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Mix JM, Gopalani SV, Miller M, Saraiya M, Darragh TM, Lynch CF, Thompson TD, Senkomago V, Greek A, Tucker TC, Unger ER. Scrotal Cancer Incidence Rates and Trends-United States, 1999-2020. Urology 2024:S0090-4295(24)00498-9. [PMID: 38936628 DOI: 10.1016/j.urology.2024.06.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/24/2024] [Accepted: 06/21/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVE To examine population-level scrotal cancer incidence rates and trends among adult men in the United States. METHODS Data from the United States Cancer Statistics, covering approximately 96% of the United States population, were analyzed to calculate age-standardized incidence rates of scrotal cancer among men aged 18 years and older from 1999 to 2020. Trends in incidence rates were evaluated by age, race and ethnicity, Census region, and histology using joinpoint regression. RESULTS Overall, 4,669 men were diagnosed with scrotal cancer (0.20 per 100,000). Incidence rates were highest among men aged 70 years and older (0.82 per 100,000). Rates were higher among non-Hispanic Asian or Pacific Islander men (0.31 per 100,000) compared to other race and ethnicity groups. The most common histologic subtypes were squamous cell carcinoma (35.9%), extramammary Paget disease (20.8%), and sarcoma (20.5%). Incidence rates decreased by 2.9% per year from 1999 to 2019 for non-Hispanic Asian or Pacific Islander men, decreased by 8.1% per year from 1999 to 2006 for basal cell carcinomas, and increased by 1.8% per year from 1999 to 2019 for extramammary Paget disease; otherwise, rates remained stable for all other variables examined. CONCLUSION While scrotal cancer incidence rates were higher than previously reported, rates were still low and stable over time.
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Affiliation(s)
- Jacqueline M Mix
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA; Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA
| | - Sameer V Gopalani
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA; Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA.
| | - Maureen Miller
- Department of Transfusion Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | - Mona Saraiya
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Teresa M Darragh
- University of California, San Francisco, Department of Pathology, San Francisco, California, USA
| | | | | | | | - April Greek
- Independent Researcher, Seattle, Washington, USA
| | - Thomas C Tucker
- University of Kentucky College of Public Health, Lexington, Kentucky, USA
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Pang KH, Fallara G, Tang S, Haider A, Freeman A, Hadway P, Nigam R, Rees R, Mitra A, Alifrangis C, Bunker C, Alnajjar HM, Muneer A. Primary squamous cell carcinoma of the scrotum: Outcomes from a specialist center. Urol Oncol 2023; 41:488.e11-488.e18. [PMID: 37903660 DOI: 10.1016/j.urolonc.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/08/2023] [Accepted: 08/12/2023] [Indexed: 11/01/2023]
Abstract
BACKGROUND Squamous cell carcinoma (SCC) of the scrotum is a rare and aggressive cancer. There are no established guidelines on the management of scrotal SCC. OBJECTIVE To analyze the clinical management and outcomes of scrotal SCC. PATIENTS AND METHODS A retrospective analysis of patients diagnosed with primary scrotal SCC over a 10-year period was performed. The type of surgery, tumor stage and histological subtypes, recurrence rate and metastases, cancer-specific mortality (CSM), and other-cause mortality (OCM) were analyzed. RESULTS Between 2012 and 2022, a total of 10 men were identified with primary scrotal SCC. The median (interquartile, IQR) age was 65.5 (55-77) years. Wide local excision was performed in 9 patients and 1 patient underwent a total scrotectomy. The pathological T-stage was: pT1, n = 3; pT2, n = 1; pT3, n = 5 (50%); pT4, n = 1. Four patients had pathologically positive inguinal lymph nodes and 2 had distant metastatic disease at presentation. At a median (IQR) follow-up of 10.5 (4-31) months 5 patients died, of which 3 died from scrotal SCC. CONCLUSION Scrotal SCC is extremely rare in the UK with only 10 primary cases identified in our center over the past 10 years. Surgical resection of the tumor and appropriate inguinal node staging are required due to a high proportion of cases which metastasize to the inguinal lymph nodes. PATIENT SUMMARY Scrotal cancer is rare. 10 cases were diagnosed over 10 years at a single center. Around half had disease spread to the groin nodes or distant organs at presentation. Surgical resection was required in all patients. At the time of analysis, half of the patients are alive. Due to the rarity and aggressiveness of the cancer, management should be carried out within a specialist center.
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Affiliation(s)
- Karl H Pang
- Division of Urology, Department of Surgery, School of Clinical Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong; Division of Urology, Queen Mary Hospital, Pok Fu Lam, Hong Kong; Department of Andrology, Male Genital Cancer Centre, Institute of Andrology, University College London Hospitals NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK
| | - Giuseppe Fallara
- Department of Urology, European Institute of Oncology, Milan, Italy
| | - Stanley Tang
- Department of Andrology, Male Genital Cancer Centre, Institute of Andrology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Aiman Haider
- Department of Histopathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Alex Freeman
- Department of Histopathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Paul Hadway
- Department of Andrology, Male Genital Cancer Centre, Institute of Andrology, University College London Hospitals NHS Foundation Trust, London, UK; Department of Urology, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - Raj Nigam
- Department of Andrology, Male Genital Cancer Centre, Institute of Andrology, University College London Hospitals NHS Foundation Trust, London, UK; Department of Urology, Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Rowland Rees
- Department of Andrology, Male Genital Cancer Centre, Institute of Andrology, University College London Hospitals NHS Foundation Trust, London, UK; Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Anita Mitra
- Department of Clinical Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Costi Alifrangis
- Department of Medical Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Chris Bunker
- Department of Dermatology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Hussain M Alnajjar
- Department of Andrology, Male Genital Cancer Centre, Institute of Andrology, University College London Hospitals NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK
| | - Asif Muneer
- Department of Andrology, Male Genital Cancer Centre, Institute of Andrology, University College London Hospitals NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK; Department of Surgical Biotechnology, University College London, London, UK; NIHR Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK.
