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目的提高对阴茎转移性膀胱移行细胞癌的认识。方法报告1例阴茎转移膀胱移行细胞癌患者资料,结合文献讨论其发病机理、临床特征及诊疗措施。患者,男,60岁,膀胱顶壁肿瘤行膀胱部分切除术后11个月余,病理报告为膀胱移行上皮细胞癌Ⅲ级,侵及深肌层,分期G3T3,发现阴茎海绵体硬结逐渐增大6个月余入院。结果阴茎海绵体硬结细针穿刺活检示纤维组织中散在异型细胞及异型细胞巢,考虑为低分化癌,行阴茎全切术。术后病理报告示海绵体间质纤维中有成团的癌组织,符合膀胱移行细胞癌转移至阴茎,切缘未见癌组织．另送检耻骨前淋巴组织未见肿瘤细胞浸润。术后12 d拔除导尿管。术后4周耻骨上区和双侧腹股沟区予60Coγ射线3000 cGy放射治疗,定期丝裂霉素膀胱灌注治疗和膀胱镜检查。现患者蹲式小便、排尿正常,随访16个月肿瘤无复发和转移。结论阴茎海绵体硬结细针穿刺活检是诊断阴茎转移癌安全、有效的方法。盆腔内存在丰富、低压力、无静脉瓣的静脉丛及淋巴循环,当回流通路阻塞或压力升高时会发生逆流导致肿瘤细胞扩散或微转移,可能是阴茎转移性膀胱癌的发病机理。术后综合治疗措施可以预防肿瘤复发、提高治疗效果。
Objective To improve the understanding of penile metastatic bladder transitional cell carcinoma. Methods One case of transitional cell carcinoma of the penis with bladder transitional cell carcinoma was reported. The pathogenesis, clinical characteristics, diagnosis and treatment measures were discussed in combination with the literature. Patients, male, 60 years old, bladder top wall tumors after partial resection of bladder more than 11 months, the pathological report of bladder transitional epithelial cancer grade Ⅲ, invasion and deep muscle, staging G3T3 and found that the penis cavernous sclerosis gradually increased 6 months after admission. Results penile cavernous fine needle puncture biopsy showed fibrous tissue scattered in abnormal cells and abnormal cell nests, considered as poorly differentiated carcinoma, the penis total excision. Postoperative pathology report cavernous interstitial fibrocytes have a mass of cancer tissue, in line with the transfer of bladder transitional cell carcinoma to the penis, no margin of the cancerous tissue. In addition, there was no tumor cell infiltration in the pre-pubic lymphoid tissue. The catheter was removed 12 days after operation. The suprapubic region and the bilateral inguinal region were irradiated with 60Coγ ray 3000 cGy 4 weeks after operation. The patients were treated with mitomycin C intravesical instillation and cystoscopy regularly. Patient now squat urination, normal urination, follow-up of 16 months without tumor recurrence and metastasis. Conclusion Penile cavernous fine needle aspiration biopsy is a safe and effective method for the diagnosis of penile metastasis. The existence of pelvic cavity rich, low pressure, no venous plexus and lymphatic circulation, when the reflux path obstruction or pressure rise will occur when the countercurrent caused by tumor cell proliferation or micrometastasis, may be the pathogenesis of penile metastatic bladder cancer. Postoperative comprehensive treatment can prevent tumor recurrence and improve the therapeutic effect.