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BACKGROUND: Penile cancer is high in some underdeveloped countries. Signal transducer and activator of transcription 3 (STAT3) and CD44, CD24, and SOX2+ are known to be markers of diagnosis and prognosis in other cancers, but without studies in penile cancer. METHODS: A cross-sectional study was conducted at the Hospital de Cancer de Pernambuco from March 2015 to December 2017. We performed SOX2, STAT3, CD24, and CD44 analyses in blood and tumor tissue by flow cytometry. RESULTS: High levels of CD44highCD24low, CD44highCD24lowpSTAT3+ and CD44hig hCD24low in the blood of patients compared to the controls (p < 0.05). Low of SOX2+ T cells in blood of patients compared to controls. High CD44highCD24low levels in patients with perineural invasion (PNI), tumor size > 3 cm, and pT2 stage (p < 0.05). High T cell levels in the blood and tumor tissue of patients with tumor ≤3 cm (p < 0.05). Increased SOX2+ T cells in blood of patients with PNI (-) and pT1 stage (p < 0.05). CD44highCD24lowpSTAT3+ (r = 0.669; p = 0.024) and SOX2+T cells (r = 0.404, p = 0.029) correlation were observed between blood and tumor tissue in penile cancer patients. CONCLUSION: CD44, CD24, and SOX2 molecules were markers of advanced disease associated with the worst prognosis in CaPe. However, pSTAT3 and T cells were associated with a more favorable prognosis in this study.
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The main goal of the present study was to analyze the expression profile of cyclin D1 in patients with PC, and to determine possible correlations with clinical and histopathological features. A survey was conducted with 100 patients diagnosed with PC, who were treated at two reference hospitals in São Luís, Maranhão, Brazil, between 2013 and 2017. A review of clinical, epidemiological, and histopathological data was performed, Human Papillomavírus (HPV) DNA was detected using polymerase chain reaction (PCR) and cyclin D1 expression analysis was performed using immunohistochemical techniques. The data revealed that the absence of cyclin D1 expression was significantly associated with HPV-positive histological subtypes (p = 0.001), while its expression was associated with high-grade tumors (p = 0.014), histological subtype (p = 0.001), presence of sarcomatoid transformation (p = 0.04), and perineural invasion (p = 0.023). Patients with cyclin D1 expression exhibited lower disease-free survival compared to the cyclin D1-negative group, although the difference was not statistically significant. The results suggest that cyclin D1 may be a potential biomarker for PC, especially for poorer prognosis.
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Biomarcadores Tumorais , Ciclina D1 , Neoplasias Penianas , Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Pessoa de Meia-Idade , Biomarcadores Tumorais/metabolismo , Biomarcadores Tumorais/genética , Brasil/epidemiologia , Ciclina D1/metabolismo , Ciclina D1/genética , Intervalo Livre de Doença , Imuno-Histoquímica , Infecções por Papillomavirus/virologia , Infecções por Papillomavirus/metabolismo , Neoplasias Penianas/genética , Neoplasias Penianas/patologia , Neoplasias Penianas/virologia , PrognósticoRESUMO
Objetivo: proporcionar reflexões sobre o cuidado de enfermagem com abordagem à sexualidade para a saúde do homem penectomizado por câncer de pênis. Conteúdo: corresponde a estudo reflexivo construído a partir de leituras em produções científicas sobre o cuidado de Enfermagem e a sexualidade para o paciente oncológico penectomizado, à luz dos pensamentos e pressupostos ontológicos e teóricos de Martin Heidegger. Considerações finais: as novas condições impostas pelo adoecimento por câncer de pênis e o tratamento mutilador, a penectomia, exigem uma Enfermagem que aborde a sexualidade, considerando o indivíduo em sua totalidade e com ênfase no cuidado com perspectiva na profundidade e subjetividade existenciais humanas(AU)
Objective: to provide reflections on nursing care with an approach to sexuality for the health of men undergoing penectomy for penile cancer. Content: reflective study developed from readings in scientific productions on Nursing care and sexuality for the penectomized cancer patient, in the light of Martin Heidegger's ontological and theoretical thoughts and assumptions. Final considerations: the new conditions imposed by illness from penile cancer and the mutilating treatment, penectomy, require Nursing that addresses sexuality, considering the individual in its entirety and with an emphasis on care with a perspective on human existential depth and subjectivity(AU)