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3
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Menon S, Moch H, Berney DM, Cree IA, Srigley JR, Tsuzuki T, Compérat E, Hartmann A, Netto G, Rubin MA, Gill AJ, Turajlic S, Tan PH, Raspollini MR, Tickoo SK, Amin MB. WHO 2022 classification of penile and scrotal cancers: updates and evolution. Histopathology 2023; 82:508-520. [PMID: 36221864 DOI: 10.1111/his.14824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 09/06/2022] [Accepted: 09/25/2022] [Indexed: 11/29/2022]
Abstract
Squamous cell carcinoma (SCC) is the most common malignant tumour of the penis. The 2022 WHO classification reinforces the 2016 classification and subclassifies precursor lesions and tumours into human papillomavirus (HPV)-associated and HPV-independent types. HPV-associated penile intraepithelial neoplasia (PeIN) is a precursor lesion of invasive HPV- associated SCC, whereas differentiated PeIN is a precursor lesion of HPV-independent SCC. Block-type positivity of p16 immunohistochemistry is the most practical daily utilised method to separate HPVassociated from HPVindependent penile SCC. If this is not feasible, the term SCC, not otherwise specified (NOS) is appropriate. Certain histologies that were previously classified as "subtypes" are now grouped, and coalesced as "patterns", under the rubric of usual type SCC and verrucous carcinoma (e.g. usual-type SCC includes pseudohyperplastic and acantholytic/pseudoglandular carcinoma, and carcinoma cuniculatum is included as a pattern of verrucous carcinoma). If there is an additional component of the usual type of invasive SCC (formerly termed hybrid histology), the tumour would be a mixed carcinoma (e.g. carcinoma cuniculatum or verrucous carcinoma with usual invasive SCC); in such cases, reporting of the relative percentages in mixed tumours may be useful. The consistent use of uniform nomenclature and reporting of percentages will inform the refinement of future reporting classification schemes and guidelines/recommendations. The classification of scrotal tumours is provided for the first time in the fifth edition of the WHO Blue book, and it follows the schema of penile cancer classification for both precursor lesions and the common SCC of the scrotum. Basal cell carcinoma of the scrotum may have a variable clinical course and finds a separate mention.
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Affiliation(s)
- S Menon
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - H Moch
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Switzerland
| | - D M Berney
- Barts Cancer Institute, London, UK
- Department of Cellular Pathology, Barts Health NHS Trust, London, UK
| | - I A Cree
- Head, WHO Classification of Tumours Head, Evidence Synthesis and Classification, International Agency for Research on Cancer (IARC), World Health Organization, Lyon, France
| | - J R Srigley
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - T Tsuzuki
- Department of Surgical Pathology, Aichi Medical University, Aichi, Japan
| | - E Compérat
- Department of Pathology, Medical University of Vienna, General Hospital of Vienna, Wien, AT, Austria
| | - A Hartmann
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen, Germany
| | - G Netto
- Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - M A Rubin
- Department of Biomedical Research (DBMR), Bern Center for Precision Medicine Inselspital University Hospital Bern, Bern, Switzerland
| | - A J Gill
- Sydney Medical School Sydney, The University of Sydney, NSW, Australia
- Royal North Shore Hospital, NSW Health Pathology, Department of Anatomical Pathology St Leonards, NSW, Australia
- Royal North Shore Hospital, Pathology Group, Kolling Institute of Medical Research, St Leonards, NSW, Australia
| | - S Turajlic
- The Francis Crick Institute, London and The Royal Marsden NHS Foundation Trust, London, UK
| | - P H Tan
- Division of Pathology, Singapore General Hospital, Singapore
| | - M R Raspollini
- Histopathology and Molecular Diagnostics University Hospital Careggi, Florence, Florence, Italy
| | - S K Tickoo
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - M B Amin
- The University of Tennessee Health Science Center College of Medicine Memphis, Tennessee, USA
- Department of Urology, University of Southern California, Keck School of Medicine, USA
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4
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Approaches to Tumors of the Nail Unit and Genitalia. Dermatol Clin 2022; 41:163-174. [DOI: 10.1016/j.det.2022.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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5
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Noor F, Saleem MH, Chen JT, Javed MR, Al-Megrin WA, Aslam S. Integrative bioinformatics approaches to map key biological markers and therapeutic drugs in Extramammary Paget's disease of the scrotum. PLoS One 2021; 16:e0254678. [PMID: 34292991 PMCID: PMC8297842 DOI: 10.1371/journal.pone.0254678] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 06/30/2021] [Indexed: 12/16/2022] Open
Abstract
Extramammary Paget’s disease (EMPD) is an intra-epidermal adenocarcinoma. Till now, the mechanisms underlying the pathogenesis of scrotal EMPD is poorly known. This present study aims to explore the knowledge of molecular mechanism of scrotal EMPD by identifying the hub genes and candidate drugs using integrated bioinformatics approaches. Firstly, the microarray datasets (GSE117285) were downloaded from the GEO database and then analyzed using GEO2R in order to obtain differentially expressed genes (DEGs). Moreover, hub genes were identified on the basis of their degree of connectivity using Cytohubba plugin of cytoscape tool. Finally, GEPIA and DGIdb were used for the survival analysis and selection of therapeutic candidates, respectively. A total of 786 DEGs were identified, of which 10 genes were considered as hub genes on the basis of the highest degree of connectivity. After the survival analysis of ten hub genes, a total of 5 genes were found to be altered in EMPD patients. Furthermore, 14 drugs of CHEK1, CCNA2, and CDK1 were found to have therapeutic potential against EMPD. This study updates the information and yields a new perspective in the context of understanding the pathogenesis of EMPD. In future, hub genes and candidate drugs might be capable of improving the personalized detection and therapies for EMPD.
