今日の臨床サポート

陰茎腫瘍

著者: 佐藤文憲 大分大学 医学科腎泌尿器外科学講座

監修: 中川昌之 公益財団法人 慈愛会 今村総合病院 泌尿器科顧問

著者校正/監修レビュー済:2016/08/19
患者向け説明資料

概要・推奨   

疾患のポイント:
  1. 陰茎腫瘍とは、陰茎部に認める腫瘍のことで、陰茎亀頭部、包皮、冠状溝に好発し、無痛性の丘疹、疣贅、硬結、潰瘍や不整に突出した腫瘤として認められる。
  1. ほとんどは原発性で、組織学的に扁平上皮癌が最も多い。
 
診断:
  1. 陰茎局所および鼠径部の視診と触診が最も重要である。包茎では必ず包皮を翻転させて視診および触診を行う。海綿体浸潤の有無を診断することが重要である。鼠径リンパ節は腫大リンパ節の部位と大きさ、個数および可動性の有無を診断する。
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  1. 陰茎に発生する腫瘍の多くは、扁平上皮癌であるが、確定診断は生検でなされる。
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薬剤監修について:
オーダー内の薬剤用量は日本医科大学付属病院 薬剤部 部長 伊勢雄也 以下、林太祐、渡邉裕次、井ノ口岳洋、梅田将光による疑義照会のプロセスを実施、疑義照会の対象については著者の方による再確認を実施しております。
※薬剤中分類、用法、同効薬、診療報酬は、エルゼビアが独自に作成した薬剤情報であり、
著者により作成された情報ではありません。
尚、用法は添付文書より、同効薬は、薬剤師監修のもとで作成しております。
※薬剤情報の(適外/適内/⽤量内/⽤量外/㊜)等の表記は、エルゼビアジャパン編集部によって記載日時にレセプトチェックソフトなどで確認し作成しております。ただし、これらの記載は、実際の保険適用の査定において保険適用及び保険適用外と判断されることを保証するものではありません。また、検査薬、輸液、血液製剤、全身麻酔薬、抗癌剤等の薬剤は保険適用の記載の一部を割愛させていただいています。
(詳細はこちらを参照)
著者のCOI(Conflicts of Interest)開示:
佐藤文憲 : 特に申告事項無し[2021年]
監修:中川昌之 : 研究費・助成金など(武田薬品工業株式会社)[2021年]

病態・疫学・診察

疾患情報(疫学・病態)  
  1. 男性に発症する悪性疾患の0.5%未満、わが国での罹患率は100,000人あたり0.2人とまれである[1][2]
  1. 50歳以上の比較的高齢者に発症することが多いが、若年での発症もまれでない[3][4]
  1. 発症の危険因子として喫煙、包茎、亀頭炎、尖圭コンジローマ等の性感染症や先行するヒトパピローマウイルス(human papilloma virus、HPV)の感染が挙げられる[3][4][5][6][7][8]
  1. ほとんどは原発性で、組織学的に扁平上皮癌が最も多い[6][7][8]
  1. 陰茎亀頭部、包皮、冠状溝に好発し、無痛性の丘疹、疣贅、硬結、潰瘍や不整に突出した腫瘤として認められる[7][8]
  1. 遠隔転移は初期にはまれであるが、鼠径リンパ節転移を来しやすい[3][4][5][6][7][8]
  1. 進行扁平上皮癌ではSCC抗原の上昇をみることがあるが、早期診断には有用でない[6][9][10]
  1. 確定診断は必ず生検によりなされるべきである[6][7]
  1. 局所浸潤の補助診断に超音波[11][12][13]とMRI検査[13][14][15] が有用であり、リンパ節転移と遠隔転移の診断にはPET-CT/CTが有用であるが、非触知鼠径リンパ節の診断精度は低い[6][7][16][17][18][19]
  1. 根治療法は手術であり、上皮内癌では陰茎温存手術も選択され得るが、浸潤癌では陰茎切断/全摘除術とリンパ節郭清術が基本である[6][7][8]
問診・診察のポイント  
  1. ほとんどは原発性で、50歳から70歳に発症のピークをみる。ただし、50歳以下の比較的若年での発症も26%程度と、まれではない[3][4]

これより先の閲覧には個人契約のトライアルまたはお申込みが必要です。

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文献 

著者: D Maxwell Parkin, Freddie Bray
雑誌名: Vaccine. 2006 Aug 31;24 Suppl 3:S3/11-25. doi: 10.1016/j.vaccine.2006.05.111.
Abstract/Text On the basis of current evidence regarding human papillomavirus (HPV) and cancer, this chapter provides estimates of the global burden of HPV-related cancers, and the proportion that are actually "caused" by infection with HPV types, and therefore potentially preventable. We also present trends in incidence and mortality of these cancers in the past, and consider their likely future evolution.