Objetivo: proporcionar reflexiones sobre el cuidado de Enfermería con abordaje a la sexualidad para la salud del hombre que sufrió penectomía por cáncer de pene. Contenido: corresponde a estudio reflexivo construido a partir de lecturas en producciones científicas sobre el cuidado de Enfermería y la sexualidad para el paciente oncológico que sufrió penectomía, a la luz de los pensamientos y presupuestos ontológicos y teóricos de Martin Heidegger. Consideraciones finales: las nuevas condiciones impuestas por la enfermedad por cáncer de pene y el tratamiento mutilador, la penectomía, exigen una Enfermería que aborde la sexualidad, considerando al individuo en su totalidad y con énfasis en el cuidado con perspectiva en la profundidad y subjetividad existenciales humanas(AU)
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Humanos , Masculino , Neoplasias Penianas/enfermagem , Pênis/cirurgia , Sexualidade , Masculinidade , Amputação Cirúrgica , Neoplasias Penianas/cirurgia , Saúde do HomemRESUMO
Introducción: El cáncer de pene es una neoplasia maligna poco frecuente en todo el mundo; representa el 1 % de todos los cánceres que afectan a los hombres. Es una neoplasia caracterizada por un proceso proliferativo de células epiteliales, originándose a partir de la piel del prepucio interno o del glande, que se identifica por un crecimiento invasivo y diseminación metastásica temprana a ganglios linfáticos. Objetivo: Exponer la presentación clínica, diagnóstico y tratamiento de un hombre joven con cáncer de pene. Caso clínico: Paciente masculino de 31 años de edad, color de la piel blanca, con antecedentes de salud anterior y de procedencia urbana; que desde hace dos años presenta lesión ulcerosa, descamativa, granulosa en el pene; no dolorosa, con secreciones fétidas y que ha ido aumentando de tamaño. Con la aplicación de anestesia regional espinal se realizó penectomía parcial y se confirmó el diagnóstico de un carcinoma de células escamosas de pene. Conclusiones: El carcinoma de células escamosas de pene es infrecuente en hombres jóvenes y de buen pronóstico si es diagnosticado a tiempo y para cuyo diagnóstico se precisa ser especialmente estricto con los criterios histológicos. La penectomía parcial es el tratamiento de elección de la lesión primaria. El seguimiento de estos pacientes es fundamental para actuar de forma rápida ante la presencia de recidiva o adenopatías metastásicas.
Introduction : Cancer of the penis is a rare malignant neoplasm worldwide; it represents 1 % of all cancers that affect men. It is a neoplasm characterized by a proliferative process of epithelial cells, originating from the skin of the inner prepuce or glans penis, which is identified by invasive growth and early metastatic spread to lymph nodes. Objective : To expose the clinical presentation, diagnosis and treatment of a young man with penile cancer. Clinical case : Male patient 31 years of age, white skin color, with a history of previous health and urban origin; that for two years has had ulcerative, decamative, granulous lesion on the penis; not painful, with fetid secretions and that has been increasing in size. With the application of regional spinal anesthesia, partial penectomy was performed and the diagnosis of squamous cell carcinoma of the penis was confirmed. Conclusions : Squamous cell carcinoma of the penis is uncommon in young men and has a good prognosis if it is diagnosed early and for whose diagnosis it is necessary to be especially strict with the histological criteria. Partial penectomy is the treatment of choice for the primary lesion. The follow-up of these patients is essential to act quickly in the presence of recurrence or metastatic adenopathies.
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ABSTRACT Objective: to trace the clinical and epidemiological profile of penile cancer in Rio Grande do Norte/Brazil and relate them to data published in the literature. Methods: a cross-sectional study was conducted with 94 patients diagnosed with penile cancer in 2011-2018, treated at the Liga Norte Riograndense Contra o Cancer. Results: all patients were diagnosed with squamous cell carcinoma, mainly aged over 50 years, from the states interior, brown, illiterate, or with incomplete primary education. At diagnosis, 68% of patients were classified as having tumors =T2, and 30% had lymph node involvement. Distant metastases were detected in 2.1% of patients at diagnosis. Most patients received the diagnosis in the initial phase of the disease, but 20.2% were diagnosed in stage IV. Partial penectomy was the most performed surgery, and 10% of patients relapsed, mainly in the lymph nodes (87.5%). The mean follow-up of the patients was 18 months, with an estimated overall survival at five years of 59.1%. However, 25% of patients were followed up for up to 3 months, losing follow-up. Conclusion: the State of Rio Grande do Norte has a high incidence of penile cancer with a high frequency of locally advanced tumors at diagnosis and in younger patients younger than 50. Furthermore, socioeconomic factors interfere with early diagnosis and hinder access to specialized services.
