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目的:提高对阴茎假血管瘤型鳞状细胞癌(PASCC)的认识。方法:报告1例阴茎PASCC患者的临床资料,结合相关文献复习讨论。患者男性,47岁。临床表现为包皮菜花状肿物5.0cm×5.0cm×4.0cm,表面糜烂、出血伴脓性恶臭分泌物,双侧腹股沟淋巴结肿大。CT检查未发现腹部、盆腔肿大淋巴结,胸片未见异常。结果:经活检病理诊断后,行阴茎部分切除、双侧腹股沟淋巴结清扫术(T2N2M0),辅以盆腔放疗。术后2个月,因阴茎皮瓣坏死(伴局部复发)行阴茎全部切除术。首次术后11个月,患者因盆腔、肺部广泛转移死亡。光镜下见棘细胞显著松解,肿瘤主要由排列呈血管样的腔隙状、网状结构的梭形细胞和局灶的鳞状细胞癌细胞组成,二者之间存在移行过渡。电镜下见肿瘤细胞胞质内存在张力原纤维和桥粒结构。腹股沟淋巴结仅见普通型高分化鳞状细胞癌细胞(左3/9,右2/10)。复发肿瘤的结构和形态与原发肿瘤相似。免疫组化染色示肿瘤细胞CK(AE1/AE3)、34βE12、Vimentin均为阳性,EMA呈灶性或片状(+);CD31、CD34、FⅧAg、HMB45、SMA、Desmin、CEA均为阴性。HPV分型原位杂交HPVpan、HPV6B/11、HPV16/18、HPV31/33均为阴性。结论:阴茎PASCC是一种罕见的特殊鳞状细胞癌,预后不良。确诊需依赖组织病理学、免疫组化和电镜检查。早就诊、早诊断和及时恰当的治疗是关键。
Objective: To improve the understanding of penile pseudarthrosis of the hemangiomas (PASCC). Methods: The clinical data of one case of penile PASCC were reported and reviewed with the relevant literature. Male patient, 47 years old. Clinical manifestations of cauliflower-like tumor 5.0cm × 5.0cm × 4.0cm, surface erosion, bleeding with purulent discharge of stench, bilateral inguinal lymph nodes. CT examination found no abdominal, pelvic lymph nodes, chest X-ray showed no abnormalities. Results: After the biopsy pathological diagnosis, partial resection of the penis, bilateral inguinal lymph node dissection (T2N2M0), supplemented by pelvic radiotherapy. 2 months after surgery, penis flap necrosis (with local recurrence) underwent total penile resection. The first postoperative 11 months, patients due to pelvic, lung extensive metastasis. Light microscope, see the spine cells significantly loosening, the tumor mainly arranged in vascular like lacunar, reticular spindle cells and focal squamous cell carcinoma cells, there is a transitional transition between the two. Under the electron microscope, the presence of tonic fibrils and desmosomes in the cytoplasm of tumor cells was observed. Invaginal lymph nodes only see common type of well-differentiated squamous cell carcinoma cells (left 3/9, right 2/10). The structure and morphology of recurrent tumors are similar to those of primary tumors. Immunohistochemical staining showed that the tumor cells CK (AE1 / AE3), 34βE12, Vimentin were positive, EMA was focal or flaky (+); CD31, CD34, FⅧAg, HMB45, SMA, Desmin, CEA were negative. HPV type in situ hybridization HPVpan, HPV6B / 11, HPV16 / 18, HPV31 / 33 were negative. Conclusion: Penile PASCC is a rare special squamous cell carcinoma with poor prognosis. Confirmation depends on histopathology, immunohistochemistry and electron microscopy. Early consultation, early diagnosis and timely and appropriate treatment is the key.