阴茎原位癌的诊断及治疗

目的：提高Bowen病及增殖性红斑的诊治水平。方法：分析18例Bowen病及增殖性红斑患者临床病理资料。发病年龄32～72岁，平均49岁。病程3个月～3年，平均1．5年。10例行局部病变切除术或包皮环切术，8例电凝治疗。结果：15例随访4～48个月，2例在阴茎头未治疗区出现新的病变，外涂5％5．氟脲嘧啶软膏治疗治愈后随访3及9个月无复发；13例治愈无复发。结论包括较深层组织的病理活检是鉴别Bowen病或增殖性红斑与阴茎癌以及其他男性外生殖器疾病的关键，局部病变手术切除，5-氟脲嘧啶软膏外涂可有效治疗Bowen病或增殖性红斑。     

Treatment of carcinoma in situ of the glans penis with topical chemotherapy agents

Background

The use of topical agents in the treatment of carcinoma in situ (CIS) of the penis has been well described in the literature. Previous studies have been limited by small sample size and imprecise end points.

Objective

Establish the response rate of 5-fluorouracil (5-FU) and imiquimod (IQ) in the treatment of penile CIS in a large contemporary series in a supranetwork centre.

Design, setting, and participants

Retrospective review of all primary and recurrent cases of penile CIS treated with 5-FU and IQ identified from a prospective database over a 10-yr period. Therapy was standardised in all cases with application to the lesion for 12 h every 48 h for 28 d.

Intervention

5-FU was the first-line therapy, and IQ was the second-line topical agent.

Outcome measurements and statistical analysis

The primary end point was defined as complete response (CR; ie, resolution of lesion), partial response (PR; ie, lesion reduced in size and or visibility), or no response (NR; ie, no improvement in lesion size and or visibility). The secondary end points included local toxicity and adverse events. No statistical analysis or software was used.

Results and limitations

A total of 86 patients were diagnosed with CIS of the penis over the 10-yr period. Forty-four (51%) received topical chemotherapy. The mean follow-up was 34 mo. CR to topical chemotherapy was seen in 25 (57%), PR was seen in 6 (13.6%), and NR was seen in the remaining 13 (29.5%) patients. Local toxicity was experienced by 10% of patients, and 12% had an adverse event following application of 5-FU. The retrospective design and short follow-up were the major limitations of this study.

Conclusions

Topical chemotherapy agents are moderately effective first-line therapy in the treatment of penile CIS. Toxicity and adverse events were few with our treatment protocol. The issues of long-term surveillance and assessment of partial responders remain a challenge. Topical chemotherapy should remain a first-line treatment option for penile CIS.     

A Large Cutaneous Horn of the Glans Penis: a Rare Presentation

Cutaneous horn (cornu cutaneum) is a relatively uncommon lesion consisting of a projectile, conical, dense, hyperkeratotic nodule which resembles the horn of an animal. Cutaneous horns most frequently occur in sun-exposed parts and are typically found in the face and the scalp, but may also occur on the hands, eyelids, nose, chest, neck, shoulder and penis. Their occurrence on the penis is uncommon. We report a 42-year-old man presenting with penile cutaneous horn. The association with malignancy on the penis makes proper identification of these lesions essential. Standard treatment involves local excision, but the presence of malignancy mandates a partial penectomy.     

Complication of treatment of carcinoma in situ of the bladder with photodynamic targeted cystodiathermy

We report two cases of bladder contracture following photodynamic or ‘blue light’ detection and cystodiathermy for bladder carcinoma in situ. These patients were unsuitable for treatment with immunotherapy/chemotherapy or had disease recurrence following such treatment. Radical cystectomy was not a treatment option in either patient. Each underwent serial photodynamic cystodiathermy over a three-year period. Neither patient developed muscle invasive disease. However, treatment resulted in contracture of the bladder and incontinence of urine. Patients need to be fully aware of this potential complication in order to make informed choices about their care.     

Preoperative breast MRI in the surgical treatment of ductal carcinoma in situ

Accurate determination of the size or extent of ductal carcinoma in situ (DCIS) by imaging is uncertain, and incomplete resection of tumor results in involved margins in up to 81% of cases. This study examined the accuracy of magnetic resonance imaging (MRI) for assessment of DCIS size, and evaluated the effect of preoperative breast MRI on achievement of tumor-free surgical margins after breast-conserving surgery (BCS). One-hundred and fifty-eight female patients with DCIS were identified from a prospective database: 60 patients (62 cases) had preoperative breast MRI, and 98 patients did not have MRI. The accuracy of tumor size assessed by MRI was determined by comparison with histopathologic size. All patients underwent BCS initially. The rate of involved margins after resection was compared in MRI and no-MRI groups. The overall correlation between MRI size and histopathologic size was high (p < 0.0001). MRI assessment of size was significantly more accurate when DCIS was high grade (p < 0.0001) or intermediate grade (p = 0.005) versus low grade (p = 0.187). The rate of tumor-involved margins was not significantly different in MRI and no-MRI groups (30.7% and 24.7%, respectively; p = 0.414). The rate of mastectomy was significantly higher in the MRI group than the no-MRI group (17.7% versus 4.1%; p = 0.004). These findings indicate that MRI can detect DCIS, especially when lesions are high or intermediate grade, but that MRI does not accurately predict the size of DCIS. In this study, MRI did not improve the surgeon's ability to achieve clear margins following BCS.     