PMID 16949997  Vaccine. 2006 Aug 31;24 Suppl 3:S3/11-25. doi: 10.1016/・・・
著者: Tomomi Marugame, Kota Katanoda, Tomohiro Matsuda, Yuka Hirabayashi, Ken-ichi Kamo, Wakiko Ajiki, Tomotaka Sobue, Japan Cancer Surveillance Research Group
雑誌名: Jpn J Clin Oncol. 2007 Apr;37(4):319-23. doi: 10.1093/jjco/hym020.
Abstract/Text
PMID 17553822  Jpn J Clin Oncol. 2007 Apr;37(4):319-23. doi: 10.1093/j・・・
著者: Janet R Daling, Margaret M Madeleine, Lisa G Johnson, Stephen M Schwartz, Katherine A Shera, Michelle A Wurscher, Joseph J Carter, Peggy L Porter, Denise A Galloway, James K McDougall, John N Krieger
雑誌名: Int J Cancer. 2005 Sep 10;116(4):606-16. doi: 10.1002/ijc.21009.
Abstract/Text Few population-based case-control studies have assessed etiologic factors for penile cancer. Past infection with high-risk human papillomavirus (HPV) is a known risk factor for penile cancer; however, few previous studies have related the HPV DNA status of the tumor to potential demographic and behavioral risk factors for the disease or evaluated whether in situ and invasive penile cancer share risk factors. Little information is available on the role and timing of circumcision in the etiology of penile cancer. We conducted a population-based case-control study in western Washington state that included 137 men diagnosed with in situ (n = 75) or invasive (n = 62) penile cancer between January 1, 1979, and December 31, 1998, and 671 control men identified through random digit dialing. Cases and controls were interviewed in person and provided peripheral blood samples. Case and control blood samples were tested for antibodies to HPV16 and HSV-2, and tumor specimens from cases were tested for HPV DNA. Men not circumcised during childhood were at increased risk of invasive (OR = 2.3, 95% CI 1.3-4.1) but not in situ (OR = 1.1, 95% CI 0.6-1.8) penile cancer. Approximately 35% of men with penile cancer who had not been circumcised in childhood reported a history of phimosis compared to 7.6% of controls (OR = 7.4, 95% CI 3.7-15.0). Penile conditions such as tear, rash and injury were associated with increased risk of disease. Among men not circumcised in childhood, phimosis was strongly associated with development of invasive penile cancer (OR = 11.4, 95% CI 5.0-25.9). When we restricted our analysis to men who did not have phimosis, the risk of invasive penile cancer associated with not having been circumcised in childhood was not elevated (OR = 0.5, 95% CI 0.1-2.5). Cigarette smoking was associated with a 4.5-fold risk (95% CI 2.0-10.1) of invasive penile cancer. HPV DNA was detected in 79.8% of tumor specimens, and 69.1% of tumors were HPV16-positive. The proportion of HPV DNA-positive tumors did not vary by any risk factors evaluated. Many risk factors were common for both in situ and invasive disease. However, 3 factors that did not increase the risk for in situ cancer proved significant risk factors for invasive penile cancer: lack of circumcision during childhood, phimosis and cigarette smoking. The high percentage of HPV DNA-positive tumors in our study is consistent with a strong association between HPV infection and the development of penile cancer regardless of circumcision status. Circumcision in early childhood may help prevent penile cancer by eliminating phimosis, a significant risk factor for the disease.

(c) 2005 Wiley-Liss, Inc.
PMID 15825185  Int J Cancer. 2005 Sep 10;116(4):606-16. doi: 10.1002/i・・・
著者: J Dillner, G von Krogh, S Horenblas, C J Meijer
雑誌名: Scand J Urol Nephrol Suppl. 2000;(205):189-93.
Abstract/Text OBJECTIVE: To review the epidemiology of invasive cancer of the penis based on scientific publications identified by a Medline search from 1966-2000 for the keywords penis/penile, cancer/carcinoma and risk as well as the cited references in the identified papers.
RESULTS: Strong risk factors (OR >10) identified by case-control studies included phimosis, chronic inflammatory conditions such as balanopostitis and lichen sclerosus et atrophicus and treatment with psoralen and ultraviolet A photochemotheraphy (PUVA). A consistent association was found between penile cancer and smoking that was dose-dependent and not explained by investigated confounding factors such as sexual history. Sexual history and self-reported history of condyloma were associated with a 3-5-fold increased penile cancer risk. Cervical cancer in the wife was not consistently associated with cancer of the penis in the husband. Circumcision was associated with penile cancer risk in ecological studies. In a case-control study, circumcision neonatally, but not after the neonatal period, was associated with a 3-fold decreased risk, albeit 20% of penile cancer patients had been circumcised neonatally. In a large number of case series, human papillomavirus (HPV) DNA was identified in penile neoplastic tissue. In penile intraepithelial neoplasia, between 70 and 100% of lesions were HPV DNA positive, whereas invasive penile cancer was positive in only 40-50% of cases. A few serological case-control studies and one prospective study also identified an association between HPV type 16 and penile cancer risk. An association between penile cancer risk and HPV prevalence in the population was also suggested by ecological studies.
CONCLUSION: The evidence on risk factors for penile cancer suggests that preventive measures that could be considered include prevention of phimosis, treatment of chronic inflammatory conditions, limiting PUVA treatment, smoking cessation and prophylactic prevention of HPV infection.

PMID 11144896  Scand J Urol Nephrol Suppl. 2000;(205):189-93.
著者: Natasha L Larke, Sara L Thomas, Isabel dos Santos Silva, Helen A Weiss
雑誌名: Cancer Causes Control. 2011 Aug;22(8):1097-110. doi: 10.1007/s10552-011-9785-9. Epub 2011 Jun 22.
Abstract/Text OBJECTIVE: We systematically reviewed the evidence of an association between male circumcision and penile cancer.
METHODS: Databases were searched using keywords and text terms for the epidemiology of penile cancer. Random effects meta-analyses were used to calculate summary odds ratios (ORs) and 95% confidence intervals (CI).
RESULTS: We identified eight papers which evaluated the association of circumcision with penile cancer, of which seven were case-control studies. There was a strong protective effect of childhood/adolescent circumcision on invasive penile cancer (OR = 0.33; 95% CI 0.13-0.83; 3 studies). In two studies, the protective effect of childhood/adolescent circumcision on invasive cancer no longer persisted when analyses were restricted to boys with no history of phimosis. In contrast, there was some evidence that circumcision in adulthood was associated with an increased risk of invasive penile cancer (summary OR = 2.71; 95% CI 0.93-7.94; 3 studies). There was little evidence for an association of penile intra-epithelial neoplasia and in situ penile cancer with circumcision performed at any age.
CONCLUSIONS: Men circumcised in childhood/adolescence are at substantially reduced risk of invasive penile cancer, and this effect could be mediated partly through an effect on phimosis. Expansion of circumcision services in sub-Saharan Africa as an HIV prevention strategy may additionally reduce penile cancer risk.

PMID 21695385  Cancer Causes Control. 2011 Aug;22(8):1097-110. doi: 10・・・
著者: G Sonpavde, L C Pagliaro, C Buonerba, T B Dorff, R J Lee, G Di Lorenzo
雑誌名: Ann Oncol. 2013 May;24(5):1179-89. doi: 10.1093/annonc/mds635. Epub 2013 Jan 4.
Abstract/Text Background Penile cancer (PC) is a rare cancer in western countries, but is more common in parts of the developing world. Due to its rarity and the consequent lack of randomized trials, current therapy is based on retrospective studies and small prospective trials. Design Studies of PC therapy were searched in PubMed and abstracts at major conferences. Results PC is generally an aggressive malignancy characterized by early locoregional lymph node (LN) spread and later metastases in distant sites. Given the strong predictive value of LN involvement for overall survival, evaluating regional LNs is critical. Advanced LN involvement is increasingly being treated with multimodality therapy incorporating chemotherapy and/or radiation. A single superior cisplatin-based regimen has not been defined. Further advances may occur with a better collaboration on an international scale and comprehensive understanding of tumor biology. To this end, the preventive role of circumcision and understanding of the oncogenic roles of Human Papilloma Virus-16, and smoking may yield advances. Preliminary data suggest a role for agents targeting epidermal growth factor receptor and angiogenesis. Conclusion Advances in therapy for PC will require efficient trial designs, synergistic collaboration, incentives to industry and the efforts of patient advocacy groups and venture philanthropists.

