阴茎疣状癌临床病理与生物学行为的研究
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中华医学研究杂志
【摘要】 目的 通过对76例阴茎疣状癌的临床病理学研究，分析其生物学行为与预后的关系，对其治疗措施进行探讨。方法 用组织化学HE，特殊组织化学网状纤维和免疫组化keratin、laminin染色观察。结果 阴茎疣状癌呈疣状、乳头状向表面生长，深部“推进式”局部侵袭，生长缓慢、病程长，极少转移，预后好。结论 阴茎疣状癌恶性程度低，在诊断与治疗方面应与鳞状细胞癌区别对待。手术治疗应以局部肿瘤切除或阴茎部分切除为宜，不需要阴茎全切或扩大根治手术。
关键词 疣状癌 阴茎 病理学 生物学行为 手术范围
【文献标识码】 A 【文章编号】 1680-6115(2003)09-0779-03
The clinicopathological and biological behavior
study on verrucous carcinoma of penis
, 百拇医药
Wang Xuzhou，Wang Tao
Department of Pathology，the Qilu Hospital of Shandong University，Jinan250012.
【Abstract】 Objective To analyse the relation between the biological behavior and the prognosis of the verruˉcous carcinoma of penis through the clinicopathological study on76cases of verrucous carcinoma of penis and disˉcussed the treatment measures.Methods The studywas carried out by using common and special histochemical stainˉings and immunohistochemical method.Results The tumors were the characteristics of verrucous or papillary appearˉance，propulsive local invasion，slow growth，long course，rare metastasis，favorable prognosis.Conclusion Our study demonstrates that the malignant degree of verrucous carcinoma of penis
, 百拇医药
is low and it should be differentiated from squamous cell carcinoma in diagnosis and treatment.It is preferable that local tumor resection or partial amputation of penis should be carried out and not necessarily to have total amputation ofpenis or enlarging radical operation.
Key words verrucous carcinoma penis pathology biological behavior extent of operation
Verrucous carcinoma is a special type of squamous cell carcinoma，which was first named by Ackerman [1] in31tumours of mucosa of mouth in1948.Seven cases of verrucous carcinoma of penis were reported clinicoˉpathologically by Lowe [2] in1983.Thereafter few reports on the histopathological study of this tumor appeared，there are even no report about whether there should be a difference between the extent of operation of verrucous carcinoma and that of squamous cell carcinoma of penis.Hence we analysed the
, http://www.100md.com
relationship among histopathologˉical changes，biological behaviour and prognosis of the verrucous carcinoma of penis in76cases，and discussed the treatment measures.
1 Materials and methods
Seventy-six cases of resected verrucous carcinoma specimens were selected from the surgical carcinoma of penis hospitalized between1966～2002in Qilu Hospital of Shandong University.In38cases of them regional lymph nodes were resected.The specimens were formalin-fixed(10%concentration)，paraffin-embedded and stained with hematoxylin and eosin，and special histoˉchemical modified Gordon-Sweets and immunohistocheˉmical of Keratin
, 百拇医药
，Laminin method.
2 Results
2.1 Pathological Study
2.1.1 Gross appearance The tumours of penis ranged from1to7.5cm in diameter.The tumours were verruˉcous or cauliflower in the67cases(88%).In the other9cases，they were nodular.
2.1.2 Microscopic appearance The tumour was comˉposed of large well-differentiated squamous epithelial cells，showing papilloma-like upward growth and covˉered by thick parakeratic or hyperkeratic materials.And their epithelial retia showed spheroid or sharp downward expansion，below some of which the masses of well-difˉferentiated squamous cell could be observed.The adˉvancing margins of the epithelial retia with well-defined delimitation often pushed away the adjacent tissues and downward local invasion(Figure1).The tumour invaded tunica propriae in36cases，facia in10cases，tunica alˉbuginea in26cases and superficial cav
, 百拇医药
ernosa in4cases.Pathological mitosis and mild atypia could be rarely seen.The basement membrane could be observed intact in the Gordon-Sweets staining(Figure2).Immunohisˉtochemical staining，Keratin were expressed in tumor cells，Laminin were expressed in basement membranes.
In all cases，the inflammatory cells，more or less，infiltrated into the stroma，with immerging into or encirˉcling the nests of carcinoma in35cases(46%).The tuˉmor cells underwent degeneration and necrosis，and were phagocytized by phagocytes forming carcinolysis(Figure3).The metastasis were not found by pathological examiˉnation in all resection of the regional lymph nodes taking from38patients.(Figure1～3to be seen in attached page2)
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2.2 Follow-up The follow-up survey was made in all cases，but only succeed in65cases(85.5%).Among the succeeded ones，37patients took regional excision oftumor or partial amputation of penis and28cases did toˉtal amputation or enlarging radical operation.The survey showed that no patients died of this disease with a36years follow-up after surgical treatment and in good health.
