Intraarterial chemotherapy with gemcitabine and cisplatin in locally advanced or recurrent penile squamous cell carcinoma

The prognosis of locally advanced or recurrent squamous cell carcinoma(SCC) of the penis after conventional treatment is dismal. This study aimed to evaluate the therapeutic effects of intraarterial chemotherapy with gemcitabine and cisplatin on locally advanced or recurrent SCC of the penis. Between April 1999 and May 2011, we treated 5 patients with locally advanced penile SCC and 7 patients with recurrent disease with intraarterial chemotherapy. The response rate and toxicity data were analyzed, and survival rates were calculated. After 2 to 6 cycles of intraarterial chemotherapy with gemcitabine and cisplatin, 1 patients with locoregionally advanced disease achieved a complete response, and 4 achieved partial response. Of the 7 patients with recurrent disease, 2 achieved complete response, 3 achieved partial response, 3 had stable disease, and 1 developed progressive disease. An objective tumor response was therefore achieved in 10 of the 12 patients. The median overall survival for the patients was 24 months(range, 10-50 months). Three out of 10 patients who responded were long-term survivors after intraarterial chemotherapy. Intraarterial chemotherapy with gemcitabine and cisplatin may be effective and potentially curative in locoregionally advanced or recurrent penile SCC. The contribution of this therapy in the primary management of advanced or recurrent penile SCC should be prospectively investigated.

Penile metastasis from rectal carcinoma: A case report

BACKGROUND Metastasis to the penis is an unusual event,and penile metastasis from rectal carcinoma(PMRC)is extremely rare and associated with a dismal prognosis.Thus far,approximately 80 cases have been reported.CASE SUMMARY Herein,we report the case of a 49-year-old man with PMRC.The patient presented to the urology clinic with a complaint of penile pain during urination.The patient underwent the Dixon operation for rectal carcinoma 2 mo before the presentation.During hospitalisation,abdominal computed tomography revealed a nodular lesion on the left penis.The postoperative pathological examination revealed a typical intestinal-type adenocarcinoma.Previous cases of PMRC were retrieved from PubMed to characterise the clinicopathological features and identify the prognostic factors of PMRC.CONCLUSION The analysis suggested that approximately 24 mo is the median time to metastasis occurrence and 150 d is the survival time after diagnosis.Furthermore,poor pathological differentiation,lymph node involvement of the primary RC,metastasis time<6 mo,penile metastatic nodule diameter>1 cm,and treatment abandonment are negative predictors of survival outcomes.Close follow-up,surgical resection,chemotherapy,and radiotherapy may potentially improve the prognosis of patients.

Surgical treatment of a rare case of penile squamous cell carcinoma in a 65-year-old man

阴茎有鳞的房间癌通常在过去的十年被报导了。我们与肿瘤生长，为总数， penectomy，会阴的 urethrostomy 和双边的腹股沟的淋巴腺切除术被执行的 4 年的历史在 65-year-oldpatient 描述阴茎的巨大的有鳞的细胞癌的一个稀罕案例。我们建议好攻击的外科的干预应该不管肿瘤的尺寸与区分得好的阴茎癌为那些被推荐。

Programmed cell death protein 4 expression in renal cell carcinoma, penile carcinoma and testicular germ cell cancer

AIM:To investigate the expression of programmed cell death 4(Pdcd4)tumor suppressor gene in tissue specimen of renal cell carcinoma(RCC),testicular germ cell cancer and penile cancer.METHODS:Pdcd4 expression was studied using immunohistochemistry in 188 cases of RCC and 28 controls(including 9 oncocytoma);in 74 cases of penile carcinoma(including 17 metastatic tissue samples)and26 controls;in 11 cases of seminoma,in 14 cases of non-seminoma and 5 controls.RESULTS:Control tissues exhibited strong core and cytoplasmatic Pdcd4 staining.In contrast,core and cy-toplasmatic Pdcd4 levels were significantly decreased in cancer tissues.CONCLUSION:Our data support a role for Pdcd4(down-)regulation in urologic tumors.Interestingly,Pdcd4 expression seem to be a potential diagnostic marker for renal or penile tumors.