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Affiliation(s)
- Fatima Noor
- Department of Bioinformatics and Biotechnology, Government College University, Faisalabad, Pakistan
| | | | - Jen-Tsung Chen
- Department of Life Sciences, National University of Kaohsiung, Kaohsiung, Taiwan
| | - Muhammad Rizwan Javed
- Department of Bioinformatics and Biotechnology, Government College University, Faisalabad, Pakistan
| | - Wafa Abdullah Al-Megrin
- Biology Department, Faculty of Science, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Sidra Aslam
- Department of Bioinformatics and Biotechnology, Government College University, Faisalabad, Pakistan
- * E-mail:
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6
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Waldron T. Sibyl Horner, Sydney Alexander Henry, and occupational skin disease. JOURNAL OF MEDICAL BIOGRAPHY 2020; 28:207-213. [PMID: 29998786 DOI: 10.1177/0967772018783383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Occupational skin disease was, and remains, a major cause of morbidity, accounting for many thousands of hours lost from work each year. Investigating the causes, and seeking preventive measures, occupied much of the time of the early Medical Inspectors of Factories. Two of the inspectors, Sydney Henry and Sibyl Horner, became specialists in certain types of skin disease.
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7
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Xu JG, Wu ML, Dai HY, Wang YC, Xue CY. Divisional Reconstruction Strategy: The Repair of Perineal Skin Defect After Tumor Resection. Scand J Surg 2020; 110:73-77. [PMID: 32031049 DOI: 10.1177/1457496920903980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS The unique anatomical and physiological function of the perineum region makes it difficult to be repaired after tumor resection. We aim to evaluate the efficacy of PSC divisional reconstruction strategy in the reconstruction of perineal skin defect. MATERIALS AND METHODS This study includes patients undergoing perineal skin defect reconstruction with PSC strategy-P (penis), S (scrotum), C (circum-penoscrotal skin) divisional reconstruction strategy. RESULTS From August 2013 to August 2018, 47 patients were enrolled in the surgical procedure. The defect area after resection measured 2 cm × 2.5 cm, minimum, and 12 cm × 18 cm, maximum. Among them, the cases involved one, two, and three zones are 12, 10, and 25, respectively. The skin defects were divisionally repaired. All flaps were well survived without complications or scar contracture. No tumor recurrence happened. CONCLUSION The application of PSC divisional reconstruction strategy is a promising way to repair wounds in circum-penoscrotal skin area. Moreover, this strategy is easy to process and shows no significant complications during follow-up period.
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Affiliation(s)
- J-G Xu
- Department of Plastic Surgery, First Affiliated Hospital of Second Military Medical University, Shanghai, China
| | - M-L Wu
- Department of Plastic Surgery, First Affiliated Hospital of Second Military Medical University, Shanghai, China
| | - H-Y Dai
- Department of Plastic Surgery, First Affiliated Hospital of Second Military Medical University, Shanghai, China
| | - Y-C Wang
- Department of Plastic Surgery, First Affiliated Hospital of Second Military Medical University, Shanghai, China
| | - C-Y Xue
- Department of Plastic Surgery, First Affiliated Hospital of Second Military Medical University, Shanghai, China
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Abstract
Extramammary Paget's disease (EMPD) is a rare and lethal intraepithelial malignancy that remains poorly understood. No standardized guidelines or consensus statements exist with regards to the diagnostic evaluation, therapeutic approaches and follow-up management. Complete surgical excision with negative margins has been accepted as the mainstay of treatment for EMPD to decrease the risk of local recurrence and to maximize durable cure. Non-invasive therapies, such as laser therapy, photodynamic therapy, radiotherapy and topical chemotherapy have been utilized, but are best reserved for non-surgical candidates. While the debate on the surgical approach between wide local excision (WLE) and Mohs micrographic surgery (MMS) continues, several studies have demonstrated the ability of WLE to be performed safely and effectively and to yield equally satisfactory outcomes with similar rates of recurrence to MMS. Patients undergoing surgical excision often require complex closures with skin grafting or local flaps to close genital defects. We aim to provide an up-to-date review of the current knowledge of EMPD. In addition to discussing the clinical presentation and prognostic outcomes, we focus and elaborate on the diagnostic approaches and treatment alternatives available. This information may serve as a primer for the urologist who may be called upon to treat this malignancy primarily or to provide wound coverage secondarily.
