阴囊基底细胞癌诊治分析

Diagnosis and treatment of basal cell carcinoma of the scrotum

目的 探讨阴囊基底细胞癌的诊断和治疗方法.方法 回顾性分析7例阴囊基底细胞癌患者的资料.患者平均年龄66（50～74）岁.主要症状为阴囊皮肤出现斑块或结节伴瘙痒,病程1～20年.肿瘤最大径1.5～4.5cm.5例曾误诊为湿疹或皮炎.7例均经活检确诊,均无远处转移.7例均行肿瘤广泛切除术治疗.结果 7例术后病理检查见肿瘤为基底样细胞和间质组成的团块,标本切缘均为阴性.1例术后21个月发生左腹股沟淋巴结转移,行双侧腹股沟淋巴结清扫术.术后随访36个月无瘤生存.1例术后48个月出现双肺转移,予环磷酰胺＋表阿霉素＋顺铂联合方案化疗6个疗程,获得完全缓解.化疗结束后13个月无瘤生存.其余5例术后未行辅助放、化疗,随访14～72个月均无瘤生存.结论阴囊基底细胞癌临床罕见.手术广泛切除肿瘤有可能获得治愈.部分患者在术后数年会发生转移,术后需要长期随访.

Objective To review the diagnosis and treatment of basal cell carcinoma of the scrorum. Methods Clinical data of 7 patients with basal cell carcinoma of the scrotum were analyzed retrospectively. The mean age of the patients was 66 years. The most common presenting symptom was a plaque or nodular lesion with pruritis on the scrotum. The lesions ranged from 1.5 cm to 4.5 cm in diameter. Five of the 7 patients had a history of misdiagnosis. The diagnosis was established by biopsy of the lesion in all the patients. All of the 7 patients had no distant metastasis at the time of diagnosis and were treated by wide surgical resection.Results Histopathologic examination of the specimens confirmed the negative surgical margins in all cases.The most common histological feature was lobules, columns, bands and cords of basaloid cells associated with a surrounding loose fibromucinous stroma.One patient developed left inguinal lymph node metastasis at 21 months postoperatively,and was treated by bilateral inguinal lymph node dissection.The patient was free of cancer for 36 months after that. Another patient developed lung metastasis 48 months after the first operation.He was treated by systemic chemotherapy with cyclophosph amide, epirubicin and cisplatin for 6 cycles and obtained complete remission.This patient was free of cancer for 13 months after the chemotherapy.The remaining 5 patients were all free of cancer after the operation. Conclusions Basal cell carcinoma of the scrotum is rare.Wide surgical resection alone is usually considered to be curative. Because of its potential of metastasis, long-term followup is indicated for this disease.