PMID 23293117  Ann Oncol. 2013 May;24(5):1179-89. doi: 10.1093/annonc/・・・
著者: Stavros Touloupidis, Athanasios Zisimopoulos, Stylianos Giannakopoulos, Athanasios G Papatsoris, Christos Kalaitzis, Anastasios Thanos
雑誌名: Int J Urol. 2007 Feb;14(2):174-6. doi: 10.1111/j.1442-2042.2007.01694.x.
Abstract/Text BACKGROUND: We present our initial experience with the use of the squamous cell carcinoma (SCC) antigen (SCCAg) in 16 men with penile SCC (SCC group), in four men with condyloma acuminatum (benign group), and in 32 blood donors (control group).
METHODS: The SCCAg levels were measured at presentation and every 6 months (upper limit was 2 ng/mL). The mean follow-up time was 4 years.
RESULTS: All non-SCC patients had normal SSCAg serum levels in contrast with the SCC patients. The presence of nodal and/or distant metastases resulted in statistically significant higher SCCAg levels, both at presentation and during the follow-up. In patients undergoing lymph node dissection with elevated SCCAg levels prior to the procedure, there was a statistically significant decrease of the SCCAg levels after the operation.
CONCLUSION: The SCCAg level could be a serum marker that holds promise for clinical use in penile SCC. Sequential monitoring of SCCAg level might indicate developing of nodal and/or distant metastases and could be useful in following the response to treatment.

PMID 17302580  Int J Urol. 2007 Feb;14(2):174-6. doi: 10.1111/j.1442-2・・・
著者: Edwin Hungerhuber, Boris Schlenker, Peter Schneede, Christian G Stief, Alexander Karl
雑誌名: Urology. 2007 Nov;70(5):975-9. doi: 10.1016/j.urology.2007.07.013.
Abstract/Text OBJECTIVES: In penile cancer, radical groin dissection is the reference standard for lymph node staging, but it is associated with high morbidity. Prognostic markers for lymphatic spread would be helpful to select patients for a surveillance program. Squamous cell carcinoma (SCC) antigen is a well-known marker for various carcinomas. Our aim was to evaluate the value of the SCC antigen in terms of lymph node staging and treatment control.
METHODS: From 1994 to 2004, the serum levels of SCC antigen were analyzed in 54 men with penile carcinoma at different disease stages. The SCC antigen values were compared in patients without evidence of tumor, with a primary tumor only, with nodal metastases, and with progressive metastatic disease. In 13 patients, repeated SCC antigen measurements correlated with the treatment effects.
RESULTS: Once lymph node metastases occurred, a trend was found toward increased SCC antigen levels and at the stage of organ metastases, the SCC antigen levels had risen significantly (P <0.01). In cases of repeated measurements, a correlation was found between SCC antigen values and treatment effect. A response to treatment occurred, even if the values were within normal limits.
CONCLUSIONS: The SCC antigen levels seemed to correlate with tumor burden in patients with penile carcinoma. However, it is of limited value in the primary prediction of occult lymph node metastases because the SCC antigen levels increased significantly only after massive lymph node involvement or metastatic disease has occurred. However, the SCC antigen could be used as a marker for treatment control in penile carcinoma.

PMID 18068457  Urology. 2007 Nov;70(5):975-9. doi: 10.1016/j.urology.2・・・
著者: S Horenblas, R Kröger, M P Gallee, D W Newling, H van Tinteren
雑誌名: Urology. 1994 May;43(5):702-7.
Abstract/Text OBJECTIVE: As part of the staging procedure in squamous cell carcinoma of the penis, we assessed the role of ultrasound examination, in particular its role in assessing the extent and the invasion into the corpora.
METHODS: From 1988 until 1992, all patients referred for primary treatment underwent ultrasound assessment with a 7.5 MHz linear array small parts transducer as part of the clinical workup. All ultrasound images were reviewed by one radiologist, without knowledge of the clinical outcome and were compared with the results obtained at histopathologic examination.
RESULTS: In 16 patients the primary tumor and in 1 patient a recurrent cancer after primary therapy were examined. All tumors were identified as hypoechoic lesions. Ultrasound examination in the region of the glans was not able to differentiate between invasion of the subepithelial tissue and invasion into the corpus spongiosum, but absence or presence of invasion into the tunica albuginea of the corpus cavernosum was clearly demonstrated. Accurate measurement by ultrasound of maximum tumor thickness was seen in seven of sixteen examinations.
CONCLUSIONS: While ultrasound examination is inexpensive and easily done, it is not accurate enough for staging small penile cancers located at the glans penis. However, for larger tumors ultrasound can be a useful addition to physical examination by delineating reliably the anatomic relations of the tumor to structures such as the tunica albuginea, corpus cavernosum, and urethra.

PMID 8165771  Urology. 1994 May;43(5):702-7.
著者: A Agrawal, D Pai, N Ananthakrishnan, S R Smile, C Ratnakar
雑誌名: J Clin Ultrasound. 2000 Oct;28(8):399-406.
Abstract/Text PURPOSE: This study was performed to assess the accuracy of high-resolution sonography in measuring penile carcinoma.
METHODS: Sonography was performed using a 7.5-MHz linear-array transducer in 59 patients with penile carcinoma. The sonographic measurement of tumor extent was compared with clinical and pathologic measurements. The tumor extent measured by gross pathologic evaluation on cut sections of the fresh penectomy specimen was used as the definitive standard. The echogenicity of the tumor was compared with that of the surrounding normal penile tissue to classify the tumor as hyperechoic, hypoechoic, or of mixed echogenicity (containing both hyperechoic and hypoechoic elements). We evaluated the relationship between the echogenicity of the tumor and both tumor morphology (exophytic or infiltrative) and tumor grade as determined on pathologic examination.
RESULTS: The overall mean difference +/- standard deviation in the tumor extent between clinical and gross pathologic evaluation was 3.9 +/- 5.3 mm (range, 1-9 mm), whereas the overall mean difference between sonographic and gross pathologic evaluation was 1.2 +/- 1.7 mm (range, 1-7 mm). As determined with reference to the gross pathologic extent, the error in measuring the extent on clinical examination was significantly greater than the error on sonography (p < 0.001). Lesions involving the glans alone were more often underestimated by clinical examination than were lesions involving the shaft (with or without glanular involvement). The error in measuring the extent of tumor by sonography was not related to the site of the tumor. The tumor was hyperechoic in 21 cases (36%), hypoechoic in 28 cases (47%), and of mixed echogenicity in 10 cases (17%). There was no significant association between echogenicity and tumor morphology or grade.
CONCLUSIONS: Sonography gives a more accurate estimate of penile tumor extent than does physical examination. Routine use of sonography for such measurements should enable preservation of more of the penis.