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Affiliation(s)
- Joon Yau Leong
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia PA, USA
| | - Paul H Chung
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia PA, USA
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9
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Extramammary Paget Disease of the Scrotum: A Contemporary Clinicopathologic Analysis of 20 Cases in the United States. Appl Immunohistochem Mol Morphol 2019; 28:524-531. [PMID: 31290785 DOI: 10.1097/pai.0000000000000789] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Extramammary Paget disease (EMPD) often involves apocrine gland-bearing locations including vulva and perianal area. EMPD of the scrotum is rare. Twenty patients were identified from the pathology files of 4 institutions between 2000 and 2018. Patients were 63- to 87-year-old (mean: 73 y) with a history of symptoms of between 4 months and 10 years. Two patients had a history of prostate cancer. Follow-up was available in 11 patients for a median of 71 months (range: 8 to 126 mo). Nine of 11 patients (82%) had positive margins, and 73% required reexcisions. Three patients had a focal dermal invasion, 1 of whom reportedly died of another etiology 25 months post diagnosis and 2 were disease-free at 24 and 68 months. No patient had inguinal lymphadenopathy. Two patients were alive with disease. Immunohistochemically, GATA3 and GCDFP15 were expressed in 6/6 cases, CK7 in 8/8 cases, and androgen receptor in 13/13 cases. HER2 was positive in 5/12 cases. PSA was positive in 1 patient who had a history of prostate cancer, whereas other prostate markers (NKX3.1 and prostein) were negative, and CK7 and GCDFP15 were positive, rendering primary EMPD diagnosis. Twelve other cases were negative for PSA and NKX3.1. In conclusion, EMPD of the scrotum has an insidious onset and its nonspecific symptoms can be misdiagnosed as dermatitis or fungal infection. Although localized EMPD has a favorable prognosis, the invasive disease is rare and did not predict metastasis or progression. Margins are frequently positive requiring reexcision. Occasionally, cases can be positive for PSA leading to diagnostic pitfalls.
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10
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Zhang G, Zhou S, Zhong W, Hong L, Wang Y, Lu S, Pan J, Huang Y, Su M, Crawford R, Zhou Y, Mai R. Whole-Exome Sequencing Reveals Frequent Mutations in Chromatin Remodeling Genes in Mammary and Extramammary Paget's Diseases. J Invest Dermatol 2019; 139:789-795. [PMID: 30905357 DOI: 10.1016/j.jid.2018.08.030] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 08/06/2018] [Accepted: 08/06/2018] [Indexed: 02/05/2023]
Abstract
Paget's disease (PD) is an intraepidermal adenocarcinoma of the skin at the breast (mammary PD) or urogenital locations (extramammary PD [EMPD]). At present, there is lack of clarity on PD's pathogenesis, the relationship between its subtypes, and its lineage link with the underlying invasive carcinomas. Here we describe that mammary PD and EMPD have similar mutational profiles, with the most frequent recurrent mutations occurring in the chromatin remodeling genes, such as KMT2C (MLL3, 39%) and ARID2 (22%), with additional recurrent somatic mutations detected in genes previously not known to be mutated in cancers, such as CDCC168 (34%), FSIP2 (29%), CASP8AP2 (29%), and BIRC6 (24%). In paired mammary PD and underlying breast carcinoma samples, distinct gene mutations were detected, indicating that they represent independent oncogenic events. Finally, multistage EMPD tissue sequencing revealed KMT2C gene occurring early in EMPD oncogenesis, and that multifocal EMPD samples share the same early gene mutations, suggesting clonal origin of multifocal EMPD. Our results reveal similar genomic landscapes between mammary PD and EMPD, including early aberrations in chromatin remodeling genes. In addition, mammary PD and underlying breast ductal carcinomas represent independent oncogenic events. These findings provide approaches for developing diagnostic tools and therapeutic interventions for PD.
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Affiliation(s)
- Guohong Zhang
- Department of Pathology, Shantou University Medical College, Shantou, Guangdong, China
| | - Songxia Zhou
- Department of Pathology, Shantou University Medical College, Shantou, Guangdong, China
| | - Weixiang Zhong
- Department of Pathology, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Liangli Hong
- Department of Pathology, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Yuanyuan Wang
- Department of Pathology, Shantou Central Hospital of and the Affiliated Shantou Hospital of Sun Yat-Sen University, Shantou, Guangdong, China
| | - Shanming Lu
- Department of Pathology, Meizhou Central Hospital, Meizhou, Guangdong, China
| | - Jiankai Pan
- Department of Pathology, Shantou Hospital of Dermatology, Shantou, Guangdong, China
| | - Yuansheng Huang
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mingwan Su
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Richard Crawford
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Youwen Zhou
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Ruiqin Mai
- Department of Laboratory Medicine, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China.