RESUMO Objetivo: traçar o perfil clínico e epidemiológico do câncer de pênis no Rio Grande do Norte/Brazil e relacioná-los com dados publicados na literatura. Métodos: realizou-se estudo transversal de 94 pacientes diagnosticados com câncer de pênis no período de 2011-2018, tratados na Liga Norte Riograndense Contra o Câncer. Resultados: todos os pacientes foram diagnosticados com carcinoma espinocelular, principalmente com idade acima dos 50 anos, provenientes do interior do estado, pardos, analfabetos ou com ensino fundamental incompleto. Ao diagnóstico, 68% dos pacientes foram classificados com tumores =T2 e 30% possuiam envolvimento linfonodal. Metástases à distância foram detectadas em 2,1% dos pacientes ao diagnóstico. A maioria dos pacientes recebeu o diagnóstico na fase inicial da doença, mas 20,2% foram diagnosticados em estádio IV. Penectomia parcial foi a cirurgia mais realizada e 10% dos pacientes recidivaram, principalmente para linfonodos (87,5%). A média de seguimento dos pacientes foi de 18 meses, apresentando estimativa de sobrevida global em 5 anos de 59,1%. No entanto, 25% dos pacientes foram acompanhados por até 3 meses, perdendo o seguimento. Conclusão: o Estado do Rio Grande do Norte apresenta elevada incidência de câncer de pênis com alta frequência de tumores localmente avançados ao diagnóstico, assim como em pacientes mais jovens, menores que 50 anos de idade. Outrossim, o fator socioeconômico interfere no diagnóstico precoce e dificulta o acesso a serviços especializados. .
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Introduction: Primary skin leiomyosarcomas are infrequent neoplasms. They correspond to 2-3% of skin sarcomas and are most frequently located on the lower extremities, trunk and genitals. Methods: We present a case of a 73-year-old man with a 4-month evolution of foreskin leiomyosarcoma. The lesion was biopsied for histopathological study with HE and immunohistochemistry with smooth muscle actin, specific muscle actin, CD34, p63 and S-100 (-). Results: We observed a leiomyosarcoma of high histological grade and mitotic count. It was positive by immunohistochemistry for smooth muscle actin, while the other markers were negative. Surgical limits were compromised so a reoperation with wide margins of healthy tissue was necessary. Conclusion: The skin lesions should be removed all, without exception, since they can be neoplasms of variable biological behavior. The histological study must be complemented with immunohistochemistry to differentiate them from other neoplasms. For the prognosis, the histological grade, size, location and the possibility of resection with wide margins must be taken into account.
Introducción: Los leiomiosarcomas primarios de piel son neoplasias infrecuentes. Corresponden al 2-3 % de los sarcomas cutáneos y se localizan con mayor frecuencia en las extremidades inferiores, tronco y genitales. Método: Presentamos un caso de un varón de 73 años con un leiomiosarcoma en prepucio de 4 meses de evolución. Se le practicó biopsia excisional de la lesión para estudio histopatológico con HE e inmunohistoquímica con actina de músculo liso, actina muscular específica, CD34, p63 y S-100 (-). Resultados: Observamos un leiomiosarcoma de alto grado histológico y recuento mitótico. Presentó positividad por inmunohistoquímica para actina de músculo liso, en tanto que los otros marcadores fueron negativos. Los límites quirúrgicos estuvieron comprometidos por lo que fue necesaria una reintervención con amplios márgenes de tejido sano. Conclusión: Las lesiones de piel deben extirparse todas, sin excepción, ya que pueden tratarse de neoplasias de conducta biológica variable. El estudio histológico debe complementarse con inmunohistoquímica para diferenciarlas de otras neoplasias. Para el pronóstico se debe tener en cuenta el grado histológico, el tamaño, la localización y la posibilidad de resección con amplios márgenes.
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Leiomiossarcoma , Actinas , Idoso , Prepúcio do Pênis/patologia , Humanos , Imuno-Histoquímica , Leiomiossarcoma/patologia , Leiomiossarcoma/cirurgia , Masculino , PrognósticoRESUMO
ABSTRACT Purpose: To determine independent predictors of inguinal lymph node (ILN) metastasis in patients with penile cancer. Patients and methods: We retrospectively analyzed all patients with penile cancer who underwent surgery at our medical center in the last ten years (n=157). Using univariate and multivariate logistic-regression models, we assessed associations with age, medical-history, phimosis, onset-time, number and maximum diameter of involved ILNs measured by imaging, pathological T stage, degree of tumor differentiation and/or cornification, lymphatic vascular infiltration (LVI), nerve infiltration, and ILN metastases. Interaction and stratified analyses were used to assess age, phimosis, onset time, number of ILNs, cornification, and nerve infiltration. Results: A total of 110 patients were included in the study. Multiple logistic regression analysis showed that the following factors were significantly correlated with ILN metastasis: maximum diameter of enlarged ILNs, T stage, pathological differentiation, and LVI. Among patients with a maximum ILN diameter ≥1.5cm, 50% had lymph node metastasis whereas 30.6% patients with a maximum ILN diameter <1.5cm showed LNM. Among 44 patients with stage Ta/T1, 10 showed ILN metastases, while 47.0% patients with stage T2 showed ILN metastases. Among 40 patients with highly differentiated penile-cancer, eight showed ILN metastasis, while 47.1% patients with low-to-middle differentiation showed ILN metastases. The rate of LNM was 33.3% in the LVI-free group and 64.3% in the LVI group. Conclusion: Our single-center results suggested that maximum ILN diameter, pathological T stage, pathological differentiation, and LVI were independent risk factors for ILN metastases.