Copyright 2000 John Wiley & Sons, Inc.
PMID 10993967  J Clin Ultrasound. 2000 Oct;28(8):399-406.
著者: A P Lont, A P E Besnard, M P W Gallee, H van Tinteren, S Horenblas
雑誌名: BJU Int. 2003 Apr;91(6):493-5.
Abstract/Text OBJECTIVE: To determine the accuracy of physical examination and imaging in assessing the extent of the primary tumour in squamous cell carcinoma of the penis.
PATIENTS AND METHODS: A physical examination, ultrasonography and magnetic resonance imaging (MRI) were used before surgery in 33 patients with penile carcinoma. The tumour size, infiltration of the penile structures and infiltration depth were assessed. The results were compared with the histopathological examination of the resected specimen.
RESULTS: Tumour size was determined with the highest precision by the physical examination (residual sd of 8.1 mm); ultrasonography and MRI were less precise (residual sd 8.9 mm and 9.3 mm). In assessing infiltration depth, ultrasonography and MRI had comparable precision (residual sd 3.7 mm and 3.8 mm). The positive predictive value of corpus cavernosum infiltration was 6/6 for physical examination, 4/6 for ultrasonography and 6/8 for MRI; the sensitivity was 6/7, 4/7 and 6/6, respectively.
CONCLUSION: Physical examination is a reliable method for estimating penile tumour size and predicts corpus cavernosum infiltration with a high positive predictive value. Tumours for which the infiltration of the corpora cannot be determined properly by physical palpation only should be examined by imaging.

PMID 12656901  BJU Int. 2003 Apr;91(6):493-5.
著者: Oliver Kayes, Suks Minhas, Clare Allen, Chris Hare, Alex Freeman, David Ralph
雑誌名: Eur Urol. 2007 May;51(5):1313-8; discussion 1318-9. doi: 10.1016/j.eururo.2006.11.014. Epub 2006 Nov 13.
Abstract/Text OBJECTIVES: To assess the accuracy of magnetic resonance imaging (MRI) as a local staging technique in penile cancer and its role in selecting patients for conservative surgical management.
METHODS: Fifty-five men diagnosed with invasive penile carcinoma on biopsy were locally staged with the use of MRI. Prostaglandin E1 (alprostadil) was injected into the corpora to induce an artificial erection. Radiologic staging was compared against final histopathologic stage of the tumour. Sensitivity, specificity, and kappa agreement values were calculated for each tumour stage. Additionally, corpora cavernosa involvement was reviewed in 20 consecutive cases and suitability for conservative surgery assessed.
RESULTS: A good correlation between radiologic and histologic staging was achieved with an overall kappa value of 0.75 (p<0.001). Stage-specific sensitivities and specificities were calculated: T1 (85%; 83%), T2 (75%; 89%), and T3 (88%; 98%). MRI accurately predicted corpora cavernosa invasion in all cases of pathologically proven disease. These patients were selected to undergo partial penectomy. There were no complications using this imaging technique.
CONCLUSIONS: This study demonstrates that penile MRI is highly accurate in the local staging of penile cancer. Associated improvements in surgical planning allow the provision of conservative surgical treatments over more radical procedures.

PMID 17113213  Eur Urol. 2007 May;51(5):1313-8; discussion 1318-9. doi・・・
著者: A Kirkham
雑誌名: Br J Radiol. 2012 Nov;85 Spec No 1:S86-93. doi: 10.1259/bjr/63301362.
Abstract/Text MRI of the penis is an expensive test that is not always superior to clinical examination or ultrasound. However, it shows many of the important structures, and in particular the combination of tumescence from intracavernosal alprostadil, and high-resolution T(2) sequences show the glans, corpora and the tunica albuginea well. In this paper we summarise the radiological anatomy and discuss the indications for MRI. For penile cancer, it may be useful in cases where the local stage is not apparent clinically. In priapism, it is an emerging technique for assessing corporal viability, and in fracture it can in most cases make the diagnosis and locate the injury. In some cases of penile fibrosis and Peyronie's disease, it may aid surgical planning, and in complex pelvic fracture may replace or augment conventional urethrography. It is an excellent investigation for the malfunctioning penile prosthesis.

PMID 23118102  Br J Radiol. 2012 Nov;85 Spec No 1:S86-93. doi: 10.1259・・・
著者: Niels M Graafland, Joost A P Leijte, Renato A Valdés Olmos, Cornelis A Hoefnagel, Hendrik J Teertstra, Simon Horenblas
雑誌名: Eur Urol. 2009 Aug;56(2):339-45. doi: 10.1016/j.eururo.2009.05.016. Epub 2009 May 19.
Abstract/Text BACKGROUND: Penile carcinoma patients with inguinal lymph node involvement (LNI) have an increased risk for pelvic nodal involvement with or without distant metastases.
OBJECTIVE: To evaluate the diagnostic accuracy of fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) with computed tomography (CT; 18F-FDG PET/CT) scanning in determining further metastatic spread in patients with tumour-positive inguinal nodes.
DESIGN, SETTING, AND PARTICIPANTS: Eighteen patients with penile squamous cell carcinoma with unilateral or bilateral cytologically tumour-positive inguinal disease underwent whole-body 18F-FDG-PET/CT scanning for tumour staging.
MEASUREMENTS: Images were blindly assessed by two nuclear medicine physicians. All scans were evaluated for pelvic nodal involvement per basin and for distant metastases. Histopathology (when available), radiologic imaging, and clinical follow-up (with a minimum of 1 yr) served as a reference standard. The diagnostic value of PET/CT scanning for predicting pelvic nodal involvement was evaluated using standard statistical methods.
RESULTS AND LIMITATIONS: The reference was available in 28 of the 36 pelvic basins. Of the 11 tumour-positive pelvic basins, 10 were correctly predicted by PET/CT scan, as were all 17 tumour-negative pelvic basins. PET/CT scan showed a sensitivity of 91%, a specificity of 100%, a diagnostic accuracy of 96%, a positive predictive value of 100%, and a negative predictive value of 94% in detecting pelvic nodal involvement. Additionally, PET/CT scans showed distant metastases in five patients. In four patients, the presence of distant metastases could be confirmed, while in one patient, no radiologic confirmation was found for that particular lesion. A potential limitation is that the diagnostic accuracy of PET/CT scanning was calculated on 28 pelvic basins only. Furthermore, no comparison was made with conventional CT scans, as not all patients had undergone contrast-enhanced CT scans.
CONCLUSIONS: PET/CT scanning appears promising for detecting pelvic lymph node metastases with great accuracy, and it identifies distant metastases in penile carcinoma patients with inguinal LNI. In our practice, PET/CT scanning has become part of routine staging in such patients.