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Chung PH, Leong JY, Voelzke BB. Surgical Experience With Genital and Perineal Extramammary Paget's Disease. Urology 2019; 128:90-95. [PMID: 30902697 DOI: 10.1016/j.urology.2019.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/04/2019] [Accepted: 03/08/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe our surgical experience for the treatment and management of extramammary Paget's disease (EMPD). METHODS Our surgical approach involves excising a 2-cm margin of normal appearing skin around the EMPD-suspicious lesion. Prior to excision, the tissue is oriented and demarcated into predefined segments in coordination with a pathologist. Frozen sections are performed when necessary to guide additional excision. Xenograft or wet-to-dry dressings are applied depending on size and location of the wound while the specimen is expeditiously reviewed over the following 24-48 hours. If positive margins remain, further excision of the corresponding skin segment is performed. Delayed complex wound closure +/- split thickness skin grafting is performed once negative margins are confirmed. RESULTS Ten EMPD patients were referred to two academic centers between 2014 and 2018. Two patients had positive lymph nodes at diagnosis and underwent palliative surgery and died within 12 and 29 months. The remaining 8 patients underwent a median of 1 surgery (range 0-3) with referring providers before undergoing a median of 3 surgeries (range 2-5) at our institutions to achieve negative surgical margins and wound reconstruction (7 split thickness skin grafts, 1 secondary closure). At mean follow-up of 15 months, 1 patient recurred, required further excision, and remains disease free. CONCLUSION EMPD is a rare malignancy with poorly described treatment methodologies. Due to its multifocal distribution and asymmetric spread, obtaining negative margins can be challenging. Our systematic approach to obtaining wide margins and documenting excised skin has enabled us to achieve negative margins for this challenging malignancy.
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Affiliation(s)
- Paul H Chung
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.
| | - Joon Yau Leong
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Bryan B Voelzke
- Department of Urology, University of Washington Medical Center, Seattle, WA
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12
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Yao H, Xie M, Fu S, Guo J, Peng Y, Cai Z, Jiang Y, Zheng D, Wang Z. Survival analysis of patients with invasive extramammary Paget disease: implications of anatomic sites. BMC Cancer 2018; 18:403. [PMID: 29636019 PMCID: PMC5894213 DOI: 10.1186/s12885-018-4257-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 03/20/2018] [Indexed: 11/21/2022] Open
Abstract
Background Extramammary Paget disease (EMPD) is a rare malignant dermatosis with poorly defined outcomes. We investigated clinical characteristics of invasive EMPD at different anatomic sites and by subject demographics to determine prognostic factors for overall survival (OS). Methods All patient data were collected from the Surveillance, Epidemiology, and End Results (SEER) program, 1973–2013, of the U.S. National Cancer Institute. Patients with invasive EMPD of skin, vulva/labia, vagina, scrotum/penis, or other sites were included. After excluding patients with unknown radiation status, data of 2001 patients were analyzed. Primary endpoint was EMPD mortality by anatomic sites. Independent variables included patients’ demographic data, concurrent malignancy (ie, non-EMPD related cancers), tumor size, distant metastasis, and surgery and/or radiation or not. Results Multivariate regression analysis showed that mortality was significantly higher in patients with vaginal EMPD than in patients with vulvar/labial EMPD (adjusted hazard ratio [aHR] = 3.26, p < 0.001). Patients with distant metastasis had higher mortality than those without (aHR = 3.36, p < 0.001). Patients who received surgery had significantly lower mortality than those who did not receive surgery (aHR = 0.77, p = 0.030), and those treated with radiation had significantly higher mortality than those who did not receive radiation (aHR = 1.60, p = 0.002). Older age was associated with significantly increased mortality (aHR = 1.09, p < 0.001), and mortality was significantly higher in males than in females (aHR = 1.42, p = 0.008). Conclusions In conclusion, among EMPD patients, mortality is higher in patients with vaginal EMPD than in those with vulvar/labial EMPD and higher in those who are older, those with concurrent malignancy or distant metastasis. Mortality is also higher in males than in females. Surgery is a protective factor and radiation is a risk factor for OS. Greater understanding of EMPD clinical characteristics, and considering EMPD in differential diagnosis of chronic genital and perianal dermatoses may provide support for early EMPD diagnosis and definitive surgical treatment.
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Affiliation(s)
- Haijun Yao
- Department of Urology, Shanghai 9th People's Hospital, Shanghai Jiao Tong University, School of Medicine, 639 Zhizaoju Rd, Shanghai, 200011, People's Republic of China
| | - Minkai Xie
- Department of Urology, Shanghai 9th People's Hospital, Shanghai Jiao Tong University, School of Medicine, 639 Zhizaoju Rd, Shanghai, 200011, People's Republic of China
| | - Shibo Fu
- Department of Urology, Shanghai 9th People's Hospital, Shanghai Jiao Tong University, School of Medicine, 639 Zhizaoju Rd, Shanghai, 200011, People's Republic of China
| | - Jianhua Guo
- Department of Urology, Shanghai 9th People's Hospital, Shanghai Jiao Tong University, School of Medicine, 639 Zhizaoju Rd, Shanghai, 200011, People's Republic of China
| | - Yubing Peng
- Department of Urology, Shanghai 9th People's Hospital, Shanghai Jiao Tong University, School of Medicine, 639 Zhizaoju Rd, Shanghai, 200011, People's Republic of China
| | - Zhikang Cai
- Department of Urology, Shanghai 9th People's Hospital, Shanghai Jiao Tong University, School of Medicine, 639 Zhizaoju Rd, Shanghai, 200011, People's Republic of China
| | - Yueqing Jiang
- Department of Urology, Shanghai 9th People's Hospital, Shanghai Jiao Tong University, School of Medicine, 639 Zhizaoju Rd, Shanghai, 200011, People's Republic of China
| | - Dachao Zheng
- Department of Urology, Shanghai 9th People's Hospital, Shanghai Jiao Tong University, School of Medicine, 639 Zhizaoju Rd, Shanghai, 200011, People's Republic of China.
| | - Zhong Wang
- Department of Urology, Shanghai 9th People's Hospital, Shanghai Jiao Tong University, School of Medicine, 639 Zhizaoju Rd, Shanghai, 200011, People's Republic of China.