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Humanos , Masculino , Neoplasias Penianas/cirurgia , Neoplasias Penianas/patologia , Prognóstico , Estudos Transversais , Estudos Retrospectivos , Fatores de Risco , Excisão de Linfonodo , Linfonodos/patologia , Metástase Linfática/patologia , Estadiamento de NeoplasiasRESUMO
OBJECTIVES: To determine the effectiveness of adjuvant chemotherapy compared with neoadjuvant chemotherapy in patients with node-positive penile cancer in terms of overall and disease-free survival. METHODS: We conducted a search strategy in MEDLINE, Embase, and Central databases. We complemented the search with unpublished literature through manual search, conferences, thesis databases, Open Grey, Google Scholar, and Clinicaltrials.gov. There were no restrictions in language. We used the MINORS tool to assess the risk of bias. Furthermore, we performed a random-effects meta-analysis according to the expected heterogeneity. The outcomes were overall survival, progression-free survival, and adverse effects. The Effect measure was hazard ratio (HR) with a confidence interval of 95%. RESULTS: We included 1,197 patients. Seven articles reported overall survival; while 3 reported progression-free survival. The pooled overall survival HR was 1.41 (0.99-2.02), while the progression-free survival HR was 1.63 (1.09-2.44) for adjuvant vs neoadjuvant therapy. An analysis of adverse effects was not possible. CONCLUSIONS: There were no differences when comparing adjuvant vs. neoadjuvant chemotherapy or adjuvant vs. no intervention chemotherapy. We conclude that progression-free survival had a better response with adjuvant chemotherapy when compared with neoadjuvant therapy. We suggest more studies with adequate design to offer a stronger recommendation.
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Terapia Neoadjuvante , Neoplasias Penianas , Quimioterapia Adjuvante , Intervalo Livre de Doença , Humanos , Linfonodos , Masculino , Neoplasias Penianas/tratamento farmacológicoRESUMO
PURPOSE: To determine independent predictors of inguinal lymph node (ILN) metastasis in patients with penile cancer. PATIENTS AND METHODS: We retrospectively analyzed all patients with penile cancer who underwent surgery at our medical center in the last ten years (n=157). Using univariate and multivariate logistic-regression models, we assessed associations with age, medical-history, phimosis, onset-time, number and maximum diameter of involved ILNs measured by imaging, pathological T stage, degree of tumor differentiation and/or cornification, lymphatic vascular infiltration (LVI), nerve infiltration, and ILN metastases. Interaction and stratified analyses were used to assess age, phimosis, onset time, number of ILNs, cornification, and nerve infiltration. RESULTS: A total of 110 patients were included in the study. Multiple logistic regression analysis showed that the following factors were significantly correlated with ILN metastasis: maximum diameter of enlarged ILNs, T stage, pathological differentiation, and LVI. Among patients with a maximum ILN diameter ≥1.5cm, 50% had lymph node metastasis whereas 30.6% patients with a maximum ILN diameter <1.5cm showed LNM. Among 44 patients with stage Ta/T1, 10 showed ILN metastases, while 47.0% patients with stage T2 showed ILN metastases. Among 40 patients with highly differentiated penile-cancer, eight showed ILN metastasis, while 47.1% patients with low-to-middle differentiation showed ILN metastases. The rate of LNM was 33.3% in the LVI-free group and 64.3% in the LVI group. CONCLUSION: Our single-center results suggested that maximum ILN diameter, pathological T stage, pathological differentiation, and LVI were independent risk factors for ILN metastases.
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Neoplasias Penianas , Estudos Transversais , Humanos , Excisão de Linfonodo , Linfonodos/patologia , Metástase Linfática/patologia , Masculino , Estadiamento de Neoplasias , Neoplasias Penianas/patologia , Neoplasias Penianas/cirurgia , Prognóstico , Estudos Retrospectivos , Fatores de RiscoRESUMO
Resumo Objetivo Analisar os significados das masculinidades durante a vivência do câncer peniano e seus tratamentos. Métodos Abordagem qualitativa de pesquisa amparada em referencial teórico da antropologia médica e das masculinidades, com o emprego do método narrativo. Foram entrevistados em profundidade 18 homens com neoplasia peniana em um hospital referência em uro-oncologia do estado de São Paulo. Cada participante foi entrevistado com roteiro de investigação, em média três vezes, sendo as entrevistas audiogravadas, transcritas e analisadas conforme a análise temática indutiva. Resultados Seis participantes realizaram a penectomia parcial e 12 total. Em relação ao estado civil, participaram dois viúvos, dois solteiros, três divorciados e 11 casados, com média de idade de 54 anos. A extirpação do pênis promoveu mudanças significativas na forma como os homens performavam suas masculinidades, sobretudo a hegemônica. Portanto, essa experiência lhes permitiu reinterpretar suas condições de saúde na tentativa de identificar outros elementos hegemônicos que sustentassem suas imagens masculinas. Para alguns foi possível representar um homem inteiro, porém outros se consideram agora meio-homens. Conclusão O adoecimento rompeu com o fluxo biográfico dos participantes, pois antes do câncer peniano a hegemonia os representava como masculinos, entretanto, após a penectomia, eles perdem um órgão que socialmente traz atributos como força, poder, trabalho e virilidade, situação que lhes trouxe a necessidade de reinterpretar o ser masculino em suas culturas. A enfermagem, para promover o cuidado integral ao homem, deve considerar que as masculinidades interferem no processo saúde e doença.
