and grade II, and with verrucous carcinoma. The management of the cervical nodes still suffices if they enlarge after the primary lesion has been removed. But radical dissection of neck lymph nodes should be performed promptly for patients with squamous cell carcinoma grade III and grade IV.     

The association of lichen planus of the penis with squamous cell carcinoma in situ and with verrucous squamous carcinoma

Two cases of squamous cell carcinoma (SCC) of the penis, one verrucous type and one in situ, arising in association with an inflammatory dermatosis most consistent with lichen planus, are described. Although SCC has previously been reported to have arisen from lichen planus of the oral mucosa, these are the first reported cases of the coexistence of these processes on the penis.     

Proliferative verrucous leukoplakia and its related lesions

Proliferative verrucous leukoplakia (PVL) is a unique type of clinical oral leukoplakia. Enigmatic in etiology, PVL behaves in a far more aggressive fashion than other forms of leukoplakia. Its aggressiveness relates not only to a high recurrence rate, but more so to a very high level of and relentless progression from a localized simple keratosis to extensive oral disease and squamous carcinomas of verrucous, or conventional squamous cell type. Diagnosis is often late in the protracted course of PVL with the disease in an advanced stage when it is especially refractory to treatment. Within the histologic spectrum that is seen in PVL, usually as a function of time, are: (1) verrucous hyperplasia (VH), a histologically defined lesion; (2) varying degrees of dysplasia; and (3) three forms of squamous cell carcinoma: verrucous, conventional and, according to some, papillary squamous cell carcinoma. Each of these are discussed both within and outside the context of PVL. VH is a forerunner of verrucous carcinoma and the transition is so consistent that the hyperplasia, once diagnosed, should be treated like verrucous carcinoma. VH is not only an oral lesion; it can occur in the upper airway (sinonasal tract and larynx) where it is not usually found within a maternal soil of PVL. Papillary squamous cell carcinoma has been a loosely defined neoplasm, more often considered a verrucal type of malignancy. It nonetheless is a distinct clinicopathologic entity, separate from verrucous carcinoma and without a predilection for the oral cavity or an association with PVL.     

Interstitial radiation therapy for carcinoma of the penis using iridium 192 wires: the Henri Mondor experience (1970-1979)

From 1970 to 1979, a group of 50 patients was treated for squamous cell carcinoma of the penis by interstitial irradiation using an afterloading technique and iridium 192 wires. The group included 9 patients with T1 tumors, 27 with T2 tumors, and 14 with T3 tumors. Forty-five patients presented with no metastatic inguinal nodes (N0), 3 patients with N1 nodes, and 2 patients had N3 nodes. After treatment, 11 patients (1 T1, 6 T2 and 4T3) developed local recurrences; 10 of these 11 patients underwent penile amputation which controlled the tumor in 7 of the patients. One patient refused amputation. Three patients developed post-therapeutic necrosis which necessitated partial amputation in 2 cases. Eight patients developed post-therapeutic urethral stenosis, which required surgical treatment in three of the cases. Overall, at their last follow-up examinations, 74% of the patients were free of disease with conservation of penile morphology and function. Most patients without metastatic nodes (37/45) at diagnosis did not receive prophylatic treatment of the groin. Two of these patients developed delayed metastatic nodes; one was successfully salvaged. All 5 patients presenting with metastatic nodes at diagnosis died, four with uncontrolled regional disease. Twenty-one percent of the patients died of their disease. We advocate interstitial irradiation using iridium 192 wires for the treatment of non-infiltrating or moderately infiltrating squamous cell carcinoma of the penis in which the largest dimension does not exceed 4 cm. Pre-implant circumcision and regular long-term follow-up are necessary. More extensive tumors are better managed surgically. When regular follow-up can be assured, it is reasonable to forgo prophylactic treatment of the inguinal nodes in patients presenting without groin metastasis.     

Radiotherapy and verrucous carcinoma of the oral cavity. A study of 107 cases.

