Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI 02903.
Office of Scientific Research, Norte University, Asunción, Paraguay 1614.
Hum Pathol. 2014 Apr;45(4):889-92. doi: 10.1016/j.humpath.2013.11.010. Epub 2013 Nov 26.
Precancerous lesions of the penis frequently share the morphologic features of the invasive counterpart. We have recently subclassified penile intraepithelial neoplasia into differentiated, warty, and basaloid subtypes, each one with distinctive microscopic morphology. Nevertheless, in our experience, some cases depart from this classification scheme and show unusual morphologic features, hindering the proper diagnosis on routine morphology alone. Herein we present a case of penile intraepithelial neoplasia with a pagetoid growth pattern, closely mimicking Paget disease. We describe the necessary steps to reach the final diagnose, including the use of immunohistochemistry for cytokeratin (CK) 7, CK20, CK34βE12, CAM 5.2, AE1/AE3, CEA, S100, Melan-A, and p63. We also discuss other differential diagnoses that should be considered such as malignant melanoma and urothelial carcinoma in situ with pagetoid spread and less common lesions such as pagetoid dyskeratosis, clear cell papulosis, and mucinous metaplasia.
阴茎的癌前病变常具有与侵袭性病变相同的形态特征。我们最近将阴茎上皮内瘤分为分化型、疣状型和基底细胞样型，每种类型都具有独特的显微镜形态。然而，根据我们的经验，有些病例不符合这种分类方案，表现出不寻常的形态特征，仅通过常规形态学检查就会妨碍正确诊断。本文介绍了一例具有派杰样生长模式的阴茎上皮内瘤，其形态非常类似于派杰病。我们描述了获得最终诊断所需的步骤，包括使用细胞角蛋白（CK）7、CK20、CK34βE12、CAM5.2、AE1/AE3、CEA、S100、Melan-A 和 p63 的免疫组织化学染色。我们还讨论了其他需要考虑的鉴别诊断，如恶性黑色素瘤和伴派杰样播散的原位尿路上皮癌，以及较少见的病变，如派杰样角化不良、透明细胞丘疹病和黏液性化生。