Resumen Objetivo Analizar los significados de las masculinidades durante la vivencia del cáncer de pene y sus tratamientos. Métodos Enfoque cualitativo de investigación respaldado en el marco referencial teórico de la antropología médica y de las masculinidades, con el uso del método narrativo. Fueron entrevistados en profundidad 18 hombres con neoplasia de pene en un hospital de referencia en urología oncológica del estado de São Paulo. Cada participante fue entrevistado con guion de investigación, tres veces en promedio. Las entrevistas fueron grabadas, transcriptas y analizadas de acuerdo con el análisis temático inductivo. Resultados Seis participantes realizaron penectomía parcial y 12 total. Respecto al estado civil, participaron dos viudos, dos solteros, tres divorciados y 11 casados, con un promedio de edad de 54 años. La extirpación del pene generó cambios significativos en la forma como los hombres practicaban su masculinidad, sobre todo la hegemónica. Por lo tanto, esta experiencia les permitió interpretar sus condiciones de salud en el intento de identificar otros elementos hegemónicos que sostengan su imagen masculina. Para algunos fue posible representar un hombre entero, pero otros ahora se consideran medio hombres. Conclusión La enfermedad rompió con el flujo biográfico de los participantes, ya que antes del cáncer de pene, la hegemonía los representaba como masculinos; sin embargo, después de la penectomía, perdieron un órgano que socialmente trae atributos como fuerza, poder, trabajo y virilidad, situación que les produjo la necesidad de reinterpretar el ser masculino en su cultura. Para promover el cuidado integral del hombre, la enfermería debe considerar que las masculinidades interfieren en el proceso salud y enfermedad.
Abstract Objective To analyze masculinity meanings during penile cancer experience and its treatments. Methods Qualitative approach supported in the theoretical framework of medical anthropology and masculinities, with the use of the narrative method. We interviewed in-depth 18 men with penile cancer in a referential Urologic Oncology hospital from the state of São Paulo. Each participant was interviewed on average three times, with a structured script, being the interviews audio-recorded, transcribed, and analyzed according to the inductive thematic analysis. Results Six patients were submitted to the partial penectomy and 12 to the total penectomy. Regarding the marital status, six were widowers, two single, three divorced, and 11 married, with an average age of 54 years old. The penis extirpation fostered significant change in the way men performed their masculinities, even the hegemonic. Thus, this experience allowed them to reinterpret their health conditions to identify other hegemonic elements that sustained their masculine images. For a few, it was possible to represent a full man however, others considered themselves half-men. Conclusion The illness broke the participant's biographic flow because, before penile cancer, the hegemony represented them as masculines, however, after the penectomy, they have lost an organ that is socially related to attributes such as strength, power, work, and virility, situation that brought them the necessity to reinterpret being masculine in their culture. To promote integrality of care to man the nursing must consider that masculinities interfere in the process of health and disease.
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Humanos , Masculino , Adolescente , Pessoa de Meia-Idade , Neoplasias Penianas/cirurgia , Processo Saúde-Doença , Masculinidade , Antropologia Médica , Amputação Cirúrgica , Enfermagem Oncológica , Entrevistas como Assunto , Assistência Integral à Saúde , Estudos de Avaliação como AssuntoRESUMO
ABSTRACT Purpose: To evaluate surgical complications and oncological outcomes of patients submitted to primary radical inguinal surgical debulking (PRISD) and myocutaneous pediculate flap reconstruction (MPFR) for locally advanced penile cancer (PC). Materials and Methods: Forty-two patients with ulcerated and/or fixed bulky inguinal masses underwent unilateral or bilateral PRISD with MPFR. Tensor fascia lata flap (TFL) was the standard of care for all patients. Additional use of the gracilis flap (GF) was carried out when necessary. Contra-lateral radical inguinal lymphadenectomy (RIL) was conduced when PRISD was performed unilaterally. Surgical complications were analyzed and stratified into minor and major according to the Bevan-Thomas classification. Adjunctive treatments were assessed and oncological outcomes analyzed. Results: Of the 42 patients evaluated, 10 (23.8%) underwent bilateral PRISD and 32 (76.2%) unilateral PRISD with contra-lateral RIL, totaling 84 lymphadenectomies. A total of 62 MPFRs were performed, 52 with TFL and 10 with GF. A total of 53 complications were identified, 49 related to PRISD with MPFR and 4 to RIL. Adjuvant chemotherapy was carried out in 16 patients. Median follow-up was 10.8 months with a median overall survival (OS) of 14.0 months against 6.0 months (p=0.006) for patients submitted to PRISD with adjuvant chemotherapy in relation to surgery alone. Conclusions: PRISD alone for advanced loco-regional PC is unlikely to promote long-term survival, although it can lead to temporary local control of the disease. Despite the feasibility of the procedure, it is related to high incidence of complications. Surgical treatment with adjuvant chemotherapy is associated with improved OS.