One hundred and seven cases of oral verrucous carcinoma treated primarily with radiotherapy at Kasturba Hospital, Manipal, India between 1977 and 1987 were analysed concerning location within the oral cavity, clinical extent, and effectiveness of radiotherapy. The most common site was the buccal mucosa followed by the buccogingival sulcus. Only 13.2% of the patients presented with T1 or T2 tumours and 32.7% had clinically negative nodes. Biopsy had to be repeated more than once in 22 patients to get confirmation of invasive carcinoma. The 5-year survival rate was 35% for stage III and 26% for stage IV. The treatment results with radiotherapy were comparable with those for ordinary squamous cell carcinoma of the oral cavity. It is felt that the treatment policy for verrucous carcinoma can be the same as for ordinary squamous cell carcinoma. In order to prevent delay in diagnosis and treatment, proper cooperation between the treating oncologist and the pathologist is essential.     

Tumor of the penis--analysis of 300 cases

300 cases of penile tumor are reported. The age peak was over 41 years (79.0%). Of these 300 cases, (66.7%) had redundant prepuce and 78 (26.0%) had phimosis which implies that penile tumors are closely related to those two conditions. Surgical treatment consisted of partial resection of penis in 182 (60.7%) patients, total resection in 66 (22.0%) and ilioinguinal lymphadenectomy after resection in 29 (9.7%). The pathological findings showed that in majority of cases, it was squamous cell carcinoma (270, 90.0%). Only 90 (30.0%) patients survived among the followed up patients. 20 patients have survived over 20 years and 32 over 15 years. It seems that the long term result of penile tumors after operation is better than that of other uro-genital neoplasms. Stricture of external meatus occurred in 22 patients and all were promptly relieved by dilation.     

阴茎疣状癌的诊断及治疗

目的：探讨阴茎疣状癌的临床诊断及治疗方法。方法回顾性分析1例阴茎疣状癌的临床诊治过程,并结合相关文献进行复习。结果阴茎疣状癌的临床表现及其诊断治疗方法不同于普通阴茎鳞癌,常被误诊为局部感染病灶或低度鳞状细胞癌,明确诊断主要依据病理检查。结论阴茎疣状癌为临床罕见病例,易误诊,手术治疗是其有效治疗手段。     

Laser treatment of urologic cancers

In urologic surgery, laser energy has been used to treat various cancers of the genitourinary system. Excellent functional and cosmetic results have been obtained with squamous cell carcinoma of the penis. In selected patients, the need for partial penectomy may be avoided. Demonstrated practical advantages and decreased patient morbidity form the basis for laser treatment of superficial bladder cancer. Therapeutic advantages over electrocautery resection are theoretical. Nd:YAG laser treatment can provide reasonable local control rates for tumors that invade the bladder muscle, but this treatment should be reserved for patients who are poor candidates for radical surgery. For kidney cancer, lasers may facilitate tumor removal in solitary kidneys and extend the margin of resection.     

Oral verrucous carcinoma. Treatment with radiotherapy

Fifty-two cases of oral verrucous carcinoma treated with radiotherapy at the Regional Cancer Centre, Trivandrum, Kerala, India in 1982 were evaluated to determine the distribution within the oral cavity, clinical extent, and effectiveness of radiotherapy in controlling the disease. The most common site was the buccal mucosa. Fifty percent of the patients had clinically negative regional lymph nodes and 33% were in earlier stages (T1, T2, N0, and M0). The overall 3-year no evidence of disease (NED) survival rate was 44%. The 3-year NED survival rate with radium implant was 86%. We cannot comment on anaplastic transformation after radiotherapy because our treatment failures have not been subjected for biopsy concerning this matter. Because the results are comparable with those of well-differentiated squamous cell carcinoma, we think that the treatment policies advocated for oral squamous cell carcinoma are also applicable to oral verrucous carcinoma.     

