Instituto de Patología e Investigación, Universidad Nacional de Asunción, Asunción, Paraguay.
Am J Surg Pathol. 2012 Jun;36(6):869-75. doi: 10.1097/PAS.0b013e318249c6f3.
There are 3 distinct variants of penile squamous cell carcinoma frequently associated with human papillomavirus (HPV): basaloid, warty-basaloid, and warty carcinomas. Considering the high incidence rates of penile cancer in some countries, a large international study was designed to evaluate the presence of HPV, its genotype distribution, and its association with histologic types of penile cancer. In this international review of >900 cases, we found a group of highly distinct papillary neoplasms composed of basophilic cells resembling urothelial tumors but frequently associated with HPV. Macroscopically, tumors were exophytic or exoendophytic. Microscopically, there was a papillomatous pattern of growth with a central fibrovascular core and small basophilic cells lining the papillae. Positivity for HPV was present in 11 of 12 tumors (92%). Single genotypes found were HPV-16 in 9 tumors and HPV-51 in 1 tumor. Multiple genotypes (HPV-16 and HPV-45) were present in another case. Overexpression of p16 was observed in all cases. Uroplakin-III was negative in all cases. The differential diagnosis was with basaloid, warty-basaloid, warty, and papillary squamous cell carcinoma and with urothelial carcinomas. Local excision (4 cases), circumcision (3 cases), or partial penectomy (5 cases) were preferred treatment choices. Tumor thickness ranged from 1 to 15 mm (average, 7 mm). Two patients with tumors invading 11 and 15 mm into the corpus spongiosum developed inguinal nodal metastasis. Of 11 patients followed up (median 48 mo), 7 were alive with no evidence of metastatic disease, 3 died from causes other than penile cancer, and another died postoperatively. This morphologically distinct tumor probably represents a papillary variant of basaloid carcinomas (papillary-basaloid carcinomas). Unlike typical basaloid carcinomas, the overall prognosis was excellent. However, deeply invasive tumors were associated with regional nodal metastasis indicating a potential for tumor-related death.
有 3 种不同的阴茎鳞状细胞癌变体，它们经常与人类乳头瘤病毒 (HPV) 相关：基底细胞样、疣状-基底细胞样和疣状癌。考虑到一些国家阴茎癌的高发病率，设计了一项大型国际研究来评估 HPV 的存在、其基因型分布及其与阴茎癌组织学类型的关联。在这项对 >900 例病例的国际回顾中，我们发现了一组由类似于尿路上皮肿瘤的嗜碱性细胞组成的高度独特的乳头状肿瘤，但经常与 HPV 相关。大体上，肿瘤呈外生性或外内生性。显微镜下，存在乳头状生长模式，中央为纤维血管核心，小嗜碱性细胞排列在乳头周围。12 例肿瘤中有 11 例（92%）HPV 阳性。发现的单一基因型为 9 例 HPV-16 和 1 例 HPV-51。另一例存在多种基因型（HPV-16 和 HPV-45）。所有病例均观察到 p16 过度表达。所有病例 uroplakin-III 均为阴性。鉴别诊断包括基底细胞样、疣状-基底细胞样、疣状和乳头状鳞状细胞癌以及尿路上皮癌。首选的治疗选择是局部切除（4 例）、包皮环切术（3 例）或部分阴茎切除术（5 例）。肿瘤厚度为 1 至 15 毫米（平均 7 毫米）。2 例肿瘤侵犯阴茎海绵体 11 和 15 毫米的患者发生腹股沟淋巴结转移。11 例随访患者（中位随访时间 48 个月）中，7 例无转移性疾病存活，3 例死于非阴茎癌原因，另 1 例术后死亡。这种形态独特的肿瘤可能代表基底细胞样癌的一种乳头状变体（乳头状-基底细胞样癌）。与典型的基底细胞样癌不同，总体预后良好。然而，深部浸润性肿瘤与区域淋巴结转移相关，提示存在肿瘤相关死亡的潜在风险。