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Humanos , Masculino , Neoplasias Penianas/cirurgia , Procedimentos de Cirurgia Plástica , Retalho Miocutâneo , Procedimentos Cirúrgicos de Citorredução , Excisão de LinfonodoRESUMO
ABSTRACT Purpose: Reviewing surgical procedures using fasciocutaneous and myocutaneous flaps for inguinal reconstruction after lymphadenectomy in metastatic penile cancer. Material and Methods: We reviewed the current literature of the Pubmed database according to PRISMA guidelines. The search terms used were "advanced penile cancer", "groin reconstruction", and "inguinal reconstruction", both alone and in combination. The bibliographic references used in the selected articles were also analyzed to include recent articles into our research. Results: A total of 54 studies were included in this review. About one third of penile cancers are diagnosed with locally advanced disease, often presenting with large lymph node involvement. Defects in the inguinal region resulting from the treatment of metastatic penile cancer are challenging for the surgeon and cause high patient morbidity, rendering primary closure unfeasible. Several fasciocutaneous and myocutaneous flaps of the abdomen and thigh can be used for the reconstruction of the inguinal region, transferring tissue to the affected area, and enabling tensionless closure. Conclusions: The reconstruction of defects in the inguinal region with the aid of flaps allows for faster postoperative recovery and reduces the risk of complications. Thus, the patient will be able to undergo potential necessary adjuvant treatments sooner.
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Humanos , Masculino , Neoplasias Penianas/cirurgia , Pênis/cirurgia , Retalhos Cirúrgicos , Canal Inguinal/cirurgia , Excisão de Linfonodo , Metástase LinfáticaRESUMO
ABSTRACT Purpose: Squamous cell carcinoma (SCC) of the penis is a rare disease in developed countries but is associated with significant morbidity and mortality. A crucial prognostic factor is the presence of inguinal lymph node metastases (ILNM) at the time of diagnosis. At least 25% of cases have micrometastases at the time of diagnosis. Therefore, we performed a literature review of studies evaluating factors, both clinical and pathological, predictive of lymph node metastases in penile SCC. Materials and methods: Studies were identified using PubMed and search terms included the following: penile cancer, penile tumor, penile neoplasm, penile squamous cell carcinoma, inguinal lymph node metastasis, lymph node metastases, nodal metastasis, inguinal node metastasis, inguinal lymph node involvement, predictors, and predictive factor. The number of patients and predictive factors were identified for each study based on OR, HR, or RR in multivariate analyses, as well as their respective significance values. These were compiled to generate a single body of evidence supportive of factors predictive of ILNM in penile SCC. Results: We identified 31 studies, both original articles and meta-analyses, which identified factors predictive of metastases in penile SCC. The following clinical factors were predictive of ILNM in penile SCC: lymphovascular invasion (LVI), increased grade, increased stage (both clinical and pathological), infiltrative and reticular invasion, increased depth of invasion, perineural invasion, and younger patient age at diagnosis. Biochemically, overexpression of p53, SOD2, Ki-67, and ID1 were associated with spread of SCC to inguinal lymph nodes. Diffuse PD-L1 expression, increased SCC-Ag expression, increased NLR, and CRP >20 were also associated with increased ILNM. Conclusions: A multitude of factors are associated with metastasis of SCC of the penis to inguinal lymph nodes, which is associated with poor clinical outcomes. The above factors, most strongly LVI, grade, and node positivity, may be considered when constructing a nomogram to risk-stratify patients and determine eligibility for prophylactic inguinal lymphadenectomy.
