Cañete-Portillo Sofía, Sanchez Diego F, Fernández-Nestosa María José, Piris Adriano, Zarza Patricia, Oneto Sabrina, Gonzalez Stark Lorena, Lezcano Cecilia, Ayala Gustavo, Rodriguez Ingrid, Hoang Mai P, Mihm Martin C, Cubilla Antonio L
1 Instituto de Patología e Investigación, Asunción, Paraguay.
2 Instituto de Previsión Social, Hospital Central, Asunción, Paraguay.
Int J Surg Pathol. 2019 Aug;27(5):477-482. doi: 10.1177/1066896918820960. Epub 2019 Jan 7.
Lichen sclerosus (LSc) with penile cancer is found in about two thirds of specimens. It has been hypothesized that LSc represents a precancerous condition. To qualify as such, in addition to cytological atypia and similarity with the invasive tumor, a spatial correlation between LSc and neoplastic lesions needs to be demonstrated. The purpose of this study was to evaluate such a spatial relationship. Circumcision (28 cases) and penectomy (81 cases) specimens were evaluated. All cases had LSc, penile intraepithelial neoplasia (PeIN), and/or invasive squamous cell carcinomas. We examined LSc in relation to invasive carcinoma, PeIN, and normal epithelia. Invasive squamous cell carcinomas, classified according to the World Health Organization criteria as non-human papillomavirus (HPV)-related and HPV-related PeIN, were present in 100 cases. Non-HPV-related (differentiated) PeIN was the most common subtype associated with LSc (89%). There were 5 spatial patterns identified: (1) LSc adjacent to PeIN (23%), (2) LSc adjacent and comprising PeIN (42%), (3) LSc next to and within invasive carcinomas (8%), (4) LSc throughout the sequence PeIN-invasive carcinoma (24%), and (5) LSc was separate (with normal tissue between the lesions) from PeIN and/or invasive carcinomas in a minority of cases (3%). LSc within the cancer was not previously described. In this series, we found 35 cases with LSc within invasive carcinomas. The striking continuous spatial relationship among LSc, PeIN, and/or invasive carcinoma as shown in this study may be a necessary (but not sufficient) condition for the hypothesis postulating LSc as a penile precancerous lesion.
约三分之二的标本中发现患有阴茎癌的硬化性苔藓（LSc）。有人提出假说，认为LSc是一种癌前病变。若要符合这一假说，除了细胞学异型性以及与浸润性肿瘤的相似性外，还需要证明LSc与肿瘤性病变之间存在空间相关性。本研究的目的是评估这种空间关系。对包皮环切术（28例）和阴茎切除术（81例）的标本进行了评估。所有病例均患有LSc、阴茎上皮内瘤变（PeIN）和/或浸润性鳞状细胞癌。我们检查了LSc与浸润性癌、PeIN和正常上皮的关系。根据世界卫生组织标准分类为非人类乳头瘤病毒（HPV）相关和HPV相关的PeIN的浸润性鳞状细胞癌存在于100例病例中。非HPV相关（分化型）PeIN是与LSc相关的最常见亚型（89%）。共识别出5种空间模式：（1）LSc与PeIN相邻（23%），（2）LSc与PeIN相邻并包含PeIN（42%），（3）LSc紧邻浸润性癌并位于其中（8%），（4）LSc贯穿PeIN - 浸润性癌序列（24%），以及（5）在少数病例中（3%），LSc与PeIN和/或浸润性癌分离（病变之间为正常组织）。癌内LSc此前未见报道。在本系列研究中，我们发现35例浸润性癌内存在LSc。本研究中所示的LSc、PeIN和/或浸润性癌之间显著的连续空间关系可能是将LSc假定为阴茎癌前病变这一假说的必要（但不充分）条件。