阴茎折断诊断及手术疗效长期观察(附9例报告并文献复习)

目的:探讨阴茎折断的诊断及手术治疗的长期效果.方法:回顾1993～2006年间9例行手术治疗的阴茎折断病例,患者年龄20～40岁,平均32.5岁;术后随访6～132个月,平均53个月.另选取5例健康已婚男性作对照.通过国际勃起功能指数(IIEF-5)问卷调查,探讨手术对勃起功能的长期影响.结果:9例患者皆通过临床表现确诊.8例(88.8%)阴茎外观正常且勃起功能未受任何影响,1例(11.1%)发生阴茎轻度弯曲,所有患者皆未发生勃起功能障碍.9例患者的IIEF-5平均评分为(21.3±2.5)分,对照组IIEF-5平均评分为(22.4±2.2)分,二者比较差异无统计学意义(P>0.05).实验组阴茎的勃起硬度和勃起能力方面的IIEF评分较高(P<0.05).结论:手术疗法对阴茎折断后勃起功能的恢复疗效确切且安全可靠,在阴茎折断的治疗中值得推荐.     

Current treatment for lobular carcinoma in situ

Background: We thought that observation for patients with lobular carcinoma in situ (LCIS) had been generally accepted by the mid-1980s. A questionnaire mailed to oncologic surgeons in 1988 revealed that 33% of the respondents still advised unilateral mastectomy, although a slim majority (54%) advised observation. New studies have been published in the intervening 8 years, and we decided it would be worth recirculating the 1988 questionnaire. Methods: The identical questionnaire was mailed to members of the same oncologic societies (Society of Surgical Oncology [SSO] and Society for the Study of Breast Disease), but changes in membership necessitated new mailing lists. Results: Observation has yet to be universally accepted by the oncologic community, but at this time 85% of the respondents suggest it as the preferred option for their patients. Conclusions: Recent studies have questioned some of the tenets laid down by Haagensen in 1978, but it appears clear that his formulation of LCIS as a marker of increased risk continues to gain ground over the original concept of inevitable progression to invasive disease.     

乳腺非典型性小叶增生及小叶原位癌52例随访报告

目的探讨乳腺非典型小叶增生和小叶原位癌的生物学行为及治疗方法。方法回顾性分析1982年7月至1996年1月间的17例非典型小叶增生、35例小叶原位癌的临床及随访资料。随访时行门诊体检、乳腺钼靶摄片、乳腺B超等检查;随访时间为3～257个月,平均146．6个月。结果非典型小叶增生和小叶原位癌多发生于绝经前妇女（69．2％）;52例患者均因各种良性病变行手术,术后病理证实为非典型小叶增生或小叶原位癌,其中25例（48．1％）有微钙化病变;有8例在随访期间癌变（5例在同侧乳房,3例在对侧乳房）,平均癌变间期为9．4年;尽管4例（50％）有乳腺癌或卵巢癌家族史,但未发现非典型小叶增生和小叶原位癌癌变与乳腺癌或卵巢癌家族史有关（P〉0．05）;同样,也未发现非典型小叶增生与小叶原位癌发生癌变的差异有统计学意义（P〉0．05）。结论非典型小叶增生和小叶原位癌局部切除是必要的。     

Ductal carcinoma in situ: surgery and radiotherapy

As a consequence of mammographic breast screening programmes, ductal carcinoma in situ is diagnosed with increasing frequency. There are widely disparate philosophies concerning diagnosis, classification and treatment. This review discusses the management of DCIS in light of the new data from randomised trials.     

