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Metastatic prostate adenocarcinoma to the penis: a series of 29 cases with predilection for ductal adenocarcinoma.

29例阴茎转移性前列腺腺癌,好发于导管腺癌

Abstract

Twenty-nine men with metastatic prostate adenocarcinoma to the penis were identified at our institution between 1993 and 2013. Of the 29 patients, 19 had a prior history of adenocarcinoma of the prostate, and 8 of those had ductal features in the primary lesion. Sixteen of 29 revealed ductal features in the metastasis. Seven of the 8 cases with ductal features in the primary had ductal features in the penile metastasis. Seven penile metastases were proven to be of prostatic origin solely by immunohistochemistry. Three cases were originally misdiagnosed as urothelial carcinoma upon review of the penile lesion. Other variant morphologies in the metastases included sarcomatoid carcinoma, small cell carcinoma, and adenosquamous carcinoma. In summary, prostate carcinoma involving the penis displays ductal features considerably more often than prostate cancer in general. Features that can cause difficulty in recognizing metastatic prostate adenocarcinoma to the penis include the unusual anatomic site for prostate cancer, poor differentiation, an increased prevalence of variant morphology, a long interval from the primary lesion, and, in some cases, no documented history of a primary prostatic lesion. Immunohistochemical analysis should be performed to rule out prostate carcinoma in penile/penile urethral tumors with morphology that differs from typical squamous or urothelial carcinoma. Even in the setting of metastatic disease, there is a critical need for an accurate diagnosis so that the appropriate therapy can be initiated, symptomatic relief can be provided, and long-term survival achieved in some cases, while at the same time avoiding penectomy for a misdiagnosis of a primary penile cancer.

摘要

在1993年到2013年间,29位男性在我中心被确诊为阴茎转移性前列腺腺癌。29例患者中,19例此前有前列腺腺癌病史,这些病例中8例在原发病灶中有管状特征。29例中16例在转移灶中显示导管特征。8例原发灶有导管特征的病例中有7例在阴茎转移灶内有导管特征。7例转移癌通过免疫组织化学证实前列腺是唯一起源。通过复检阴茎病变发现有3例在最初被误诊为尿路上皮癌。在转移灶中,其他不同的形态学特征包括肉瘤样癌、小细胞癌和腺鳞癌。总之,侵及阴茎的前列腺癌比一般前列腺癌更多显示为导管特征。导致确诊前列腺癌转移至阴茎困难的特征包括:阴茎不是前列腺癌的常见部位、分化差、多样化形态的增加、与原发病间隔时间长和在一些病例中没有原发前列腺病变的历史记录。当阴茎肿瘤或阴茎尿路上皮肿瘤具有不同于典型鳞状上皮或尿路上皮癌的形态是,应该采用免疫组织化学分析来排除阴茎的前列腺癌。在确定转移性疾病时,准确诊断是必要的,以便进行恰当的治疗、缓解症状和延长部分病例的生存期,而同时可以避免因误诊为原发阴茎癌进行阴茎切除术。

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