PMID 19477581  Eur Urol. 2009 Aug;56(2):339-45. doi: 10.1016/j.eururo.・・・
著者: Isabelle Souillac, Jérôme Rigaud, Catherine Ansquer, Louis Marconnet, Olivier Bouchot
雑誌名: J Urol. 2012 Feb;187(2):493-7. doi: 10.1016/j.juro.2011.10.033. Epub 2011 Dec 15.
Abstract/Text PURPOSE: We prospectively evaluated (18)F-fluorodeoxyglucose positron emission tomography-computerized tomography to assess inguinal lymph node status, the main prognostic factor in invasive squamous cell carcinoma of the penis.
MATERIALS AND METHODS: From March 2005 to January 2010, 30 patients with invasive squamous cell carcinoma of the penis from the department of urology at our institution were prospectively included in this study. Lymph node status was assessed preoperatively by positron emission tomography-computerized tomography to detect subclinical metastasis in 22 patients with initially cN0 disease and quantify inguinal lymph node invasion in 8 with cN+.
RESULTS: In the 22 cN0 cases (total of 44 inguinal lymph node basins analyzed) positron emission tomography-computerized tomography had 75% sensitivity and 87.5% specificity. Positive and negative predictive values were 37.5% and 97.2%, respectively. In the 8 cN+ cases (total of 16 inguinal lymph node basins analyzed) this type of imaging had 100% sensitivity, specificity and positive predictive value. In 3 cases staged clinically as cN1 positron emission tomography-computerized tomography revealed several metabolically active lesions on the same side, which was confirmed by histological examination, up-staging these cases to pN2.
CONCLUSIONS: (18)F-fluorodeoxyglucose positron emission tomography-computerized tomography is a useful staging examination for invasive penile cancer. It confirms inguinal lymph node invasion and can detect subclinical inguinal lymph node invasion.

Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
PMID 22177157  J Urol. 2012 Feb;187(2):493-7. doi: 10.1016/j.juro.2011・・・
著者: Joost A P Leijte, Niels M Graafland, Renato A Valdés Olmos, Hester H van Boven, Cornelis A Hoefnagel, Simon Horenblas
雑誌名: BJU Int. 2009 Sep;104(5):640-4. doi: 10.1111/j.1464-410X.2009.08450.x. Epub 2009 Mar 5.
Abstract/Text OBJECTIVE: To prospectively evaluate the performance of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) to detect occult metastasis in patients with clinically node-negative (cN0) penile carcinoma, as there is little information on the use of (18)F-FDG-PET/CT in penile carcinoma.
PATIENTS AND METHODS: In 24 patients, scheduled to undergo dynamic sentinel-node biopsy, hybrid PET/CT was used before surgery to assess the nodal status of the cN0-groins. Six of the 24 patients were unilaterally cN0. Thus, 42 cN0-groins were evaluated for occult metastasis using PET/CT. All scans were assessed by two experienced nuclear physicians. The histopathological tumour status of the removed sentinel node was used as the standard of care to evaluate the PET/CT-results.
RESULTS: Histopathology was tumour-positive in five of the 42 (12%) evaluated cN0-groins, two of which contained only micrometastases (<2 mm). One of the five tumour-positive cN0-groins was correctly predicted on the PET/CT-images. All false-negative PET/CT scans contained metastasis of CONCLUSION: The role of PET/CT in evaluating the groins of patients with cN0 penile cancer appears to be limited, due to its low sensitivity. In this series, only one of the five tumour-positive groins was identified. Surgical staging methods remain necessary at present.

PMID 19281465  BJU Int. 2009 Sep;104(5):640-4. doi: 10.1111/j.1464-410・・・
著者: Ramin Sadeghi, Hassan Gholami, Seyed Rasoul Zakavi, Vahid Reza Dabbagh Kakhki, Simon Horenblas
雑誌名: Clin Nucl Med. 2012 May;37(5):436-41. doi: 10.1097/RLU.0b013e318238f6ea.
Abstract/Text PURPOSE: Metastatic involvement of the inguinal lymph nodes is associated with decreased survival and is a strong prognostic factor in penile squamous cell carcinoma. The aim of the current systematic review was to evaluate the accuracy of (18)F-FDG PET/CT for inguinal lymph node staging in penile squamous cell carcinoma and possible influential factors.
MATERIALS AND METHODS: Medline, SCOPUS, Springer, Science Direct, and Google Scholar were searched using the key words "(penile or penis) and PET," with no date or language limitation. The meeting abstracts were not excluded either. Statistical pooling was performed using the random-effects model.
RESULTS: Seven studies were included in the meta-analysis. One article had 2 different subgroups of patients, and each subgroup was considered as a separate study. Pooled sensitivity and specificity were 80.9% (95% confidence interval [CI]: 69.5%-89.4%) and 92.4% (95% CI: 86.8%-96.2%), respectively. Pooled sensitivity was 96.4% (95% CI: 81.7%-99.9%) for cN+ and 56.5% (95% CI: 34.5%-76.8%) for cN0 patients.
CONCLUSIONS: (18)F-FDG PET/CT imaging has relatively low sensitivity (especially in cN0 patients) for detection of inguinal lymph node involvement in penile cancer patients, which does not justify its routine use. However, patients with clinically palpable lymph nodes may benefit from (18)F-FDG PET/CT because the sensitivity in this subgroup of patients is high.