ABH antigenicity of in situ carcinoma of the urinary bladder during intracavity treatment with doxorubicin hydrochloride

Summary Ten patients with carcinoma in situ of the urinary bladder were treated topically with doxorubicin hydrochloride. Blood group antigens were evaluated by the specific red cell adherence test. Carcinoma in situ was associated with the loss of antigenicity, the reappearance of which could be demonstrated in patients with tumour remission. This occurred in spite of a persistent nuclear atypia.Abbreviations Tis (WHO, 1978) Carcinoma in situ - BGA Blood group antigens - DOX Doxorubicin hydrochloride - TEM Transmission electronmicroscopy - TCC Transitional cell carcinoma     

The role of PTEN tumor suppressor pathway staining in carcinoma in situ of the bladder

ObjectivesThe PI3k/Akt pathway has been associated with the development and progression of bladder tumors, with most studies focused on papillary or muscle-invasive tumors. We sought to characterize the expression patterns of the PI3K/Akt pathway in a large cohort of high-risk preinvasive carcinoma in situ (CIS) tumors of the bladder. Our goal was to understand whether PI3K/Akt pathway alterations associated with CIS resemble early- or late-stage bladder cancers.Material and methodsWe evaluated tissue specimens from 97 patients with CIS of the bladder, of which 14 had a concomitant papillary tumor. All patients were treated with intravesical bacillus Calmette-Guerin. All specimens were evaluated for PTEN, p-AKT, and p-S6 immunoreactivity. Markers were evaluated for percentage and intensity of staining and were scored using a 0 to 3+grading system.ResultsPTEN staining was noted as least intense in 67% of tumor specimens and 22% of normal urothelium. P-Akt and p-S6 had intense staining in 77% and 90% of tumor specimens vs. 44% and 68% in normal tissue, respectively. Low-intensity staining for PTEN at 12 months correlated with higher recurrence risk (P = 0.026).ConclusionWe describe a large cohort of CIS bladder tumors with decreased staining intensity of PTEN and increased staining intensity of p-AKT and p-S6, similar to high-grade and high-stage papillary tumors. Low-intensity staining of PTEN at 12 months was associated with an increased risk of recurrence.     

The current treatment of ductal carcinoma in situ

A consensus conference was held in April, 1999, to help sift through the maze of controversy surrounding the treatment of mammographically detected ductal carcinoma in situ (DCIS). Members of the panel included approximately 30 DCIS experts, who addressed issues relating diagnosis, treatment, treatment of breast (and axilla), adjuvant theraphy, among others. The panel agreed that the goal of treatment for DCIS is breast conservation and attempted to divide the population of patients with DCIS into subsets who are appropriately treated by mastectomy, radiation theraphy, or by excision alone. Major criteria for breast conservation include small size of area of DCIS, clear surgical margins, and favorable biology. Neither axilliary dissection nor sentinel node biopsy is appropriate for DCIS treated by breast conservation. The role of tamoxifen is currently under study, and although approved by the FDA for "risk reduction," its use in patients with DCIS is uncertain.     

Interest of sentinel lymph node biopsy for the staging of ductal carcinoma in situ

PURPOSE: The aim of this study was to define the interest of sentinel lymph node biopsy (SLNB) for the staging of ductal carcinoma in situ (DCIS) and DCIS with micro-invasion (DCISM) in patients with breast carcinoma. MATERIAL AND METHODS: From June 1999 to December 2002 we listed, in a retrospective study, 52 patients treated surgically for a DCIS or a DCISM. All except one had an histology before surgery, and all had SLNB. Intraoperative imprint cytology of the sentinel lymph node (SLN) was performed then there were analysed by staining with hematoxylin-eosin. Patients with positive SLN underwent complete axillary dissection. RESULTS: It was removed an average of three SLNs by patient (extreme 1 to 6). Metastases in the SLN were detected in four (7,7%) of the 52 patients, including three cases had only micrometastases in the SLN. In the four patients treated with complete axillary dissection, the SLN were the only positives nodes. CONCLUSION: The SLNB for DCIS and DCISM increases the involvement rate of lymph node. Because of the widespread for early detection of breast cancer, it is noted a regular increase in the rate of DCIS. Even if the attitude to be had towards the lymph node metastases in these cases is not yet well defined, and so only 2% of the patients approximately die of this pathology, it is interesting because of increase in absolute value of mortality, to try to improve the prognosis criteria to modify the treatment of this pathology.     

乳腺导管内癌诊疗进展

近年来,随着乳腺癌钼靶筛查技术的应用和普及,乳腺导管内癌的检出率不断上升.熟悉乳腺导管内癌的临床表现、提高对乳腺导管内癌辅助检查结果的辨别能力,对诊断乳腺导管内癌至关重要.乳腺导管内癌的手术方式包括全乳腺切除、肿瘤局部广泛切除加放疗,以及单纯的肿瘤局部广泛切除;乳腺导管内癌常规不行腋窝淋巴结清扫已成为共识,前哨淋巴结活...     

