阴茎癌术后短期肺转移3例报道并文献复习

Short-term pulmonary metastasis after surgery from penile cancer:A report of 3 cases and literature review

目的:探讨阴茎癌术后短期肺转移的疾病进展、影像学表现、病理、治疗及预后情况。方法:通过回顾分析3例阴茎癌肺转移患者的临床资料,结合相关文献进行讨论。结果:3例患者,平均年龄65岁,术前平均体质量指数(body mass index,BMI)为21.2 kg/m~2,术前胸部CT均未见明显肺转移。3例患者术前均可触及肿大腹股沟淋巴结,其中1例盆腔磁共振可见淋巴结肿大。活检病理2例为低分化鳞状细胞癌,1例为中分化鳞状细胞癌。1例患者接受了阴茎部分切除术+腹股沟及盆腔淋巴结清扫术,2例患者接受阴茎部分切除术+腹股沟淋巴结清扫术。术后病理肿瘤直径3.0~5.2 cm,均提示阴茎低分化鳞状细胞癌。免疫组化:CK(+)、p40(+)、Vimentin(+)、CK5/6(+)、HCK(+)、p63(+),Ki-67均大于70%。3例患者术后1个月复查胸部CT均提示多发结节。其中1例患者术后1个月出现咯血症状,腹股沟区可触及肿块,肺结节穿刺病理证实阴茎癌肺转移。术后3例患者总生存期均≤5个月。结论:阴茎癌术后短期出现肺转移临床少见,术前多有区域淋巴结转移,术后进展迅速,可合并有肺部症状,胸部CT和穿刺活检对诊断有帮助,预后极差。

Objective:To discuss the disease progression,imaging features,clinical pathological features,treatment and prognosis about the short-term pulmonary metastasis after surgery from penile cancer.Methods:Clinical data about 3 cases of the pulmonary metastasis from penile cancer were retrospectively analyzed,and relevant literature was reviewed.Results:The age of 3 patients was 62~70 years old with a mean age of 65 years old.The average body mass index(BMI)was 21.2 kg/m 2.There was no obvious abnormality in preoperative chest CT.Three cases of inguinal lymph node enlargement were obviousand 1 cases of pelvic lymph node enlargement were showed by pelvic cavity MRI.Biopsy pathology showed 2 cases of poorly differentiated squamous cell carcinoma and 1 case of moderately differentiated squamous cell carcinoma.1 patient received partial penectomy,inguinal lymph node dissection and pelvic lymph node dissection.2 patients received partial penectomy and inguinal lymph node dissection.The tumor diameters were 3.0~5.2 cm and all postoperative pathology were poorly differentiated squamous cell carcinoma.Immunohistochemical results showed tumor cells were positive for CK,p40,Vimentin,CK5/6,HCK,p63 and Ki-67.Chest CT of 3 patients revealed multiple nodules during 1 month after surgery.1 patient received percutaneous lung biopsy because of the hemoptysis and inguinal masses which revealed the pulmonary metastasis from penile cancer.The total survival time of all 3 patients was less than 5 months after surgery.Conclusion:Short-term pulmonary metastasis after surgery from penile cancer was rarely in clinical work.There are often regional lymph node metastases before surgery.Postoperative progress is rapid and can be accompanied with pulmonary symptoms.Chest CT and needle biopsy are significant for diagnosis,and prognosis is extremely poor.