3 Discussion
3.1 Pathogenesis Phimosis and redundant prepuce are the main causes of the disease.The ratio of verrucous carcinoma to carcinoma of penis varied in different reˉports [2～4] ，which might be related to the misdiagnosis as squamous cell carcinoma.The76cases in this article acˉcount for44.2%of the patients operated with carcinoma of penis in the same time(1966～2002).Verrucous carˉcinomahas a preference to originate in penis.
, http://www.100md.com
3.2 Biological Behavior According to the pathological observation of these cases，verrucous carcinoma has the characteristics of verrucous or papillary appearance，propulsive local invasion，long course，slow growth，rare metastasis，favorable prognosis and low degree maligˉnant.
3.3 Pathological Diagnosis Our study shows that the histopathological changes and biological behavior of the verrucous carcinoma differs from those of squamous cell carcinoma of penis.Our opinion is that difference should be made on thediagnosis and surgical treatment between verrucous and squamous cell carcinoma.In the past，some took it totally as squamous cell carcinoma，leading to the unnecessary enlargement of the field of operation.54cases out of all these had original pathological diagnoˉsis as squamous cell carcinoma，leading to the unnecesˉsary total amputation of the penis and grafting of the ureˉthra in28cases，excision of testicles in17ones，and disˉ section of regional lymph nodes in38ones.In order to avoid unnecessary enlargement of the field of operation，it is proper to differentiate verrucous carcinoma from squaˉmous cell carcinoma as a special type when diagnosing.
, http://www.100md.com
3.4 Treatment and Prognosis All the patients had different surgical treatmnet.The results of the follow-up survey show a favorable prognosis and that no patient died of this tumor until now.And it also proves that surˉgical treatment is the best and the first choice.
There were more or less inflammatory cells invading the stroma in all cases.And46%of all cases had carciˉnolysis.The favorable prognosis is correlated with the body immunity against this tumor and the biological beˉhavior of it [5] 。
, http://www.100md.com
The swelling of regional lymph nodes was often caused by inflammatory reaction，but it might be easily mistaken as metastasis.93%of all patients had swelling of regional lymph nodes and11cases were clinically misdiagnosed as being advanced stage and metastatic.But no evidence of metastasis was found by pathological
examination in all lymph nodes taking from38patients.When diagnosing，the clinician should avoid taking the swelling of lymph nodes caused by inflammatory reaction as metastasis so as to let the patients miss the chance of surgical treatment.And it is also unnecessary to carry out the dissection of lymph nodes in every patients.We think biopsy should be made in the patients with swelling lymph nodes before or amid operation to assure whether metastasis have already occurred.
, 百拇医药
The follow-up survey shows there is no significant difference among effects of surgical treatment of regional excision of tumor，partial or total amputation of penis and enlarging radical operation.According to the pathological changes and biological behavior of verrucous carcinoma of penis combining with the results
of the follow-up survey，we think the following might be helpful to the surgical treatment:(1)It’s appropriate to have partial amputation of penis for the patients having verrucous carˉcinoma in the gland or prepuce and not necessarily to have total amputation and enlarging radical operation.The dissection of lymp
, 百拇医药
h nodes would be performed only on the condition that biopsy proves metastasis really ocˉcurred in the regional lymph nodes.(2)For the patients having early stage，small and superficially invasive verruˉcous carcinoma of penis，especially in the young man，reˉgional excision of tumor is preferable，but the field of
opˉeration should be large enough and the follow-up should also the carried out.Co-operation of clinician and pathologist is helpful for diagnosing verˉrucous carcinoma and taking appropriate surgical treatˉment measures.
, http://www.100md.com
References
1 Ackerman LV.Verrucous carcinoma of the oral cavity.surgery，1948，23:670.
2 Lowe D，McKee PH.Verrucous carcinoma of penis(Buschke-Lowenˉ stein tumour):A clinicopathological study.Br J Urol，1983，55(4):427.
3 Hanash KA，FurlowWL，Utz DC，et al.Carcinoma of the penis:A cliniˉcopathologic study.J Urol，19
70，104:291.
4 楼荣灿，黄美云，郑炳初.145例阴茎癌临床及疗效分析.中华肿瘤杂志，1984，6(3):223.