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Humanos , Masculino , Neoplasias Penianas/cirurgia , Prognóstico , Excisão de Linfonodo , Linfonodos , Metástase LinfáticaRESUMO
Malignant tumors of the penis are rare, most of them being squamous cell carcinomas (SCCs). We report the case of a 75-year-old man with a large penile mass submitted to partial penectomy. The specimen showed an exophytic mass involving the glans, coronal sulcus, and prepuce. Microscopic examination showed a carcinoma with two distinct areas: a mixed SCC and a sarcomatoid carcinoma. The SCC component had areas of verrucous carcinoma and areas of classical invasive SCC. The tumor cells expressed p63 with the absence of p16 expression. Vimentin and p53 were positive in the sarcomatous component. The morphology and immunohistochemistry were compatible with mixed SCC (verrucous hybrid-sarcomatoid carcinoma). Additionally, the tumor cells also expressed 3 different clones of PDL1 (22C3, SP263, and SP142). Two months later, the patient presented local recurrence with multiple lymph nodes and lung metastases, dying 7 weeks later. Mixed tumors represent diagnostic challenges. The correct identification of adverse prognostic factors can be the first step to implement the treatment with a higher probability of success.
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PURPOSE: To evaluate surgical complications and oncological outcomes of patients submitted to primary radical inguinal surgical debulking (PRISD) and myocutaneous pediculate flap reconstruction (MPFR) for locally advanced penile cancer (PC). MATERIALS AND METHODS: Forty-two patients with ulcerated and/or fixed bulky inguinal masses underwent unilateral or bilateral PRISD with MPFR. Tensor fascia lata flap (TFL) was the standard of care for all patients. Additional use of the gracilis flap (GF) was carried out when necessary. Contra-lateral radical inguinal lymphadenectomy (RIL) was conduced when PRISD was performed unilaterally. Surgical complications were analyzed and stratified into minor and major according to the Bevan-Thomas classification. Adjunctive treatments were assessed and oncological outcomes analyzed. RESULTS: Of the 42 patients evaluated, 10 (23.8%) underwent bilateral PRISD and 32 (76.2%) unilateral PRISD with contra-lateral RIL, totaling 84 lymphadenectomies. A total of 62 MPFRs were performed, 52 with TFL and 10 with GF. A total of 53 complications were identified, 49 related to PRISD with MPFR and 4 to RIL. Adjuvant chemotherapy was carried out in 16 patients. Median follow-up was 10.8 months with a median overall survival (OS) of 14.0 months against 6.0 months (p=0.006) for patients submitted to PRISD with adjuvant chemotherapy in relation to surgery alone. CONCLUSIONS: PRISD alone for advanced loco-regional PC is unlikely to promote long-term survival, although it can lead to temporary local control of the disease. Despite the feasibility of the procedure, it is related to high incidence of complications. Surgical treatment with adjuvant chemotherapy is associated with improved OS.
Assuntos
Retalho Miocutâneo , Neoplasias Penianas , Procedimentos de Cirurgia Plástica , Procedimentos Cirúrgicos de Citorredução , Humanos , Excisão de Linfonodo , Masculino , Neoplasias Penianas/cirurgiaRESUMO
PURPOSE: Reviewing surgical procedures using fasciocutaneous and myocutaneous flaps for inguinal reconstruction after lymphadenectomy in metastatic penile cancer. MATERIAL AND METHODS: We reviewed the current literature of the Pubmed database according to PRISMA guidelines. The search terms used were "advanced penile cancer", "groin reconstruction", and "inguinal reconstruction", both alone and in combination. The bibliographic references used in the selected articles were also analyzed to include recent articles into our research. RESULTS: A total of 54 studies were included in this review. About one third of penile cancers are diagnosed with locally advanced disease, often presenting with large lymph node involvement. Defects in the inguinal region resulting from the treatment of metastatic penile cancer are challenging for the surgeon and cause high patient morbidity, rendering primary closure unfeasible. Several fasciocutaneous and myocutaneous flaps of the abdomen and thigh can be used for the reconstruction of the inguinal region, transferring tissue to the affected area, and enabling tensionless closure. CONCLUSIONS: The reconstruction of defects in the inguinal region with the aid of flaps allows for faster postoperative recovery and reduces the risk of complications. Thus, the patient will be able to undergo potential necessary adjuvant treatments sooner.