Metastasis to the penis in a patient with squamous cell carcinoma of the lung with a review of reported cases

Metastasis to the penis is very rare in lung cancer. We describe a patient with squamous cell carcinoma of the lung who developed a metastatic lesion in the penis. A 75-year-old Japanese male visited a local hospital complaining cough and bloody sputum. A chest plain radiograph and computed tomographic (CT) scans of the chest demonstrated a right hilar mass. He was diagnosed with squamous cell carcinoma of the lung at stage IIIB (T4N2M0). Then he was treated with concurrent chemoradiotherapy consisting of cisplatin, docetaxel, and thoracic irradiation, and after the chemoradiotherapy, he achieved a partial response. However, 6 months later, he visited an urologist complaining of firm mass in the penis with slight pain. A biopsy of the corpus cavernosum penis was performed, which provided a histological diagnosis of squamous cell carcinoma. The histology of the specimen was consistent with that of previous lung cancer, so he was considered to have penile metastasis from squamous cell carcinoma of the lung. Radiotherapy was given to the metastatic tumor in the penis. The penile tumor was diminished and the pain was completely relieved. In addition, we review reported cases to investigate the clinical characteristics and appropriate management of this rare involvement.     

基质金属蛋白酶MMP-9在口腔疣状癌中的表达及意义

目的　研究MMP-9在口腔疣状癌和鳞癌中的表达,探讨口腔疣状癌和鳞癌的不同生物行为的分子基础。方法　取 15例口腔疣状癌, 10例正常口腔粘膜, 20例口腔鳞癌(高、低分化鳞癌各 10例),应用免疫组织化学S-P法检测上述标本MMP-9表达和分布。结果　口腔疣状癌组织中MMP-9阳性表达率为 40% (6 /15),明显低于高分化鳞癌 70% (7 /10)和低分化鳞癌 80% ( 8 /10 ) (P<0. 05 );平均染色强度低于高分化鳞癌和低分化鳞癌(P<0. 05);口腔疣状癌、口腔高分化鳞癌、口腔低分化鳞癌组织中MMP-9表达均高于正常口腔粘膜组织(P<0. 05)。结论　MMP-9在口腔疣状癌的发生中起重要作用。MMP-9在口腔疣状癌、口腔高分化鳞癌、口腔低分化鳞癌的表达存在明显差异,说明口腔疣状癌是一种独立类型的恶性肿瘤。     

The treatment of primary urethral carcinoma--the dilemmas of a rare condition: experience with partial urethrectomy and adjuvant chemotherapy.

BACKGROUND: Primary urethral carcinoma is a very rare condition, and no large-scale experience with such cases has been published. Treatment will therefore have to follow rules established for the treatment of similar conditions. PATIENTS: Six cases of primary urethral carcinoma (5 male, 1 female) who had been treated at our institution between 1995 and 1999 were retrospectively analyzed. In 3 male cases, a primary urothelial carcinoma of the distal urethra was treated by distal urethrectomy only. In 3 other cases with locally advanced tumors and/or lymph node metastases surgical treatment was followed by adjuvant cisplatinum-containing chemotherapy. RESULTS: In the 3 cases with distal urethral carcinoma, partial urethrectomy with preservation of the penis resulted in cure, with a follow-up of 12-71 months. In the cases with advanced disease, adjuvant chemotherapy after surgery has resulted in complete remissions in all 3 cases, with a follow-up of 4-47 months at present. CONCLUSIONS: In localized, noninvasive carcinoma of the distal male urethra, partial urethrectomy seems adequate and the avoidance of penile amputation justified. In advanced cases, after local excision and lymphadenectomy adjuvant chemotherapy which by necessity must follow the guidelines established for the treatment of other urothelial or squamous cell malignancies seems to be beneficial.     