5 王绪洲，李红，张轶.淋巴细胞浸润在阴茎癌预后中的意义.中华中西医杂志，2001，4:295.
作者单位:1 250012山东大学齐鲁医院病理科
2 250011山东省济南市历下人民医院
(收稿日期:2003-06-21) (编辑 秋实), 百拇医药
关键词 疣状癌 阴茎 病理学 生物学行为 手术范围
【文献标识码】 A 【文章编号】 1680-6115(2003)09-0779-03
The clinicopathological and biological behavior
study on verrucous carcinoma of penis
, 百拇医药
Wang Xuzhou，Wang Tao
Department of Pathology，the Qilu Hospital of Shandong University，Jinan250012.
【Abstract】 Objective To analyse the relation between the biological behavior and the prognosis of the verruˉcous carcinoma of penis through the clinicopathological study on76cases of verrucous carcinoma of penis and disˉcussed the treatment measures.Methods The studywas carried out by using common and special histochemical stainˉings and immunohistochemical method.Results The tumors were the characteristics of verrucous or papillary appearˉance，propulsive local invasion，slow growth，long course，rare metastasis，favorable prognosis.Conclusion Our study demonstrates that the malignant degree of verrucous carcinoma of penis
, 百拇医药
is low and it should be differentiated from squamous cell carcinoma in diagnosis and treatment.It is preferable that local tumor resection or partial amputation of penis should be carried out and not necessarily to have total amputation ofpenis or enlarging radical operation.
Key words verrucous carcinoma penis pathology biological behavior extent of operation
Verrucous carcinoma is a special type of squamous cell carcinoma，which was first named by Ackerman [1] in31tumours of mucosa of mouth in1948.Seven cases of verrucous carcinoma of penis were reported clinicoˉpathologically by Lowe [2] in1983.Thereafter few reports on the histopathological study of this tumor appeared，there are even no report about whether there should be a difference between the extent of operation of verrucous carcinoma and that of squamous cell carcinoma of penis.Hence we analysed the
, http://www.100md.com
relationship among histopathologˉical changes，biological behaviour and prognosis of the verrucous carcinoma of penis in76cases，and discussed the treatment measures.
1 Materials and methods
Seventy-six cases of resected verrucous carcinoma specimens were selected from the surgical carcinoma of penis hospitalized between1966～2002in Qilu Hospital of Shandong University.In38cases of them regional lymph nodes were resected.The specimens were formalin-fixed(10%concentration)，paraffin-embedded and stained with hematoxylin and eosin，and special histoˉchemical modified Gordon-Sweets and immunohistocheˉmical of Keratin
, 百拇医药
，Laminin method.
2 Results
2.1 Pathological Study
2.1.1 Gross appearance The tumours of penis ranged from1to7.5cm in diameter.The tumours were verruˉcous or cauliflower in the67cases(88%).In the other9cases，they were nodular.
2.1.2 Microscopic appearance The tumour was comˉposed of large well-differentiated squamous epithelial cells，showing papilloma-like upward growth and covˉered by thick parakeratic or hyperkeratic materials.And their epithelial retia showed spheroid or sharp downward expansion，below some of which the masses of well-difˉferentiated squamous cell could be observed.The adˉvancing margins of the epithelial retia with well-defined delimitation often pushed away the adjacent tissues and downward local invasion(Figure1).The tumour invaded tunica propriae in36cases，facia in10cases，tunica alˉbuginea in26cases and superficial cav
, 百拇医药
ernosa in4cases.Pathological mitosis and mild atypia could be rarely seen.The basement membrane could be observed intact in the Gordon-Sweets staining(Figure2).Immunohisˉtochemical staining，Keratin were expressed in tumor cells，Laminin were expressed in basement membranes.
In all cases，the inflammatory cells，more or less，infiltrated into the stroma，with immerging into or encirˉcling the nests of carcinoma in35cases(46%).The tuˉmor cells underwent degeneration and necrosis，and were phagocytized by phagocytes forming carcinolysis(Figure3).The metastasis were not found by pathological examiˉnation in all resection of the regional lymph nodes taking from38patients.(Figure1～3to be seen in attached page2)
, http://www.100md.com
2.2 Follow-up The follow-up survey was made in all cases，but only succeed in65cases(85.5%).Among the succeeded ones，37patients took regional excision oftumor or partial amputation of penis and28cases did toˉtal amputation or enlarging radical operation.The survey showed that no patients died of this disease with a36years follow-up after surgical treatment and in good health.
