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目的:探讨以腹股沟肿大淋巴结为首发表现的阴茎癌的临床特点及诊治方法。方法:本组患者6例.均因为肿大的腹股沟淋巴结初诊于外院,在我院经细胞穿刺学证实为鳞癌转移。全部患者均有包茎或包皮过长病史.在成年后接受过包皮环切手术。4例患者在阴茎包皮环切瘢痕处有小灶肿块或溃疡.广切后病理显示为阴茎鳞癌.2例患者既往环切术标本经病理复片后诊断为阴茎鳞癌。结果:阴茎癌原发灶病理分析显示4例为T_1期病变.2例为T_2期病变.临床病灶均较小,直径为5～10 mm。腹股沟肿大淋巴结直径最小4 cm,最大达9 cm且伴破溃。6例患者中4例先接受了手术治疗,2例接受了新辅助化疗后再次手术。术后淋巴结病理送检证实腹股沟淋巴结鳞癌累及.且均有淋巴结外癌浸犯。6例患者中有5例复发,仅1例无病存活26个月。结论:以腹股沟肿大淋巴结为首发表现的阴茎癌并不多见.但是初诊时往往被误诊为其他疾病而延误了及时治疗。提高此类患者治疗效果的关键在于早期准确诊断.需要进行腹股沟淋巴结的穿刺病理检查,细致的寻找原发病灶。
Objective: To explore the clinical features, diagnosis and treatment of penile carcinoma with inguinal lymph nodes as the first manifestation. Methods: Six patients in this group were diagnosed with metastasis of squamous cell carcinoma in our hospital because of the newly diagnosed inguinal lymph node. All patients had a history of phimosis or prepuce. They were circumcised in adulthood. In 4 patients, there was a small mass or ulcer in the circumcision of the penis. The pathology showed a penile squamous cell carcinoma after extensive excision. Two cases of patients undergoing previous circumcision specimens were diagnosed as penile squamous cell carcinoma after pathological examination. RESULTS: Pathological analysis of the primary foci of the penis carcinoma showed that 4 cases were T1 stage lesions. 2 cases were T2 stage lesions. The clinical lesions were small and the diameter was 5 to 10 mm. Inguinal lymph nodes have a diameter of at least 4 cm and a maximum of 9 cm with rupture. Of the 6 patients, 4 received surgery first, and 2 received new neoadjuvant chemotherapy. Postoperative lymph node pathology confirmed the involvement of inguinal lymph node squamous cell carcinoma. Five of the six patients had relapse, and only one patient survived 26 months without disease. Conclusions: Penile cancer with inguinal lymph nodes as the first presentation is rare. However, it is often misdiagnosed as other diseases and delays timely treatment at the time of initial diagnosis. The key to improving the therapeutic effect of these patients lies in early and accurate diagnosis. Need to carry out puncture pathological examination of inguinal lymph nodes, careful search for the primary lesion.