Thedual pathogenesisofpenileneoplasia: The heterogeneous morphology of human papillomavirus-relatedtumors

Objective:Penile neoplasia,usually of squamous histogenesis,is currently classfied into human papillomavirus(HPV)-related or-dependent and non-HPV-related or-indepen dent.There are distinct morphological differences among the two groups.New research studies on penile cancer from Northern countries showed that the presence of HPV is corre lated with a better prognosis than virus negative people,while studies in Southern countries had not confirmed,perhaps due to differences in staging or treatment.Methods:We focused on the description of the HPV.related carcinomas of the penis.The approach was to describe common clinical features followed by the pathological features of each entity or subtype stressing the characteristics for differential diagnosis,HPV genotypes,and prognostic features of the invasive carcinomas.Similar structure was followed for penile intraepithelial neoplasia,except for prognosis because of the scant evidence available.Results:Most of HPV-related lesions can be straightforwardly recognized by routine hematoxylin and eosin stains,but in some cases surrogate p16 immunohistochemical staining or molecular methods such as in situ hybridization or polymerase chain reaction can be utilized.Currently,there are eight tumor invasive variants associated with HPV,as follows:basaloid,warty,warty-basaloid,papillary basaloid,clear cell,medullary,lymphoepithelioma-like,and giant condylomas with malignant transformation.Conclusion:This review presents and describes the heterogeneous clinical,morphological,and genatypic features of the HPV-related subtypes of invasive and non-invasive penile neoplasia.

Updates in the use of radiotherapy in the management of primary and locally-advanced penile cancer

Objective:Penile cancer is a rare malignancy in most developed countries,but may represent a significant oncologic challenge in certain African,Asian,and South American regions.Various treatment approaches have been described in penile cancer,including radio-therapy.This review aimed to provide a synopsis of radiotherapy use in penile cancer management and the associated toxicities.In addition,we aimed to discuss palliative radiation for metastases to the penis and provide a brief overview of how tumor biology may assist with treatment decision-making.Methods:Peer-reviewed manuscripts related to the treatment of penile cancer with radio-therapy were evaluated by a PubMed search(1960-2021)in order to assess its role in the definitive and adjuvant settings.Selected manuscripts were also evaluated for descriptions of radiation-related toxicity.Results:Though surgical resection of the primary is an excellent option for tumor control,select patients may be treated with organ-sparing radiotherapy by either external beam radiation or brachytherapy.Data from randomized controlled trials comparing radiotherapy and surgery are lacking,and thus management is frequently determined by institutional practice patterns and available expertise.Similarly,this lack of clinical trial data leads to divergence in opinion regarding lymph node management.This is further complicated in that many cited studies evaluating lymph node radiotherapy used non-modern radiotherapy delivery techniques.Groin toxicity from either surgery or radiotherapy remains a challenging problem and further risk assessment is needed to guide intensification with multi-modal therapy.Intrinsic differences in tumor biology,based on human papillomavirus infection,may help aid future prognostic and predictive models in patient risk stratification or treatment approach.Conclusion:Penile cancer is a rare disease with limited clinical trial data driving the majority of treatment decisions.As a result,the goal of management is to effectively treat the disease while balancing the importance of quality of life through integrated multidisciplinary discussions.More international collaborations and interrogations of penile cancer biology are needed to better understand this disease and improve patient outcomes.