3 Discussion
3.1 Pathogenesis Phimosis and redundant prepuce are the main causes of the disease.The ratio of verrucous carcinoma to carcinoma of penis varied in different reˉports [2～4] ，which might be related to the misdiagnosis as squamous cell carcinoma.The76cases in this article acˉcount for44.2%of the patients operated with carcinoma of penis in the same time(1966～2002).Verrucous carˉcinomahas a preference to originate in penis.
, http://www.100md.com
3.2 Biological Behavior According to the pathological observation of these cases，verrucous carcinoma has the characteristics of verrucous or papillary appearance，propulsive local invasion，long course，slow growth，rare metastasis，favorable prognosis and low degree maligˉnant.
3.3 Pathological Diagnosis Our study shows that the histopathological changes and biological behavior of the verrucous carcinoma differs from those of squamous cell carcinoma of penis.Our opinion is that difference should be made on thediagnosis and surgical treatment between verrucous and squamous cell carcinoma.In the past，some took it totally as squamous cell carcinoma，leading to the unnecessary enlargement of the field of operation.54cases out of all these had original pathological diagnoˉsis as squamous cell carcinoma，leading to the unnecesˉsary total amputation of the penis and grafting of the ureˉthra in28cases，excision of testicles in17ones，and disˉ section of regional lymph nodes in38ones.In order to avoid unnecessary enlargement of the field of operation，it is proper to differentiate verrucous carcinoma from squaˉmous cell carcinoma as a special type when diagnosing.
, http://www.100md.com
3.4 Treatment and Prognosis All the patients had different surgical treatmnet.The results of the follow-up survey show a favorable prognosis and that no patient died of this tumor until now.And it also proves that surˉgical treatment is the best and the first choice.
There were more or less inflammatory cells invading the stroma in all cases.And46%of all cases had carciˉnolysis.The favorable prognosis is correlated with the body immunity against this tumor and the biological beˉhavior of it [5] 。
, http://www.100md.com
The swelling of regional lymph nodes was often caused by inflammatory reaction，but it might be easily mistaken as metastasis.93%of all patients had swelling of regional lymph nodes and11cases were clinically misdiagnosed as being advanced stage and metastatic.But no evidence of metastasis was found by pathological
examination in all lymph nodes taking from38patients.When diagnosing，the clinician should avoid taking the swelling of lymph nodes caused by inflammatory reaction as metastasis so as to let the patients miss the chance of surgical treatment.And it is also unnecessary to carry out the dissection of lymph nodes in every patients.We think biopsy should be made in the patients with swelling lymph nodes before or amid operation to assure whether metastasis have already occurred.
, 百拇医药
The follow-up survey shows there is no significant difference among effects of surgical treatment of regional excision of tumor，partial or total amputation of penis and enlarging radical operation.According to the pathological changes and biological behavior of verrucous carcinoma of penis combining with the results
of the follow-up survey，we think the following might be helpful to the surgical treatment:(1)It’s appropriate to have partial amputation of penis for the patients having verrucous carˉcinoma in the gland or prepuce and not necessarily to have total amputation and enlarging radical operation.The dissection of lymp
, 百拇医药
h nodes would be performed only on the condition that biopsy proves metastasis really ocˉcurred in the regional lymph nodes.(2)For the patients having early stage，small and superficially invasive verruˉcous carcinoma of penis，especially in the young man，reˉgional excision of tumor is preferable，but the field of
opˉeration should be large enough and the follow-up should also the carried out.Co-operation of clinician and pathologist is helpful for diagnosing verˉrucous carcinoma and taking appropriate surgical treatˉment measures.
, http://www.100md.com
References
1 Ackerman LV.Verrucous carcinoma of the oral cavity.surgery，1948，23:670.
2 Lowe D，McKee PH.Verrucous carcinoma of penis(Buschke-Lowenˉ stein tumour):A clinicopathological study.Br J Urol，1983，55(4):427.
3 Hanash KA，FurlowWL，Utz DC，et al.Carcinoma of the penis:A cliniˉcopathologic study.J Urol，19
70，104:291.
4 楼荣灿，黄美云，郑炳初.145例阴茎癌临床及疗效分析.中华肿瘤杂志，1984，6(3):223.
5 王绪洲，李红，张轶.淋巴细胞浸润在阴茎癌预后中的意义.中华中西医杂志，2001，4:295.
作者单位:1 250012山东大学齐鲁医院病理科
2 250011山东省济南市历下人民医院
(收稿日期:2003-06-21) (编辑 秋实), 百拇医药