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Padoveze EH, Ocampo-Garza J, Di Chiacchio NG, Cernea SS, Di Chiacchio N, Ocampo-Garza SS. Mohs micrographic surgery for basal cell carcinoma of the scrotum. Int J Dermatol 2018; 57:750-752. [DOI: 10.1111/ijd.13989] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 03/03/2018] [Accepted: 03/05/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Emerson H. Padoveze
- Department of the Sao Paulo Municipal Public Server Hospital; São Paulo Brazil
| | - Jorge Ocampo-Garza
- Dermatology Department; Faculty of Medicine of ABC; São Paulo Brazil
- Dermatology Department; University Hospital “Dr. José Eleuterio González”; Universidad Autónoma de Nuevo León; Monterrey México
| | - Nilton G. Di Chiacchio
- Department of the Sao Paulo Municipal Public Server Hospital; São Paulo Brazil
- Dermatology Department; Faculty of Medicine of ABC; São Paulo Brazil
| | - Selma S. Cernea
- Department of the Sao Paulo Municipal Public Server Hospital; São Paulo Brazil
| | - Nilton Di Chiacchio
- Department of the Sao Paulo Municipal Public Server Hospital; São Paulo Brazil
| | - Sonia S. Ocampo-Garza
- Dermatology Department; University Hospital “Dr. José Eleuterio González”; Universidad Autónoma de Nuevo León; Monterrey México
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14
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Park SO, Ha JH, Hong KY, Chang H. Usefulness of Mapping Biopsy in the Treatment of Penoscrotal Extramammary Paget’s Disease. Ann Surg Oncol 2017; 24:3229-3236. [DOI: 10.1245/s10434-017-5947-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Indexed: 11/18/2022]
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Human papillomavirus 16 is an aetiological factor of scrotal cancer. Br J Cancer 2017; 116:1218-1222. [PMID: 28376081 PMCID: PMC5418448 DOI: 10.1038/bjc.2017.74] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 02/23/2017] [Accepted: 03/01/2017] [Indexed: 01/21/2023] Open
Abstract
Background: Squamous cell scrotal carcinoma (SCSC) is an infrequent skin cancer associated historically with occupational carcinogens. Human papillomavirus (HPV) DNA has been associated with SCSC but there is no definitive proof of its oncogenic role. Methods: Human papillomavirus-DNA and –E6*I mRNA were analysed in six invasive histologically typed SCSC. LCM-PCR was used to localise HPV DNA to tumour cells. P16INK4aand p53 expression were studied by immunohistochemistry. Results: In three warty or basaloid SCSC HPV16-DNA and E6*I-mRNA were detected. LCM-PCR confirmed HPV16 was in p16INK4a-positive malignant cells. However, of three usual-type SCSC, all were HPV-negative and two expressed p53 protein but not p16INK4a. Conclusions: Human papillomavirus 16 was present in tumour cells and oncogenically active in basaloid and warty SCSC, whereas usual SCSC was HPV-negative and showed immunostaining, suggesting p53 mutation. The dual pathways of oncogenesis and relation between histological type of SCSC and HPV are similar to that in penile cancers.
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El Alaoui A, El Boté H, Ziouani O, Dembele O, El Sayegh H, Iken A, Benslimane L, Nouini Y. [Scrotal fistulas revealing mucinous adenocarcinoma of the scrotum: about a case]. Pan Afr Med J 2017; 26:190. [PMID: 28674583 PMCID: PMC5483345 DOI: 10.11604/pamj.2017.26.190.9515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 03/06/2017] [Indexed: 11/29/2022] Open
Abstract
Les fistules scrotales sont rares, et souvent secondaires à des lésions de tuberculose. Les adénocarcinomes mucineux sont des tumeurs qui renferment au moins 50% de mucus extracellulaire, et siègent préférentiellement sur le recto sigmoïde, la localisation scrotale est inhabituelle. Nous rapportons un cas d’adénocarcinome mucineux secondaire du scrotum révélé par des fistules scrotales, chez un patient âgé de 54 ans, sans antécédents pathologiques notables, qui présente depuis deux ans des fistules scrotales à répétition, sans autres signes associés. L’examen trouve de multiples fistules scrotales avec issue de pus épais, le toucher rectal est normal. Les explorations urologiques (UIV, UCRM, Cystoscopie, …) sont normales, le bilan infectieux ainsi que la recherche de BK dans les urines et le crachat sont négatives. La biopsie de la peau scrotale est revenue en faveur d’un adénocarcinome mucineux moyennement différencié, dont l’étude immun histochimique est en faveur d’une origine primitive colorectale. L’évolution a été marqué par l’apparition de fistules anales complexes, ayant a l’IRM une caractéristique active, alimentant plusieurs collections pelvi périnéales comportant des bourgeons charnus. Sur le plan thérapeutique et vu la rareté de ce cancer, il n’y a pas de consensus. La résection chirurgicale reste le traitement de choix pour cette affection. La radio chimiothérapie pré opératoire est préconisée pour ce type de cancer mais son rôle n’est pas bien établi. Chez notre patient on a opté pour une radio chimiothérapie néo adjuvante première, avant la réalisation d’une amputation abdomino- périnéale.
