阴茎假血管瘤型鳞状细胞癌的临床病理观察及人乳头瘤病毒的检测  

Pseudoangiosarcomatous Squamous Cell Carcinoma of the Penis:A Case Report with Clinicopathological and Human Papilloma Virus Analyses

作　　者：戚晓平[1] 林国兵 朱杨丽 王金泉[4] 戴晓汶[4] 马炬明[1] 阎利[1] 

机构地区：[1]解放军第一一七医院泌尿外科,浙江杭州310013 [2]温岭市第一人民医院泌尿外科,浙江温岭317500 [3]温岭市第一人民医院病理科,浙江温岭317500 [4]解放军第一一七医院病理科,浙江杭州310013

出　　处：《中华男科学杂志》2009年第2期134-139,共6页National Journal of Andrology

摘　　要：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 further understand the clinicopathological, ultrastructural and molecular features of penile pseudoangiosarco- matous squamous cell carcinoma （PASCC）, and improve its diagnosis and treatment. Methods： A 47-year-old male patient with penile PASCC was reported and the relevant literature reviewed. The main clinical manifestations of the patient were a typical surface ulceration with hemorrhage and purulent secretion with a foul smell, a papillary mass about 5.0 cm ×5.0 cm ×4.0 cm for 1 year on the foreskin of the penis, and 3 enlarged bilateral inguinal lymph nodes. CT scanning showed no enlarged lymph nodes in the abdomen and pelvis, and X-ray examination revealed no abnormality in the chest. Results ： The diagnosis was established by biopsy. Partial penectomy and bilateral inguinal lymphadenectomy （T2 N2 M0 ） were performed, followed by adjuvant pelvic radiotherapy. Two months later, total penectomy was necessitated by penile flap necrosis and local recurrence. Eleven months after the first surgery, the patient died of extensive metastasis to the pelvis and lungs. Under the light microsope, the tumor was mainly composed of vessel-like lacunal retieularis spindle cells and a few local squamous cancer cells. Careful examination revealed some focal areas with evident transition from squamous nests to the more acantholytic areas extending towards the pseudoangiosarcomatous spaces. Pathogenetically, it appeared to be the variant of acantholytic squamous cell carcinoma, hnmunohistochemically, most tumor cells were strongly positive for keratin （AE1/AE3） and focally positive for EMA, with the typical squamous cells focally positive for 34βE12 and vimentin. The vessels that proliferated in the tumor were decorated by CD31, CD34 and factor VIII-related antigens, but the tumor cells were negative for HMB45, SMA, Desmin and CEA. HPV DNA （HPVpan, HPV6B/11, HPV16/18, HPV31/33） was not detected by in situ hybridization in the primary and metastatic tumors. Conclusion ： PASCC is a speci

关 键 词：假血管瘤型鳞状细胞癌 阴茎 人乳头瘤病毒 

分 类 号：R737.27[医药卫生—肿瘤]