Alternating mitomycin C and BCG instillations versus BCG alone in treatment of carcinoma in situ of the urinary bladder: a nordic study

OBJECTIVES: To evaluate whether, in patients with carcinoma in situ (CIS) of the urinary bladder, alternating instillation therapy with mitomycin C (MMC) and bacillus Calmette-Guerin (BCG) was more effective and less toxic than conventional BCG monotherapy. METHODS: Patients were stratified prospectively for primary, secondary, and concomitant CIS and randomized to one of two regimens. Patients in the alternating group received six weekly intravesical instillations of MMC 40 mg, followed by alternating monthly instillations of BCG 120 mg and MMC for one year. In the monotherapy group, only BCG was instilled on the same schedule. RESULTS: Of 323 enrolled patients, 304 were eligible for analysis. After an overall median follow-up of 56 months, the Kaplan-Meier disease-free estimate for BCG monotherapy was significantly better than that for alternating therapy (p=0.03; log rank test). Risk for progression appeared lower in the BCG monotherapy group (p=0.07), but no differences existed in survival. Besides the regimen, CIS category also predicted outcome to some extent. BCG monotherapy caused significantly more local side-effects and premature cessation of instillation treatment than did the alternating therapy. However, no differences were observed in the number of serious side-effects. CONCLUSION: One-year BCG monotherapy was more effective than the alternating therapy for reducing recurrence and compared well with the best regimens reported from substantially smaller series. The alternating therapy was better tolerated.     

根治性切除治疗上尿路移行上皮癌

采用经腹行肾筋膜外肾、输尿管全长及膀胱壁袖状切除加腹膜后清扫的根治性切除术治疗上尿路移行细胞癌２５例，术后５～１２年存活２２例；术后３年内死亡３例，其中１例与原发病无关，另２例为继发膀胱癌或对侧肾盂癌，但无腹膜后局部复发的临床证据。认为本术的切除范围有利于预防肿瘤的局部复发。     

乳腺原位癌的临床诊治分析

目的探讨对乳腺原位癌早期诊断和治疗的方法。方法对我院2002年1月至2006年12月间29例乳腺原位癌的临床资料进行回顾性分析。结果206例乳腺癌中乳腺原位癌29例,占14.08%;术前乳腺钼靶摄片27例,其中20例阳性,阳性率74.07%;15例有单孔乳头血性溢液,行乳腺导管造影均为阳性;乳腺彩超15例中9例阳性,阳性率60%。术后病理诊断乳腺导管原位癌23例,小叶原位癌6例。行改良根治术15例,单纯乳房切除术10例,保乳手术4例。所有患者手术后恢复良好,无并发症。术后随访10个月～6年,均未发现肿瘤复发和转移。结论乳腺原位癌的早期诊断需要在临床和乳腺影像学检查发现异常的基础上通过手术活检来实现。保乳手术将是治疗乳腺原位癌的趋势。     

Interpretation of the risk associated with the unexpected finding of lobular carcinoma in situ

Background: The risk of developing invasive breast cancer after finding lobular carcinoma in situ (LCIS) is controversially reported in the literature. The surgeon who finds LCIS unexpectedly may be tempted to remove the breast, or even remove both breasts. Methods: From 1976 to 1991, 157 consecutive women with palpable or mammographically detected breast lesions underwent surgery to resolve doubt as to the presence of invasive cancer. We report on the women in whom LCIS was found after diagnostic breast surgery and analyze the incidence of breast cancer after a mean 5 years of follow-up in comparison with that in the normal reference population. Results: Eight patients developed infiltrating breast carcinoma (four ipsilateral, four contralateral as first events), equal to a homolateral rate of 0.00625. The expected rate in the normal reference population is 0.00152; ratio 4.11 (95% confidence interval 1.1–10.5). For a contralateral event the rate ratio is 3.0 (95% confidence interval 0.8–7.6). Conclusion: LCIS is one of many markers for later infiltrating cancer, so patients should be carefully followed. Ablative surgery is not justified.     

Disparities in time to definitive surgical treatment between black and white women diagnosed with ductal carcinoma in situ

BACKGROUND: Although black women develop invasive breast cancer at a lower incidence than white women, the cancers they develop tend to be of a higher grade and are more likely estrogen receptor negative. There is very little information with regard to black women and ductal carcinoma in situ (DCIS). In addition, although various reasons have been proposed for the delay to screening for black women, a delay after diagnosis has also been recognized. PURPOSE: The purpose of this study was to investigate disparities in time to treatment between black women and white women once DCIS has been diagnosed. METHODS: A retrospective analysis of 37 black women and 37 matched white women treated for DCIS was performed. Matches were made based on the date of birth, date of diagnosis, date and type of surgery, and age at diagnosis. The time from the date of diagnosis to the date of surgery was ascertained. RESULTS: Black women were 64% more likely to undergo a delay to surgery (>50 days) compared with white women (21% versus 13%, P < .05). CONCLUSION: Black women are more likely not to reach surgery within 50 days of diagnosis, which is concerning, and further studies to investigate the cause of these delays are warranted.