术前炎症指标对未触及腹股沟淋巴结的pT1a期阴茎鳞癌患者淋巴结转移的预测价值

目的:探讨3种术前炎症指标对未触及腹股沟淋巴结的p T1a期阴茎鳞癌患者发生淋巴结转移的预测价值。方法:收集苏州大学附属第一医院和泰兴市人民医院2012年1月—2023年6月收治的103例p T1a期阴茎鳞癌患者的临床资料,根据术后病理有无发生腹股沟淋巴结转移分为淋巴结转移组及非淋巴结转移组。比较两组间年龄、体重指数、高血压、糖尿病、肿瘤直径、中性粒细胞/淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)、血小板/淋巴细胞比值(platelet-to-lymphocyte ratio,PLR)、淋巴细胞/单核细胞比值(lymphocyte-to-monocyte ratio,LMR)及术后病理分级的差异。采用单因素和多因素Logistic回归分析筛选出淋巴结转移的独立危险因素。采用受试者工作特征(receiver operating characteristic,ROC)曲线比较炎症指标对p T1a期阴茎癌患者发生淋巴结转移的预测价值以及在调整灵敏度为100%后各炎性指标对淋巴结转移的预测效能。结果:(1)腹股沟淋巴结转移组24例(23.3%),非淋巴结转移组79例(76.7%),两组在NLR(P<0.001)、PLR(P=0.035)和LMR(P <0.001)方面差异有统计学意义;(2)多因素分析结果显示,NLR(P=0.045)和LMR(P=0.021)是pT1a期阴茎鳞癌发生腹股沟淋巴结转移的独立危险因素;(3)ROC曲线分析结果显示,NLR、LMR和NLR+LMR的曲线下面积分别为0.833、0.816、0.835。NLR的最佳截断值为2.33,灵敏度为95.8%,特异度为68.4%;LMR的最佳截断值为3.80,灵敏度为79.2%,特异度为78.5%;NLR+LMR联合检测的灵敏度为83.3%,特异度为74.7%;(4)当调整灵敏度为100%时,NLR和LMR对pT1a期阴茎鳞癌腹股沟淋巴结转移的预测特异度为50.6%和2.5%,截断值为1.79和11.01。结论:NLR和LMR为pT1a期阴茎鳞癌发生腹股沟淋巴结转移的独立预测因素。NLR>2.33和LMR<3.80时提示患者淋巴结转移风险极大,推荐行淋巴结清扫手术,提高患者的生存率。

Human papillomavirus and p53 protein immunoreactivity in condylomata acuminatum and squamous cell carcinoma of penis

Aim: To determine the immunoreactive pattern of human papillomavirus (HPV) antigen and p53 protein in condylo-mata acuminatum (CA) and squamous cell carcinoma (SCC) of penis. Methods: Immunohistochemistry for HPVand p53 were performed in 40 specimens of formalin fixed, paraffin embedded tissues using a polyclonal (rabbit) anti-body against HPV and a monoclonal (mouse) antibody against human p53 protein. Twenty one cases of CA and nine-teen cases of SCC were examined. Results: HPV antigen was detected in all 21 CA and 2 penile SCC. p53 proteinoverexpression was observed in 12 of 19 (63%) SCC in which 6 cases were strong positive. Five of 21 CA (24%)showed low-grade p53 protein overexpression. Conclusion; CA is related to HPV infection and some cases showp53 protein low-grade overexpression. In contrast, p53 protein overexpression is common in penile SCC, which is sel-dom related to HPV infection. (Asian J Androl 2001 Mar; 3: 75-77)

术前白蛋白与碱性磷酸酶比值对局限性阴茎癌术后复发的影响

目的探讨术前白蛋白与碱性磷酸酶的比值(AAPR)与局限性阴茎癌(T1~3N0M0)术后复发的关系。方法收集苏州大学附属第一医院2012年1月—2017年1月收治的93例局限性阴茎癌患者的临床资料,比较术后复发组与非复发组间年龄、体质指数(BMI)、AAPR、高血压、糖尿病、肿瘤直径、术后病理分级及分期的差异。Cox回归分析术后发生复发的独立危险因素。采用Kaplan-Meier法绘制生存曲线,比较高、低AAPR组间术后发生复发的差异。结果复发组较非复发组有较高的WHO/国际泌尿外科病理学学会(ISUP)病理分级(P=0.018)和病理分期(P=0.012)、较低的AAPR(P=0.001)。Cox回归结果显示,AAPR为术后发生复发的独立危险因素(P=0.041)。生存曲线结果表明,高、低AAPR组患者与术后未发生复发的生存时间负相关(P=0.028)。结论术前AAPR是局限性阴茎癌术后复发的独立危险因素,且与未发生复发时间相关。随着AAPR的升高,复发发生率下降,无进展生存时间延长。