PMID 22475891  Clin Nucl Med. 2012 May;37(5):436-41. doi: 10.1097/RLU.・・・
著者: Chris F Heyns, Arturo Mendoza-Valdés, Antonio C L Pompeo
雑誌名: Urology. 2010 Aug;76(2 Suppl 1):S15-23. doi: 10.1016/j.urology.2010.03.002.
Abstract/Text A comprehensive literature study was conducted to evaluate the levels of evidence (LEs) in publications on the diagnosis and staging of penile cancer. Recommendations from the available evidence were formulated and discussed by the full panel of the International Consultation on Penile Cancer in November 2008. The final grades of recommendation (GRs) were assigned according to the LEs of the relevant publications. The following consensus recommendations were accepted: physical examination of the primary penile lesion is mandatory, evaluating the morphologic and physical characteristics of the lesion (GR A). Evaluation of the primary lesion with ultrasonography is of limited value for local tumor staging (GR C); however, evaluation of the primary tumor with magnetic resonance (MRI) imaging during artificial erection induced by intracavernosal injection of prostaglandin might be more useful (GR B). Histologic or cytologic diagnosis of the primary lesion is mandatory (GR A). For accurate histologic grading and staging, a resected specimen is preferable to a biopsy specimen alone (GR B). Penile cancer should be staged according to the TNM system; however, the 1987/2002 TNM staging system requires revision using data from larger patient cohorts to validate the recently proposed modifications (GR B). The histopathology report should provide information on all prognostic parameters, including the tumor size, histologic type, grade, growth pattern, depth of invasion, tumor thickness, resection margins, and lymphovascular and perineural invasion (GR B). Physical examination of the inguinal and pelvic areas to assess the lymph nodes is mandatory (GR B). Ultrasound-guided fine needle aspiration cytology is indicated for both palpable and nonpalpable inguinal nodes. If the findings confirm lymph node metastasis (LNM), complete inguinal lymph node dissection is indicated (GR B). In patients with nonpalpable inguinal nodes, if the ultrasound-guided fine needle aspiration cytology findings are negative for tumor, dynamic sentinel node biopsy can be performed if the equipment and technical expertise are available (GR C). In patients at high risk of inguinal LNM according to the available guidelines and nomograms, surgical staging can be performed by complete, bilateral inguinal lymph node dissection, which might also be curative (GR B). In patients at intermediate risk of LNM, sentinel node biopsy or modified (limited) inguinal lymph node dissection might be performed (GR B). In patients with nonpalpable inguinal nodes, imaging with computed tomography (CT) or MRI is not indicated, because they are not useful in detecting small-volume LNM. Also, it is very unlikely that large-volume LNM (detectable by CT/MRI) would be present in the pelvic nodes (GR B). In patients with confirmed inguinal LNM, CT of the pelvis is indicated to detect iliac LNMs (GR B). Abdominal CT and chest radiography are advisable if the pelvic CT findings are positive (GR B).

Copyright (c) 2010 Elsevier Inc. All rights reserved.
PMID 20691881  Urology. 2010 Aug;76(2 Suppl 1):S15-23. doi: 10.1016/j.・・・
著者: Bin K Kroon, Simon Horenblas, Omgo E Nieweg
雑誌名: J Surg Oncol. 2005 Jan 1;89(1):43-50. doi: 10.1002/jso.20170.
Abstract/Text Squamous cell carcinoma (SCC) is the most common tumor of the penis. The natural history and its proclivity to spread via regional lymphatics has been well defined. Laser ablation of the primary tumor has a prominent role in patients with a superficial tumor as a penis-conserving approach. Patients with deeper infiltrating tumors, should undergo (partial) penile amputation. For patients presenting with proven metastatic nodes complete (ilio-) inguinal lymphadenectomy should be performed. During the last two decades, the management of penile carcinoma patients with impalpable regional lymph nodes has improved due to better knowledge of risks for metastases, the introduction of modified lymphadenectomy, and sentinel node biopsy. Future perspectives in penile cancer comprises continuing research to reduce mutilation without jeopardizing clinical outcome.

PMID 15611938  J Surg Oncol. 2005 Jan 1;89(1):43-50. doi: 10.1002/jso.・・・
著者: G M Videtic, C T Ago, E W Winquist
雑誌名: Med Pediatr Oncol. 1997 Dec;29(6):576-7.
Abstract/Text Hypercalcemia is the most common metabolic disorder associated with malignancies. Squamous cell carcinoma of the penis is a tumor for which this abnormality has rarely been described. This report presents a case of hypercalcemia seen in a patient with advanced penile cancer. A chemotherapy regimen of intravenous cisplatin and fluorouracil caused regression of the primary tumor and normalization of the serum calcium. A literature review supported an association between squamous cell carcinoma of the penis and hypercalcemia.

PMID 9324348  Med Pediatr Oncol. 1997 Dec;29(6):576-7.
著者: K Dorfinger, U Maier, W Base
雑誌名: J Urol. 1999 May;161(5):1570.
Abstract/Text
PMID 10210405  J Urol. 1999 May;161(5):1570.
著者: J W Slaton, N Morgenstern, D A Levy, M W Santos, P Tamboli, J Y Ro, A G Ayala, C A Pettaway
雑誌名: J Urol. 2001 Apr;165(4):1138-42.
Abstract/Text PURPOSE: We determine if histopathological factors of the primary penile tumor can stratify the risk of the development of inguinal lymph node metastases.
MATERIALS AND METHODS: Clinical records of 48 consecutive patients with squamous cell carcinoma of the penis who underwent resection of the primary lesion and either inguinal lymph node dissection or were observed for signs of recurrence (median followup 59 months) were reviewed. Parameters examined included pathological tumor stage, quantified depth of invasion and tumor thickness, histological and nuclear grade, percentage of poorly differentiated cancer in the primary tumor, number of mitoses and presence or absence of vascular invasion. Variables were compared in 18 lymph node positive and 30 lymph node negative cases.
RESULTS: Pathological tumor stage, vascular invasion and presence of greater than 50% poorly differentiated cancer were the strongest predictors of nodal metastasis on univariate and multivariate regression analyses. None of 15 pT1 tumors exhibited vascular invasion or lymph node metastases. Of 33 patients with pT2 or greater tumors 21 (64%) had vascular invasion and 18 (55%) had metastases. Only 4 of 25 patients (15%) with 50% or less poorly differentiated cancer in the penile tumor had metastases compared with 14 of 23 patients (61%) with greater than 50% poorly differentiated cancer (p = 0.001). No other variables tested were significantly different among the patient cohorts.
CONCLUSIONS: Pathological stage of the penile tumor, vascular invasion and greater than 50% poorly differentiated cancer were independent prognostic factors for inguinal lymph node metastasis. Prophylactic lymphadenectomy in compliant patients with pT1 lesions without vascular invasion and 50% or less poorly differentiated cancer does not appear warranted.

