Cunha Isabela Werneck, Guimaraes Gustavo C, Soares Fernando, Velazquez Elsa, Torres Jose J, Chaux Alcides, Ayala Gustavo, Cubilla Antonio L
Hospital do Cancer AC Camargo, Sao Paulo, Brazil.
Am J Surg Pathol. 2009 Apr;33(4):551-5. doi: 10.1097/PAS.0b013e31818a01d8.
Almost half of penile squamous cell carcinomas (SCCs) are of the usual type but there is a variegated spectrum of morphologically distinctive subtypes. In a pathologic review of 375 uniformly diagnosed and treated patients with penile SCC, we found 7 tumors with predominant pseudoglandular or adenoid features. The aim of the study was to delineate clinicopathologic features and outcome of an unusual variant of penile SCC. Clinical charts and pathologic materials were reviewed. The following informations were obtained: patient's age, tumor site, size, histologic grade (1, 2, and 3), thickness in millimeters, anatomic level of invasion [corpus spongiosum, corpus cavernosum (CC)], vascular and perineural invasion, groin nodal status, and follow-up in months. These features were compared with those of 224 cases of usual SCCs. Median age of the patients was 54 years. Tumors were large (average 4.6 cm) and involved multiple sites in 4 cases; exclusively the glans in 2 and site was unknown in 1. Microscopically, tumors were SCC with acantholytic areas ranging from solid nests with early necrosis or empty pseudoluminal spaces lined by 1 layer of squamous cells or cylindrical cells strikingly simulating glands. Tumors were deeply infiltrating (4 invaded CC, 2 corpus spongiosum, and 1 invaded preputial dermis) and were of high histologic grade (6 cases). Vascular invasion was present in 4 cases and perineural invasion in 2. The differential diagnosis was with gland forming penile tumors (surface adenosquamous, mucoepidermoid, and urethral adenocarcinomas) and the angiosarcomatoid variant of sarcomatoid carcinomas. There was regional nodal metastasis in 3 patients, 2 of which died from disease. The other 5 were either alive with no evidence of disease (12 and 21 y after diagnosis) or died from causes other than penile cancer (3, 4, and 7 y after diagnosis). Comparing with usual SCCs, pseudoglandular SCCs were of higher grade (88% vs. 44%), invaded deeper into CC (71% vs. 52%), and showed a higher incidence of regional metastasis (42% vs. 25%) and higher mortality (29% vs. 19%).
几乎一半的阴茎鳞状细胞癌（SCC）属于常见类型，但存在形态学上独特的多种亚型。在一项对375例经统一诊断和治疗的阴茎SCC患者的病理回顾中，我们发现7例肿瘤具有主要的假腺管或腺样特征。本研究的目的是描述阴茎SCC一种不寻常变体的临床病理特征及预后。回顾了临床病历和病理资料。获取了以下信息：患者年龄、肿瘤部位、大小、组织学分级（1、2和3级）、毫米厚度、浸润的解剖层次[海绵体、海绵体白膜（CC）]、血管和神经周围浸润、腹股沟淋巴结状态以及以月为单位的随访情况。将这些特征与224例常见SCC的特征进行了比较。患者的中位年龄为54岁。肿瘤较大（平均4.6厘米），4例累及多个部位；2例仅累及龟头，1例部位不明。显微镜下，肿瘤为SCC，伴有棘层松解区域，范围从有早期坏死的实性巢状结构到由一层鳞状细胞或柱状细胞内衬的空的假管腔，酷似腺体。肿瘤浸润较深（4例侵犯CC，2例侵犯海绵体，1例侵犯包皮真皮），组织学分级高（6例）。4例存在血管浸润，2例存在神经周围浸润。鉴别诊断包括形成腺体的阴茎肿瘤（表面腺鳞癌、黏液表皮样癌和尿道腺癌）以及肉瘤样癌的血管肉瘤样变体。3例患者有区域淋巴结转移，其中2例死于该疾病。另外5例要么无疾病证据存活（诊断后12年和21年），要么死于阴茎癌以外的原因（诊断后3年、4年和7年）。与常见SCC相比，假腺管型SCC分级更高（88%对44%），更深地侵犯CC（71%对52%），区域转移发生率更高（42%对25%），死亡率更高（29%对19%）。