Histological subtype is a significant predictor for inguinal lymph node metastasis in patients with penile squamous cell carcinoma

The present study aimed to investigate the relationship between histopathological subtype and the probability of inguinal lymph node metastasis （ILNM） in patients with penile squamous cell carcinoma （PSCC）. The clinical records of 198 consecutive patients with PSCC were analyzed retrospectively. Primary lesions were reevaluated according to the 2016 World Health Organization （WHO） histopathological classification. We retrieved the clinicopathological factors from the medical records including age, clinical lymph node stage, pathological tumor stage, lymphatic invasion, and nerve invasion. Uni- and multivariate logistic regression analyses were used to explore the risk factors of ILNM. Multivariate analyses identified clinical lymph node stage （P = 0.000）, pathological tumor stage （P = 0.016）, histologic grade （P = 0.000）, and risk group of histological subtypes （P = 0.029） as independent predictors for ILNM. Compared with the low-risk group of PSCC subtypes, the intermediate- （HR： 3.66, 95% CI. 1.30-10.37, P = 0.021） and high-risk groups （HR： 28.74, 95% Ch 2.37-348.54, P = 0.008） were significantly associated with ILNM. In conclusion, the histopathological subtype of the primary lesion is a significant predictor for ILNM in patients with PSCC.

阴茎疣状癌的诊治(附4例报告)

目的：探讨阴茎疣状癌的诊断和治疗方法。方法：分析4例阴茎疣状癌患者的临床、病理资料。结果：患者年龄42—76（平均52）岁。肿瘤均呈菜花状、外生型生长，最大直径1．4—5．8cm。2例病变局限于阴茎头，另2例肿瘤侵犯至冠状沟（其中1例合并梅毒感染）。1例肿瘤局限于阴茎头且瘤体较小者（直径1．4cm）行阴茎头切除术；1例肿瘤局限于阴茎头且瘤体较大者及2例肿瘤侵犯至冠状沟者均行阴茎部分切除术（其中1例合并梅毒感染者经苄星青霉素治疗后再手术）。4例患者肿瘤标本病理显示肿瘤细胞分化好，切缘均呈阴性。标本切片均显示上皮呈乳头瘤状结构并过度角化，肿瘤细胞于基底部呈球茎状推进式生长。周围间质见淋巴细胞浸润。术后随访3—7年，平均4．6年，肿瘤均无复发。合并梅毒感染者术后复查快速血浆反应素试验转为阴性，梅毒螺旋体颗粒凝集试验仍呈阳性。结论：阴茎疣状癌表现为局部侵袭性生长，很少有淋巴结或远处转移者。治疗方法采用阴茎头切除或阴茎部分切除术，患者预后较好。

包皮环切术后发生阴茎鳞状细胞癌17例报道

目的：分析包皮环切术后发生的阴茎癌的诊治。方法：回顾性分析我院1997年1月-2004年12月行包皮环切术后1个月～16年发生阴茎癌17例患者的临床资料。结果：本组患者中术后1～12个月发现阴茎癌者11例，术后3～16年发现者6例；16例行阴茎部分切除术＋腹股沟淋巴结活检术，1例行扩大包皮环切术后复发相继行阴茎部分切除、全切术。复发的1例死亡，其余16例存活至今。结论：成年人行包皮环切术后仍有发生阴茎癌可能，对伴有包皮炎症、溃疡等病变的患者行包皮环切术应常规行病理检查，术后需密切随访，阴茎部分切除术是治疗早期阴茎鳞状细胞癌有效的方法，术中有必要行前哨淋巴结活检。