PMID 11257655  J Urol. 2001 Apr;165(4):1138-42.
著者: Paul K Hegarty, Oliver Kayes, Alex Freeman, Nim Christopher, David J Ralph, Suks Minhas
雑誌名: BJU Int. 2006 Sep;98(3):526-31. doi: 10.1111/j.1464-410X.2006.06296.x.
Abstract/Text OBJECTIVE: To prospectively assess the outcome of patients treated according to the European Association of Urology (EAU) guidelines on the management of penile cancer, a system originally based on retrospective series.
PATIENTS AND METHODS: Between 2002 and 2005, 100 consecutive patients (median age 62 years) with penile cancer were treated at one institution; all were categorized and treated according to EAU guidelines. Data were analysed using the z-test, with significance defined as P < 0.05.
RESULTS: Survival curves were limited to those with >12 months of follow-up (mean 29); the survival of the whole group was 92%. Of men with palpable nodes, 72% had lymph node involvement, whereas 18% of those with impalpable nodes who had lymphadenectomy according to the guidelines had lymph node disease. The grade of the primary tumour was more predictive than T stage for lymph node involvement and survival. The 3-year disease-specific survival for N0, N1 and N2 disease was 100%, 100% and 73%, respectively, and survival at 12 months for N3 disease was 67%. The median survival for those with metastases was 3 months.
CONCLUSION: The overall survival of men with penile cancer is high, with a clear benefit for early lymphadenectomy in men with positive nodal disease. However, the current EAU guidelines are limited in predicting those patients with micrometastatic disease, with the result that 82% of patients undergo unnecessary prophylactic lymphadenectomy. There is a need to identify more accurate molecular markers for predicting lymph node disease, or the role of novel staging techniques must be assessed.

PMID 16925747  BJU Int. 2006 Sep;98(3):526-31. doi: 10.1111/j.1464-410・・・
著者: B K Kroon, S Horenblas, S H Estourgie, A P Lont, R A Valdés Olmos, O E Nieweg
雑誌名: J Urol. 2004 Jun;171(6 Pt 1):2191-4.
Abstract/Text PURPOSE: Evaluation of the false-negative dynamic sentinel node procedures in penile carcinoma at our institute.
MATERIALS AND METHODS: Between January 1994 and February 2003, 123 patients with penile squamous cell carcinoma underwent dynamic sentinel node biopsy.
RESULTS: The sentinel node revealed metastasis in 28 (23%) of 123 patients. Regional recurrence after excision of a tumor-negative sentinel node or after nonvisualization was seen in 6 patients resulting in a false-negative rate of 18% (6 of 34). We assume that 1 false-negative case was due to tumor blockage, 3 to tumor blockage and rerouting, 1 to a pathological sampling error and 1 to a low radioactivity level in the sentinel node during surgery.
CONCLUSIONS: Based on the false-negative results, important adaptations have been made in the dynamic sentinel node biopsy procedure for penile carcinoma at our institute. Pathological analysis was extended by serial sectioning and immunohistochemical staining, and preoperative ultrasonography with fine needle aspiration cytology has been added. Furthermore, exploration of groin without visualized sentinel nodes and intraoperative palpation of the wound have been introduced.

PMID 15126783  J Urol. 2004 Jun;171(6 Pt 1):2191-4.
著者: Joost A P Leijte, Bin K Kroon, Renato A Valdés Olmos, Omgo E Nieweg, Simon Horenblas
雑誌名: Eur Urol. 2007 Jul;52(1):170-7. doi: 10.1016/j.eururo.2007.01.107. Epub 2007 Feb 7.
Abstract/Text OBJECTIVES: Dynamic sentinel node biopsy (DSNB) has been performed at our department since 1994 to assess status of inguinal lymph nodes of clinically node-negative (cN0) patients with penile carcinoma. Over time, several modifications were made to reduce the false-negative rate and thus increase sensitivity. We compared the false-negative and complication rates of the current procedure, as performed at our institute since 2001, with the prior procedures.
MATERIALS AND METHODS: The patients who underwent DSNB for penile carcinoma in the period from 1994 until July 2004 were divided into two cohorts: cohort A: patients treated from 1994 until 2001; cohort B: patients treated from 2001 until 2004. Cohort A consisted of 92 patients, in whom 157 groins were explored. Cohort B consisted of 58 patients, with a total of 105 explored groins. Medians for follow-up in cohorts A and B were 83 (range: 24-130) and 30 (range: 24-49) mo, respectively. The false-negative and complication rates were determined in both cohorts.
RESULTS: In cohort A, 21 of 157 explored groins contained tumour-positive sentinel nodes, and five false-negative procedures were encountered, resulting in a false-negative rate of 19.2%. In cohort B, 20 of 105 explored groins contained tumour-positive sentinel nodes, and one procedure was false-negative. The false-negative rate was 4.8%. The rate of complications dropped from 10.2% in cohort A to 5.7% in cohort B. All complications were minor and transient.
CONCLUSIONS: The false-negative and complication rates of DSNB have decreased since the procedure was modified. The current procedure has false-negative and complication rates of 4.8% and 5.7%, respectively. DSNB has matured into a reliable and safe method for assessing status of lymph nodes in cN0 penile carcinoma patients.

PMID 17316967  Eur Urol. 2007 Jul;52(1):170-7. doi: 10.1016/j.eururo.2・・・
著者: S Horenblas
雑誌名: BJU Int. 2001 Sep;88(5):473-83.
Abstract/Text
PMID 11589660  BJU Int. 2001 Sep;88(5):473-83.
著者: J C Lindegaard, O S Nielsen, F A Lundbeck, A Mamsen, H N Studstrup, H von der Maase
雑誌名: Br J Urol. 1996 Jun;77(6):883-90.
Abstract/Text OBJECTIVE: To identify prognostic factors for penile cancer and to evaluate the treatment strategy for early-stage disease, proposed recently by the European Board of Urology (EBU).
PATIENT AND METHODS: The records of 82 patients consecutively referred to the uro-oncological centre at Aarhus University Hospital between 1965 and 1993 were reviewed. The importance of tumour stage, differentiation, patient age, local control and regional lymph node control were assessed using univariate and multivariate analyses.
RESULTS: Cox multivariate analysis identified differentiation (odds ratio [OR] = 6.04), UJCC-1978 T-stage (OR = 1.88) and age (OR = 1.04) as independent prognostic variables for survival. Penile amputation in tumours < 4 cm in diameter improved local control but not survival. Regional control and survival were not significantly improved by prophylactic adenectomy.
CONCLUSION: Differentiation, T-stage and age were prognostic factors for survival. The results support the EBU treatment strategy involving penis-conserving therapy and watchful waiting for early-stage disease.

