阴茎疣状癌的诊治

Diagnosis and treatment of penile verrucous carcinoma

目的探讨阴茎鳞状细胞癌的特殊类型疣状癌的诊断和治疗方法。方法回顾性分析8例阴茎疣状癌患者的诊治资料。患者平均年龄46岁。肿瘤均为菜花状、外生型,最大径2～6cm,局限于阴茎头5例,侵犯至冠状沟近侧3例。经活检病理诊断后,3例肿瘤侵犯冠状沟近侧者和1例位于阴茎头肿瘤较大者行阴茎部分切除术,4例局限于阴茎头者行肿瘤局部切除术。结果病理检查见肿瘤细胞分化好,标本切缘均阴性。1例肿瘤局部切除术者术后14个月阴茎残端复发,再行阴茎部分切除术,术后随访9年,无肿瘤复发或转移。其余7例术后随访4～13年,均无肿瘤复发或转移。肿瘤局部切除术者术后性生活较满意。结论阴茎疣状癌的生物学行为以局部侵袭性生长为主,很少发生区域性淋巴结转移或远处转移,采用恰当的治疗方法后患者预后好。

Objective To explore the diagnosis and treatment of penile verrucous carcinoma,a distinctive variant of squamous cell carcinoma. Methods The clinical data of 8 patients (mean age,46 years) with penile verrucous carcinoma were analyzed retrospectively.All the tumors showed exophytic,papillary lesions,ranging from 2 to 6 cm in the greatest dimension.The tumors were located at glans in 5 patients and invaded to shafts in the other 3.The diagnosis was established by biopsy of the lesion.Three patients with tumor invading to shafts and 1 patient with large tumor at glans underwent partial penectomy, while the other 4 with the tumors localized at glans were treated by local excision. Results Histopathologic examination of the specimens confirmed tumors-free surgical margins in all the cases.The tumor cells were mostly well-differentiated.Fourteen months postoperatively,local recurrence occurred in 1 patient with local excision and partial penectomy was performed; postoperative follow-up of 9 years showed no recurrence and metastasis. During a follow-up of 4 to 13 years,the other 7 patients were disease-free.The patients with local excision of the tumors reported satisfaction of their sexual lives. Conclusions Verrucous carcinoma of penis is characterized by slow growth and a locally aggressive nature.It seldom develops metastasis to regional lymph nodes or distant areas.The prognosis is favorable after appropriate treatment.