58例阴茎鳞状细胞癌治疗的临床分析

目的：提高阴茎鳞状细胞癌的治疗水平,寻求鳞状细胞癌合理有效的治疗方法。方法：回顾分析58例病理活检证实阴茎鳞状细胞癌治疗的临床资料。结果：按照Jackson分期,Ⅰ期25例,Ⅱ期18例,Ⅲ期11例,Ⅳ期4例。53例行手术治疗;行阴茎肿瘤局部切除及阴茎癌部分切除43例;阴茎全切除并尿道会阴部造口术及髂腹股沟淋巴清扫术10例（腹股沟淋巴结均阳性,髂淋巴结阳性1例）。术前新辅助治疗（热疗加化疗）联合术后化疗37例,仅术后化疗12例,单纯手术治疗4例;5例未手术治疗患者行化疗和/或放疗。48例随访2-5年,4例行阴茎部分切除者2年内复发,4例2年内死亡,7例2-5年内死亡,2年生存率为91.7%,5年生存率为77.1%,10例失访或随访期未满2-5年。结论：外科手术治疗、术前新辅助治疗联合术后化疗是目前治疗阴茎鳞状细胞癌的有效方法,淋巴结的清扫根据临床分级具体处理,手术联合术前新辅助治疗及术后化、放疗是否可减少复发及提高生存率,还需进一步研究。

阴茎肿瘤引起的阴茎异常勃起2例报告并文献复习

目的：提高临床医生急诊处理阴茎异常勃起疾病的能力。方法：2例阴茎肿瘤引起的阴茎异常勃起患者经阴茎海绵体根部注射间羟胺2～8mg治疗无效，在龟头、阴茎海绵体根部各置9号针头，以肝素化生理盐水对冲的保守治疗亦无效后，行手术治疗。结果：2例患者均手术行阴茎全切术，术后病理证实1例为阴茎原发肉瘤，1例为膀胱癌转移所致移行细胞癌。结论：阴茎肿瘤致阴茎异常勃起疾病临床少见。在急诊收治异常勃起患者时不应遗漏该诱因。

阴茎疣状癌的临床诊断和治疗

为了探讨阴茎癌的少见类型疣状癌的临床诊断和治疗,结合文献回顾性分析6例阴茎疣状癌的临床资料。6例患者全部为包皮过长或包茎,肿块直径0.4~6cm;基底位于包皮内板2例,局限于龟头3例,侵犯冠状沟近侧1例;3例经活检确诊,1例误诊为乳头状瘤,1例经反复复发切除4次尚确诊。所有患者均经手术治疗,其中阴茎部分切除4例,包皮环切1例,局部切除1例。所有患者均未行腹股沟淋巴结清除以及放化疗。行包皮环切的1例患者,术后3个月发现阴茎结节,活检确诊为前次手术结扎线头的炎症反应,随访至今3年,未见复发;其余患者随访0.5~8年,1例患者自然死亡,其余患者均未见肿瘤复发或转移。初步研究结果提示,阴茎疣状癌细胞分化良好,以局部侵袭性生长为主,几乎不发生淋巴结等远处转移,活检方法不当易于误诊,恰当的手术切除效果肯定,应最大限度保留阴茎外观和功能,但术后应严密观察局部复发。

同期腹腔镜下双侧腹股沟淋巴结清扫术在阴茎癌手术中的应用

目的探讨同期腹腔镜下双侧腹股沟淋巴结清扫术在阴茎癌手术中的临床应用价值。方法回顾性分析2012年4月至2014年8月采用该手术方法治疗的14例阴茎鳞状细胞癌患者的临床资料。结果所有手术均顺利完成,手术平均时间112 min,术中平均出血量47 ml,平均住院时间10 d;平均切除淋巴结数量为9.1枚,14例共28处腹股沟淋巴结中,2处有5枚淋巴结发生转移。术后1例患者右侧下肢出现皮下积液伴高热,经治疗后好转,其余患者无明显并发症。术后随访2~48个月,所有患者均无肿瘤复发和转移。结论阴茎癌同期行腹腔镜双侧淋巴结清扫术具有术中出血少、术后恢复快、住院时间短、并发症少等优点,是一项安全有效的手术。

