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Clear Cell Carcinoma of the Penis: An HPV-related Variant of Squamous Cell Carcinoma: A Report of 3 Cases.

阴茎透明细胞癌3例报道:一种与HPV相关的鳞状细胞癌变异亚型

Sanchez DF,Rodriguez IM,Piris A,Cañete S,Lezcano C,Velazquez EF,Fernandez-Nestosa MJ,Mendez-Pena JE,Hoang MP,Cubilla AL

Abstract

Penile clear cell carcinoma originating in skin adnexal glands has been previously reported. Here, we present 3 morphologically distinctive penile tumors with prominent clear cell features originating not in the penile skin but in the mucosal tissues of the glans surface squamous epithelium. Clinical and pathologic features were evaluated. Immunohistochemical stains were GATA3 and p16. Human papilloma virus (HPV) detection by in situ hybridization was performed in 3 cases, and whole-tissue section-polymerase chain reaction was performed in 1 case. Patients' ages were 52, 88, and 95 years. Tumors were large and involved the glans and coronal sulcus in all cases. Microscopically, nonkeratinizing clear cells predominated. Growth was in solid nests with comedo-like or geographic necrosis. Focal areas of invasive warty or basaloid carcinomas showing in addition warty or basaloid penile intraepithelial neoplasia were present in 2 cases. There was invasion of corpora cavernosa, lymphatic vessels, veins, and perineural spaces in all cases. p16 was positive, and GATA3 stain was negative in the 3 cases. HPV was detected in 3 cases by in situ hybridization and in 1 case by polymerase chain reaction. Differential diagnoses included other HPV-related penile carcinomas, skin adnexal tumors, and metastatic renal cell carcinoma. Features that support primary penile carcinoma were tumor location, concomitant warty and/or basaloid penile intraepithelial neoplasia, and HPV positivity. Clinical groin metastases were present in all cases, pathologically confirmed in 1. Two patients died from tumor dissemination at 9 and 12 months after penectomy. Clear cell carcinoma, another morphologic variant related to HPV, originates in the penile mucosal surface and is probably related to warty carcinomas.

摘要

目前文献报道的阴茎透明细胞癌起源于皮肤附属器的腺体。本文介绍3例形态学独特的阴茎肿瘤,该肿瘤具有明显的透明细胞特点,但并非起源于阴茎皮肤,而是起源于龟头粘膜组织的鳞状上皮。作者对其临床及病理学特征进行分析。

免疫组化检测GATA3及p16的表达。采用原位杂交检测3例中人乳头瘤病毒(HPV)的表达情况,其中1例全组织切片进行聚合酶链反应。患者年龄分别为52岁、88岁及95岁。肿瘤均较大,并累及龟头及冠状沟。镜下,以非角化性透明细胞为主,呈实性巢状生长,伴粉刺样或地图状坏死。2例病例中除疣状或基底样鳞状上皮内瘤变外,局灶区域还存在侵袭性疣状癌或基底细胞样癌。所有病例均侵犯阴茎海绵体、淋巴管、静脉以及周围神经间隙。3例中p16均阳性,GATA3均阴性。3例均采用原位杂交,1例再行聚合酶链反应检测HPV。

鉴别诊断包括其它与HPV相关的阴茎癌、皮肤附属器肿瘤以及转移性肾细胞癌。肿瘤的部位、伴发的疣状和/或基底细胞样上皮内瘤变以及HPV阳性等特点支持原发性阴茎癌。临床检查所有病例均存在腹股沟淋巴结转移,其中1例通过病理学检查得以证实。2例患者在阴茎切除后9个月及12个月死于肿瘤播散。透明细胞癌,又一种与HPV相关的鳞状细胞癌变异亚型,起源于阴茎粘膜表面,可能与疣状癌有关。

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