Assuntos
Neoplasias Penianas , Humanos , Canal Inguinal/cirurgia , Excisão de Linfonodo , Metástase Linfática , Masculino , Neoplasias Penianas/cirurgia , Pênis/cirurgia , Retalhos CirúrgicosRESUMO
PURPOSE: Squamous cell carcinoma (SCC) of the penis is a rare disease in developed countries but is associated with significant morbidity and mortality. A crucial prognostic factor is the presence of inguinal lymph node metastases (ILNM) at the time of diagnosis. At least 25% of cases have micrometastases at the time of diagnosis. Therefore, we performed a literature review of studies evaluating factors, both clinical and pathological, predictive of lymph node metastases in penile SCC. MATERIALS AND METHODS: Studies were identified using PubMed and search terms included the following: penile cancer, penile tumor, penile neoplasm, penile squamous cell carcinoma, inguinal lymph node metastasis, lymph node metastases, nodal metastasis, inguinal node metastasis, inguinal lymph node involvement, predictors, and predictive factor. The number of patients and predictive factors were identified for each study based on OR, HR, or RR in multivariate analyses, as well as their respective significance values. These were compiled to generate a single body of evidence supportive of factors predictive of ILNM in penile SCC. RESULTS: We identified 31 studies, both original articles and meta-analyses, which identified factors predictive of metastases in penile SCC. The following clinical factors were predictive of ILNM in penile SCC: lymphovascular invasion (LVI), increased grade, increased stage (both clinical and pathological), infiltrative and reticular invasion, increased depth of invasion, perineural invasion, and younger patient age at diagnosis. Biochemically, overexpression of p53, SOD2, Ki-67, and ID1 were associated with spread of SCC to inguinal lymph nodes. Diffuse PD-L1 expression, increased SCC-Ag expression, increased NLR, and CRP >20 were also associated with increased ILNM. CONCLUSIONS: A multitude of factors are associated with metastasis of SCC of the penis to inguinal lymph nodes, which is associated with poor clinical outcomes. The above factors, most strongly LVI, grade, and node positivity, may be considered when constructing a nomogram to risk-stratify patients and determine eligibility for prophylactic inguinal lymphadenectomy.
Assuntos
Neoplasias Penianas , Humanos , Excisão de Linfonodo , Linfonodos , Metástase Linfática , Masculino , Neoplasias Penianas/cirurgia , PrognósticoRESUMO
PURPOSE: To evaluate the erectile function in patients who underwent partial penectomy and identify factors associated with penile functional status. MATERIALS AND METHODS: We identified patients who underwent partial penectomy due to penile cancer between 2009 and 2014. Clinical and pathological characteristics included patient age at the time of diagnosis, obesity, hypertension, dyslipidemia, diabetes, smoking, metabolic syndrome, Eastern Cooperative Oncology Group (ECOG) status, penile shaft length, tumor size, primary tumor stage (pT), clinical nodal status, and local recurrence. Erectile function was assessed prospectively with the International Index of Erectile Function (IIEF-5) at least 3 months after partial penectomy. RESULTS: A total of 81 patients met analysis criteria. At the diagnosis, the median age was 62 years (range from 30 to 88). Median follow-up was 17 months (IQR 7-36). Of total patients, 37 (45%) had T2 or higher disease. Clinically positive nodes were present in 16 (20%) patients and seven (8.6%) developed local recurrence. Fifty patients (62%) had erectile dysfunction (ED) after partial penectomy, 30% had moderate or severe erectile dysfunction scores. Patients with ED versus without ED were similar in baseline characteristics except for age, penile shaft length, and presence of inguinal adenopathy (p <0.05). Multivariate analysis using logistic regression confirmed that older patients, shorter penile shaft length, and clinically positive lymph node were significantly associated with ED. CONCLUSION: Partial penectomy due to penile cancer provides adequate local control of the disease, however, proper counselling is important especially in relation to ED consequences. Preservation of penile length yields to more optimal erectile recovery.
Assuntos
Disfunção Erétil , Neoplasias Penianas , Adulto , Idoso , Idoso de 80 Anos ou mais , Disfunção Erétil/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Ereção Peniana , Neoplasias Penianas/cirurgia , Pênis/cirurgiaRESUMO
Malignant tumors of the penis are rare, most of them being squamous cell carcinomas (SCCs). We report the case of a 75-year-old man with a large penile mass submitted to partial penectomy. The specimen showed an exophytic mass involving the glans, coronal sulcus, and prepuce. Microscopic examination showed a carcinoma with two distinct areas: a mixed SCC and a sarcomatoid carcinoma. The SCC component had areas of verrucous carcinoma and areas of classical invasive SCC. The tumor cells expressed p63 with the absence of p16 expression. Vimentin and p53 were positive in the sarcomatous component. The morphology and immunohistochemistry were compatible with mixed SCC (verrucous hybrid-sarcomatoid carcinoma). Additionally, the tumor cells also expressed 3 different clones of PDL1 (22C3, SP263, and SP142). Two months later, the patient presented local recurrence with multiple lymph nodes and lung metastases, dying 7 weeks later. Mixed tumors represent diagnostic challenges. The correct identification of adverse prognostic factors can be the first step to implement the treatment with a higher probability of success.
Assuntos
Humanos , Masculino , Idoso , Neoplasias Penianas/patologia , Carcinoma de Células Escamosas , Carcinoma VerrucosoRESUMO
Abstract We present the case of an HIV-negative man with asymptomatic penile erythematoviolaceous papules associated with similar slightly verrucous papules in the interdigital space of the right foot. A biopsy of the penile lesion confirmed Kaposi's sarcoma. No other causes of immunosuppression were observed. Penile lesions of KS are rare in HIV-negative individuals but it should also be considered in the differential diagnosis. Careful follow-up is recommended.