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Affiliation(s)
| | - Hicham El Boté
- Service d'Urologie A, Hôpital Ibn Sina, CHU Rabat, Maroc
| | | | | | | | - Ali Iken
- Service d'Urologie A, Hôpital Ibn Sina, CHU Rabat, Maroc
| | | | - Yassine Nouini
- Service d'Urologie A, Hôpital Ibn Sina, CHU Rabat, Maroc
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Bickell M, Beilan J, Wallen J, Wiegand L, Carrion R. Advances in Surgical Reconstructive Techniques in the Management of Penile, Urethral, and Scrotal Cancer. Urol Clin North Am 2017; 43:545-559. [PMID: 27717440 DOI: 10.1016/j.ucl.2016.06.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
This article reviews the most up-to-date surgical treatment options for the reconstructive management of patients with penile, urethral, and scrotal cancer. Each organ system is examined individually. Techniques and discussion for penile cancer reconstruction include Mohs surgery, glans resurfacing, partial and total glansectomy, and phalloplasty. Included in the penile cancer reconstruction section is the use of penile prosthesis in phalloplasty patients after penectomy, tissue engineering in phallic regeneration, and penile transplantation. Reconstruction following treatment of primary urethral carcinoma and current techniques for scrotal cancer reconstruction using split-thickness skin grafts and flaps are described.
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Affiliation(s)
- Michael Bickell
- Department of Urology, University of South Florida, Tampa, FL, USA
| | - Jonathan Beilan
- Department of Urology, University of South Florida, Tampa, FL, USA
| | - Jared Wallen
- Department of Urology, University of South Florida, Tampa, FL, USA
| | - Lucas Wiegand
- Department of Urology, University of South Florida, Tampa, FL, USA
| | - Rafael Carrion
- Department of Urology, University of South Florida, Tampa, FL, USA.
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18
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Glaser ZA, White M, McKinley E, Glaser JS. Squamous Cell Carcinoma of the Scrotum After Brachytherapy and External Beam Radiotherapy for Prostate Cancer: Case Report and Review of the Literature. Clin Genitourin Cancer 2016; 15:e91-e93. [PMID: 27634567 DOI: 10.1016/j.clgc.2016.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 08/01/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Zachary A Glaser
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN.
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19
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Halfya A, Elmortaji K, Redouane R, Fethi M, Rafik A, Mohamed E, Abdessamad C. [Squamous cell carcinomas of the scrotum: about 7 cases with review of the literature]. Pan Afr Med J 2015; 20:163. [PMID: 26113906 PMCID: PMC4469445 DOI: 10.11604/pamj.2015.20.163.5991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 02/10/2015] [Indexed: 11/11/2022] Open
Abstract
Quoique rare le carcinome épidermoïde du scrotum a un mauvais pronostic. Les Carcinomes du scrotum induite et - liées au travail sont moins fréquentes en raison d'une meilleure hygiène, vêtements de protection, et la sensibilisation de la cancérogénicité des huiles industrielles. L’épidémie à l'HPV a induit une augmentation de l'incidence. Le traitement de dépend toujours exérèse locale de la lésion primaire. La radiothérapie a peu de bénéfice thérapeutique dans le traitement d'un carcinome épidermoïde du scrotum. La bléomycine peut être utile comme traitement adjuvant pour les maladies ilio-inguinal généralisée avant la tentative exérèse, même si cela n'a pas encore été prouvé. Entre janvier 2011 au 1er janvier 2013, 7 patients atteints de carcinome épidermoïde ont été pris en charge, Trois patients ont présenté une localisation ganglionnaire. Les sept patients ont eu un traitement chirurgical par exérèse large avec reconstruction, Deux patients ont été adressé pour chimiothérapie.2 patients ont présenté une récidive, dont un est décédé.