A phase II study of 13-cis retinoic acid plus interferon alpha-2a in advanced stage penile carcinoma: an Eastern Cooperative Oncology Group study (E3893)

PURPOSE: Combined biological therapy with 13-cis-retinoic acid (13-cRA) and interferon alpha-2a (IFN alpha-2a) was reported to be highly effective in squamous cell carcinoma of the cervix and skin. Squamous cell carcinoma of the penis is rare in the United States, accounting for less than 1/2% of all male malignancies. Because of the association of infection with human papillomavirus with both carcinomas of the cervix and penis and their shared squamous cell histology, we carried out a phase II study of 13-cRA and IFN alpha-2a in carcinoma of the penis. MATERIALS AND METHODS: Eighteen ambulatory patients with surgically unresectable, recurrent, and/or metastatic squamous cell carcinoma of the penis were treated with IFN alpha-2a, 3MU/day administered subcutaneously and 13-cRA, 1 mg/kg orally daily for at least eight weeks, unless intolerable toxicity occurred. RESULTS: One patient was ineligible; one patient withdrew prior to treatment. Among the 16 eligible, treated patients, there was one complete response. Fourteen patients had progressive disease as their only treatment effect. Two patients were unevaluable for tumor response because they had no follow-up tumor measurements. No unexpected treatment-related toxicities were found on study. The only common form of grade 3 toxicity was hypertriglyceridemia found in eight of the 17 patients (47%). No toxicities above grade 3 were observed. CONCLUSION: In contrast to its benefit in squamous cell carcinomas of the cervix and skin, the combination of 13-cRA and IFN alpha-2a has low efficacy in advanced carcinoma of the penis.     

Transitional cell carcinoma of the anterior urethra

We report a case of transitional cell carcinoma of the anterior male urethra. Unlike squamous cell carcinoma of the anterior urethra, which usually requires partial penectomy, transitional cell carinoma of this location can be managed with conservative local resection and preservation of the penis. Possible explanations for the origin of this lesion are discussed.     

Verrucous carcinoma arising in ulcerative lichen planus of the soles

Verrucous carcinoma is a low-grade squamous cell carcinoma. Chronic inflammation is an important factor in its pathogenesis. This is the first case of plantar verrucous carcinoma arising in a lesion of ulcerative lichen planus. This paper also lends further support to the successful use of Mohs micrographic surgical technique as the treatment of choice for verrucous carcinoma.     

Total resection of glans penis surface by CO2 laser microsurgery

Fifteen patients underwent resection of the whole glans surface with laser microsurgical technique from May 1983 to September 1987. The operations were performed in one stage in 11 cases and in two stages in 4. In 3 cases the resected lesions represented multiple dysplasia grade III or carcinoma in situ, in 1 case hyper/parakeratosis and penile horn, and in 11 cases superficial squamous cell carcinoma. In 8 cases primary superficial and flat tumors occupied more than half the circumference of the organ, and in the remaining 7 cases there were flat, superficial residues after systemic chemotherapy for exophytic, non-infiltrating carcinomas. The CO2 laser beam was used under constant microscopic visual control at a mean output power of 20W, CW or pulsed for the tissue excision from the meatus to the sulcus level. Maximum depth of resection was 2.6 mm. Postoperative external radiotherapy (60 Gy) was given in the first case of the series (microscopically invasive cancer). Satisfactory cosmetic and functional results were observed in all cases. During the follow-up period, ranging from 2 to 48 months, persistent cancer was found at the perimeatal area in 1 case 4 months after laser resection. The procedure can be considered for conservative treatment of wide or multiple superficial lesions of the glans penis.     

123例老年人肺癌的外科治疗体会

本文报告自１９９０年５月～１９９５年４月，手术治疗６０岁以上肺癌１２３例。鳞癌４７例，腺癌４３例，小细胞癌１６例，其他１２例。手术切除１１０例（８９．４％），术后并发症２４例（１９．５％），死亡１例（０．８％）。５年生存率３２．３％（１０／３１）。体会：加强围手术期的处理，选择适当的手术方式，是预防老年人肺癌手术后并发症的关键。