电视腹腔镜下腹股沟淋巴结清扫术的安全性探讨(附1例报告)

目的探讨电视腹腔镜腹股沟淋巴结清扫术的可行性和安全性,并提供手术成功的案例。方法 1例60岁阴茎癌(pT2N1M0)患者经双侧腹股沟淋巴结活检证实为左侧转移癌后,行腹腔镜双侧腹股沟淋巴结清扫术。手术步骤:首先在双侧大腿标明股三角区,在相应的部位置入穿刺套管,充气创建操作平面。随后用超声刀清扫腹股沟区浅深淋巴结,同时切除大隐静脉。最后取出标本,负压引流,缝合切口。结果右、左侧手术时间分别为120、90 min,术中出血约30 mL。右、左侧淋巴结数目各为6个和7个,均为阴性。术后约4周左侧有50 mL积液,穿刺吸液后愈合。随访6个月未见复发。结论作者结合文献复习与实际操作成功案例分析认为,电视腹腔镜下腹股沟淋巴结清扫术安全可行,但仍须更多病例和更长时间的随访,以进一步观察并发症发生率并证实其疗效。

阴茎鳞状细胞癌1例

报告1例阴茎鳞癌。患者男,50岁,阴茎龟头菜花样肿块3年,破溃1年。3年半前有尖锐湿疣史。皮损组织人乳头瘤病毒(HPV)6,11型阳性。组织病理:高分化鳞癌(龟头皮损);淋巴结慢性炎症和反应性增生(右腹股沟)。

阴茎癌腹股沟淋巴结清扫术保留阔筋膜技术的控瘤效果

目的 探讨保留阔筋膜的腹股沟淋巴结清扫术治疗阴茎癌患者的控瘤效果。 方法 回顾性分析2002~2011年104例阴茎癌患者在我院行保留阔筋膜的腹股沟淋巴结清扫术的资料。 结果 中位随访时间36（10~130）个月，单侧腹股沟淋巴结清扫术清出淋巴结数目平均12.5（3~31）枚。总体患者3年疾病特异性生存率为92.1%，其中pN0、pN1、pN2和pN3的患者分别为100%、91.3%、80%和33.3%。1例患者术后7月复发，位于外环口上方阔肌膜范围之外。结论 保留阔筋膜腹股沟淋巴结清扫术治疗无淋巴结结外侵犯阴茎癌患者控瘤效果与经典根治术相似。

腔镜下阴茎癌双侧腹股沟淋巴结清扫术14例报告

目的探讨腔镜下阴茎癌双侧腹股沟淋巴结清扫术的效果。方法 2009年9月～2011年11月对14例阴茎癌行腔镜下双侧腹股沟淋巴结清扫术。术前对腹股沟淋巴结和隐静脉进行多普勒超声扫描和盆腔淋巴CT检查,术中建立人工手术腔隙,置入腔镜以及操作器械,先用超声刀扩大皮下腔隙,向上至腹股沟韧带上方的腹外斜肌腱膜,外侧至缝匠肌外缘,内侧为长收肌内侧,下界为股三角顶端,解剖出股动静脉、大隐静脉及其分支,并切除该范围内的淋巴结和脂肪组织,从穿刺孔取出清扫的淋巴结和脂肪组织,术后置引流管引流。结果 14例均顺利完成腔镜下腹股沟淋巴清扫术,术中未发生并发症。手术时间平均103 min(95～112 min),术中出血量平均85 ml(20～130 ml)。双侧切除淋巴结共5～14枚,平均9枚,淋巴结均阴性。术后留置引流管平均5 d(3～7 d)。术后住院5～8 d,平均6 d。1例出现淋巴囊肿,2个月后消退,其余患者未发生股血管损伤、皮缘坏死、愈合延迟、皮下积液和淋巴漏等切口相关的并发症。14例术后随访6～20个月,平均9个月,患者无明显双下肢肿胀及活动障碍。结论腔镜下阴茎癌双侧腹股沟淋巴结清扫术可以保证清扫范围并减少标准开放手术带来的切口相关并发症。