Pathology Department, Hospital Universitario La Paz, Madrid, Spain.
Pathology Department, Universidad Autónoma de Madrid, Madrid, Spain.
Int J Surg Pathol. 2021 Aug;29(5):488-495. doi: 10.1177/1066896920988348. Epub 2021 Jan 19.
Urethral adenocarcinoma is a rare disease with poor prognosis that can display multiple histologic patterns and has an unclear histogenesis. Radical surgery with extensive periurethral resection is the preferred therapeutic approach. Both chemotherapy and radiotherapy have been used as complementary treatment options. Due to the tendency of these tumors to recur, treatment-associated complications, and the limited choice of therapeutic options, patient management can be difficult. Given the lack of literature regarding immunotherapy in urethral adenocarcinoma, our objective was to explore the expression of programmed death receptor-ligand 1 (PD-L1) throughout the different histological subtypes of primary urethral adenocarcinoma.
We reviewed all primary urethral adenocarcinomas diagnosed at our hospital between 1965 and 2019, performed immunohistochemical assays on the tissue blocks, classified them according to their histology and origin, and performed PD-L1 (22C3) immunohistochemistry assays in all cases.
We found a total of 5 cases of primary urethral adenocarcinoma. All of the patients were women. One of the cases was a cribriform adenocarcinoma, 2 were columnar-mucinous adenocarcinomas, and 2 were clear cell adenocarcinomas. One of the clear cell adenocarcinomas strongly expressed PD-L1. In addition, a profuse inflammatory infiltration constituted by CD3-positive and CD8-positive T lymphocytes within tumor cells was observed in this case. None of the other cases showed PD-L1 expression.
In conclusion, some urethral adenocarcinomas may strongly express PD-L1 and thus could potentially allow the use of immunotherapy in selected cases of advanced or recurrent adenocarcinoma.
尿道腺癌是一种预后不良的罕见疾病，可呈现多种组织学形态，其发生机制尚不清楚。广泛的尿道周围切除术的根治性手术是首选的治疗方法。化疗和放疗都已被用作辅助治疗选择。由于这些肿瘤有复发倾向、治疗相关并发症以及治疗选择有限，患者管理可能具有挑战性。鉴于尿道腺癌免疫治疗的文献有限，我们的目的是探讨 PD-L1 在原发性尿道腺癌的不同组织学亚型中的表达情况。
我们回顾了 1965 年至 2019 年间在我院诊断的所有原发性尿道腺癌病例，对组织块进行免疫组织化学检测，根据其组织学和起源进行分类，并对所有病例进行 PD-L1（22C3）免疫组化检测。
我们共发现 5 例原发性尿道腺癌。所有患者均为女性。其中 1 例为筛状腺癌，2 例为柱状黏液腺癌，2 例为透明细胞腺癌。1 例透明细胞腺癌强烈表达 PD-L1。此外，在该病例中还观察到肿瘤细胞内 CD3 阳性和 CD8 阳性 T 淋巴细胞的大量炎症浸润。其他病例均未显示 PD-L1 表达。
总之，一些尿道腺癌可能强烈表达 PD-L1，因此在某些晚期或复发性腺癌的情况下可能允许使用免疫疗法。
