阴茎疣状癌的临床病理特征及治疗

Clinicopathological features and management of penile verrucous carcinoma

目的:探讨阴茎疣状癌的临床病理特征,提高对阴茎疣状癌的诊断和治疗水平。方法:回顾性分析18例阴茎疣状癌患者的临床资料。患者平均年龄52(35~66)岁,主要表现为阴茎肿物成菜花样,均伴有脓性分泌物,最大直径2.5~8.7 cm。巨大疣状癌侵犯至会阴1例(既往尖锐湿疣,阴茎肿物切除史),局限于阴茎头2例,侵犯至冠状沟4例(均有包皮过长史,1例合并阴茎头炎),侵犯至全阴茎11例(其中4例既往包皮、阴茎肿物,2例合并包茎史)。2例肿瘤侵犯冠状沟近侧者和2例肿瘤位于阴茎头相对较小(<3.5 cm)者行阴茎部分切除术,2例阴茎头部肿瘤较大(>3.5 cm)者、11例累及全阴茎、1例累及会阴者行阴茎肿瘤根治术。结果:术后病理检查:18例均提示肿瘤细胞分化好,切缘呈阴性,上皮呈乳头状结构并过度角化伴增生,周围间质见淋巴细胞浸润,符合阴茎疣状癌病理特征。术后随访1~8年,平均3.8年,肿瘤均无复发。结论:阴茎疣状癌病理表现为局部侵袭性生长,很少有淋巴结或远处转移,治疗方法采用阴茎部分切除或阴茎肿瘤根治术,患者预后较好。

Objective ： To explore the clinicopathological characteristics, diagnosis and treatment of penile verrucous carcinoma （VC）. Methods： We retrospectively analyzed the clinical data about 18 penile VC patients at the mean age of 52 （35 -66） years. The tumors were cauliflower-like, measuring 2.5 - 8.7 cm in diameter, all with mucopurulentive discharge. A giant tumor invaded the perineum in 1 case, which had a history of surgical excision of penile condyloma acuminatum. The lesions invaded the glans penis in 2 cases, the shafts in 4 （ all with a history of phimosis or redundant prepuce） , and the whole penis in 11. Partial penectomy was per- formed for 2 cases with the proximal coronary sulcus involved and another 2 with the eondylomata located in the glans penis and measur- ing 〈 3.5 cm in diameter. Radical surgery was done for 2 cases of glans VC 〉 3.5 cm in diameter, 11 cases with the whole penis in- volved, and 1 case with the perineum invaded. Results ： Postoperative pathology showed well-differentiated tumor cells, negative sur- gical margins, papillary epithelia with hyperkeratosis and hyperplasia, and lymphocyte infiltration in the surrounding interstitial tissue in all the cases. Neither recurrence nor metastasis was found during the 1 to 8 years of follow-up. Conclusion ： Penile VC is a special type of squamous cell carcinoma with little invasiveness and rare regional lymph node or distant metastasis, for the treatment of which partial penectomy or radical surgery confers good prognosis.