PMID 8705227  Br J Urol. 1996 Jun;77(6):883-90.
著者: Joost A P Leijte, Peter Kirrander, Ninja Antonini, Torgny Windahl, Simon Horenblas
雑誌名: Eur Urol. 2008 Jul;54(1):161-8. doi: 10.1016/j.eururo.2008.04.016. Epub 2008 Apr 15.
Abstract/Text BACKGROUND: Current follow-up recommendations for patients with penile carcinoma are based on small numbers of patients.
OBJECTIVES: To give further insight into the recurrence patterns of penile carcinoma in different treatment settings and provide recommendations for follow up. DESIGNS, SETTING, AND PARTICIPANTS: In this retrospective study, we analysed 700 patients from two referral centres for penile carcinoma for recurrences.
MEASUREMENTS: Recurrences were categorized as local, regional, or distant. The rate of local recurrences was compared between patients undergoing penile-preserving treatments and partial/total amputation. Regional recurrences were compared between patients surgically staged as pN0 or pN+ and clinically node-negative (cN0) patients subjected to a wait-and-see policy. The total recurrence rate, type of recurrence, time to recurrence, and survival were calculated.
RESULTS AND LIMITATIONS: 205 out of 700 patients (29.3%) had a recurrence, consisting of 18.6% local, 9.3% regional, and 1.4% distant recurrences. Of the recurrences, 92.2% occurred within 5 yr after primary treatment. All regional and distant recurrences occurred within 50 and 16 mo, respectively. The local recurrence rate was 27.7% after penile-preserving therapy and 5.3% after amputation. The regional recurrence rate was 2.3% in patients staged as pN0, 19.1% in patients staged as pN+, and 9.1% in patients undergoing a wait-and-see policy. The 5-yr disease-specific survival was 92% after a local recurrence and 32.7% after a regional recurrence. All patients with a distant recurrence died within 22 mo. Although the number of analysed patients is substantial, the results do not necessarily reflect those of other centres using different techniques for the management of penile carcinoma.
CONCLUSIONS: Patients undergoing penile-preserving therapy, patients surgically staged as pN+, and those undergoing a wait-and-see policy for the nodal status are at high risk of developing a recurrence. Follow-up recommendations are provided based on the risk and impact on survival of a recurrence.

PMID 18440124  Eur Urol. 2008 Jul;54(1):161-8. doi: 10.1016/j.eururo.2・・・
著者: Curtis A Pettaway, Lance Pagliaro, Christine Theodore, Gabriel Haas
雑誌名: Urology. 2010 Aug;76(2 Suppl 1):S58-65. doi: 10.1016/j.urology.2010.03.082.
Abstract/Text OBJECTIVES: To review the treatment strategies among patients with Stage IV penile cancer to describe potentially curative or palliative therapy.
METHODS: The International Consultation on Urologic Disease for Penile Cancer subcommittee on the treatment of Stage IV penile cancer reviewed reports related to the topics of advanced penile cancer and metastatic penile cancer alone and combined with chemotherapy, radiotherapy, and inguinal lymphadenectomy. The reports were rated as to their level of evidence using the criteria of the Oxford Centre for evidence-based medicine. Treatment recommendations were made by consensus, with the appropriate grades determined from the level of evidence.
RESULTS: The incidence of Stage IV disease using the current or modified TNM or Jackson descriptions was 0%-14%. Cisplatin-containing regimens were the most active, with patients exhibiting an average response and survival rate of 26% (range 15%-32%) and 5.5 months (range 4.7-7), respectively. Bleomycin-containing regimens were associated with significant pulmonary toxicity. The role of radiotherapy for advanced penile cancer has been largely palliative. Data have suggested that surgical consolidation among patients exhibiting an objective response to chemotherapy could be associated with durable survival.
CONCLUSIONS: Treatment with a cisplatin-containing regimen in Stage IV penile cancer should be considered and might facilitate curative resection. The use of bleomycin was associated with a high level of toxicity and should be discouraged as first-line therapy. Surgical consolidation to achieve disease-free status or palliation should be considered in fit patients with an objective response to systemic chemotherapy. Palliative radiotherapy to inguinal or skeletal metastases might be of benefit.

Copyright (c) 2010 Elsevier Inc. All rights reserved.
PMID 20691886  Urology. 2010 Aug;76(2 Suppl 1):S58-65. doi: 10.1016/j.・・・
著者: A Agrawal, D Pai, N Ananthakrishnan, S R Smile, C Ratnakar
雑誌名: BJU Int. 2000 Feb;85(3):299-301.
Abstract/Text OBJECTIVE: To explore the possibility of reducing the margin of clearance at surgery for carcinoma of the penis without causing an increase in the incidence of local tumour recurrence, so that the functional and cosmetic compromise associated with penectomy might be minimized.
PATIENTS AND METHODS: Sixty-four patients underwent partial or total penectomy based on the extent of tumour. The specimens were evaluated histologically for grade and for proximal microscopic extensions beyond the grossly visible tumour margin, by examining serial proximal 5 mm sections. The histological grade of the lesion was correlated with its clinical site, morphology and proximal microscopic spread. Differences were assessed using the chi-squared test.
RESULTS: Of 64 tumours, 31% were grade 1, 50% grade 2 and the remaining 19% grade 3. Higher grade lesions were more likely to involve the penile shaft. The maximum proximal histological extent was 5 mm for grades 1 and 2, and 10 mm for grade 3 tumours; there was no discontinuous spread.
CONCLUSIONS: Histological grading is mandatory in the management of carcinoma of the penis. A 10-mm clearance is adequate for grade 1 and 2 lesions, and 15 mm for grade 3 tumours. This approach would qualify more patients for partial rather than total amputation; the residual length of the penis would then be cosmetically and functionally more acceptable.

PMID 10671885  BJU Int. 2000 Feb;85(3):299-301.

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