Histologic and Immunohistochemical Assessment of Penile Carcinomas in a North American Population
Histologic and Immunohistochemical Assessment of Penile Carcinomas in a North American Population
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DOI：
10.1097/pas.0000000000000124
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发表时间：
2014-10-01
影响因子：
5.6
通讯作者：
Cathro, Helen P.
中科院分区：
文献类型：
--
作者：
Mentrikoski, Mark J.;Stelow, Edward B.;Cathro, Helen P.
阴茎鳞状细胞癌（SCC）有时是一种侵袭性疾病，在全球范围内的发病率各不相同，部分原因是炎症和感染风险因素的发病率不同。在发达国家，阴茎鳞状细胞癌是一种罕见的恶性肿瘤，因此大多数研究起源于欠发达国家。本研究旨在探讨低发病率地区阴茎鳞状细胞癌的形态学和免疫组化特征。对59例患者的62例完全或部分阴茎切除术标本进行了审查。26例发生转移，3例复发，7例因肿瘤死亡。大多数患者未行包皮环切术（72%）。22%的癌症与硬化性苔藓有关。神经周围浸润与转移显著相关（P = 0.007）。65%的SCC具有典型的角化形态，且与上皮内病变的分化程度（P <0.0001）、p53阳性（P = 0.002）、cyclin D1阳性（P = 0.007）和EGFR过表达（P = 0.003）显著相关。人乳头状瘤病毒（HPV）相关肿瘤占27%，为基底细胞样癌（8%）、疣状癌（10%）、混合型癌（6%）或淋巴上皮瘤样癌（4%）变体.与p16表达（P <0.0001）和未分化型上皮内病变（P <0.001）显著相关。在所有SCC中，原发肿瘤和转移瘤之间的免疫组化或原位杂交谱没有差异。虽然阴茎SCC在美国很少见，但肿瘤变异、免疫组化特征和HPV相关肿瘤的比例与欠发达国家相似。两种不同的途径似乎导致癌变;一种是与潜在的慢性炎症状态，涉及p53突变，细胞周期蛋白D1过表达，并在经典的角化SCC中达到高潮。另一种途径涉及高危型HPV感染，表现出强烈的p16表达，并导致SCC具有不同但独特的形态。
Penile squamous cell carcinoma (SCC) is sometimes an aggressive disease that has a variable worldwide incidence, in part due to differing rates of inflammatory and infectious risk factors. In the developed world, penile SCC is a rare malignancy, and most studies therefore originate in less developed countries. The current study was undertaken to examine the morphologic and immunohistochemical features of penile SCC from a region with low disease incidence. Sixty-two complete or partial penectomy specimens from 59 patients were reviewed. Twenty-six patients had metastasis, 3 had recurrent disease, and 7 were dead due to tumor. Most patients were uncircumcised (72%). Twenty-two percent of carcinomas were associated with lichen sclerosis. Perineural invasion was significantly associated with metastasis (P = 0.007). Most SCCs (65%) had the usual keratinizing morphology, and these tumors were significantly associated with the differentiated form of intraepithelial lesion (P < 0.0001), p53 positivity (P = 0.002), cyclin D1 positivity (P = 0.007), and EGFR overexpression (P = 0.003). Human papilloma virus (HPV)-associated tumors accounted for 27% and were basaloid (8%), warty (10%), mixed (6%), or lymphoepithelioma- like carcinoma (4%) variants. These were significantly associated with p16 expression (P < 0.0001) and the undifferentiated form of intraepithelial lesion (P < 0.001). Among all SCCs, there was no difference in the immunohistochemical or in situ hybridization profile between primary tumors and metastases. Although penile SCC is rare in the United States, the tumor variants, immunohistochemical profiles, and proportion of HPV-associated tumors are similar to those in less developed countries. Two distinct pathways appear to lead to carcinogenesis; one is related to underlying chronic inflammatory states, involves p53 mutation, cyclin D1 overexpression, and culminates in classic keratinizing SCC. The other pathway involves high-risk HPV infection, demonstrates strong p16 expression, and results in SCC with varied, but distinctive morphologies.