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Affiliation(s)
- Ayoub Halfya
- Service d'Urologie du Chu Ibn Rochd, Casablanca, Maroc
| | | | | | - Meziane Fethi
- Service d'Urologie du Chu Ibn Rochd, Casablanca, Maroc
| | - Amine Rafik
- Centre Nationale des Brules et de Chirurgie Plastique -CHU Ibn-Rochd, Casablanca, Maroc
| | - Ezzoubi Mohamed
- Centre Nationale des Brules et de Chirurgie Plastique -CHU Ibn-Rochd, Casablanca, Maroc
| | - Chlihi Abdessamad
- Centre Nationale des Brules et de Chirurgie Plastique -CHU Ibn-Rochd, Casablanca, Maroc
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20
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Herrel LA, Weiss AD, Goodman M, Johnson TV, Osunkoya AO, Delman KA, Master VA. Extramammary Paget’s Disease in Males: Survival Outcomes in 495 Patients. Ann Surg Oncol 2015; 22:1625-1630. [DOI: 10.1245/s10434-014-4139-y] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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21
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Phukan C, Abrol N, Kumar RM, Devasia A. Squamous cell carcinoma of the scrotum: the revisit of a rare disease. ANZ J Surg 2015; 87:E161-E162. [PMID: 25766760 DOI: 10.1111/ans.13059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Chandan Phukan
- Department of Urology, Christian Medical College, Vellore, India
| | - Nitin Abrol
- Department of Urology, Christian Medical College, Vellore, India
| | - Ramani M Kumar
- Department of Pathology, Christian Medical College, Vellore, India
| | - Antony Devasia
- Department of Urology, Christian Medical College, Vellore, India
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22
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Vyas R, Zargar H, Trolio RD, Lorenzo GD, Autorino R. Squamous cell carcinoma of the scrotum: A look beyond the chimneystacks. World J Clin Cases 2014; 2:654-660. [PMID: 25405188 PMCID: PMC4233419 DOI: 10.12998/wjcc.v2.i11.654] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 08/23/2014] [Accepted: 09/17/2014] [Indexed: 02/05/2023] Open
Abstract
Despite the low incidence, squamous cell carcinoma (SCC) remains the most common scrotal malignancy with a propensity for recurrence and metastasis. In recent years there has been a significant change in the epidemiology of scrotal SCC. Surgery is the mainstay of treatment for resectable disease. Sentinel lymph node dissection adapted from experience with penile SCC can reduce the morbidity of routine lymph node dissection. Emerging treatments for advanced and metastatic SCC are at the cusp of significantly changing management of this disease. We have performed a comprehensive review of scrotal SCC with a focus on these topics.
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Maniar KP, Nayar R. HPV-related squamous neoplasia of the lower anogenital tract: an update and review of recent guidelines. Adv Anat Pathol 2014; 21:341-58. [PMID: 25105936 DOI: 10.1097/pap.0000000000000035] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Squamous cell carcinomas of the lower anogenital tract that are related to human papillomavirus (HPV) infection represent a significant disease burden worldwide. The diagnosis and management of their noninvasive precursors has been the subject of extensive study and debate over several decades, accompanied by an evolving understanding of HPV biology. Recent new consensus recommendations for the pathologic diagnosis of these precursor lesions were published in 2012, the result of the Lower Anogenital Squamous Terminology project cosponsored by the College of American Pathologists and the American Society for Colposcopy and Cervical Pathology. Most salient among the new guidelines are the recommendation to switch to a 2-tiered nomenclature (high-grade squamous intraepithelial lesion and low-grade squamous intraepithelial lesion) rather than the traditional 3-tiered "intraepithelial neoplasia" terminology, and the recommendation to expand use of the immunohistochemical marker p16 to distinguish between low-grade squamous intraepithelial lesion and high-grade squamous intraepithelial lesion/intraepithelial neoplasia 2. The goals of the project were to align diagnostic terminology with our knowledge of HPV biology, increase reproducibility, consolidate diverse systems of nomenclature, and ultimately better determine a patient's true cancer risk. The clinical guidelines for screening and management of cervical intraepithelial neoplasia have also been recently updated, most notably with a lengthening of screening intervals. In this review, we focus on the new guidelines put forth for pathologic diagnosis of HPV-related anogenital neoplasia, with discussion of the evidence behind them and their potential implications. We also provide an update on relevant biomarkers, clinical recommendations, and the newest developments relating to cervical neoplasia.
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Scrotal abscess as initial presentation of squamous cell carcinoma. Case Rep Urol 2013; 2013:807346. [PMID: 24102031 PMCID: PMC3786534 DOI: 10.1155/2013/807346] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 08/13/2013] [Indexed: 11/17/2022] Open
Abstract
We report a case of scrotal squamous cell carcinoma in a 67-year-old man that presented as a recurrent nonhealing scrotal abscess. Radical scrotectomy and bilateral simple orchiectomy were performed. A pudendal thigh flap was used for wound closure. To our knowledge, this is the first report of its use after radical surgery for scrotal cancer. The clinical features, staging, and treatment of scrotal squamous cell carcinoma are reviewed. In this report, we highlight the importance of including scrotal cancer in the differential diagnosis when evaluating a scrotal abscess.
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Adult inguinoscrotal sarcomas: outcome analysis of 21 cases, systematic review of the literature and meta-analysis. World J Urol 2013; 32:445-51. [DOI: 10.1007/s00345-013-1124-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 06/24/2013] [Indexed: 10/26/2022] Open
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Verhoeven RHA, Aben KKH, van Rossum MM, Reedijk AM, Botterweck AA, Veerbeek L, Visser O, van der Aa MA, Ho VKY, Coebergh JWW, Kiemeney LALM. New insights into the aetiology of scrotal cancer, a nationwide case-control study in the Netherlands. J Eur Acad Dermatol Venereol 2012; 28:65-71. [PMID: 23216598 DOI: 10.1111/jdv.12056] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Although scrotal cancer is traditionally regarded as an occupational disease, there is increasing evidence that factors which are involved in cutaneous and genital carcinogenesis might play a role in the carcinogenesis of scrotal cancer. OBJECTIVE This exploratory study aimed to detect exposures that might have an aetiological relation with scrotal cancer. METHODS A nationwide population-based case-control study was conducted in the Netherlands. The patients were identified through the Netherlands cancer registry. Controls were recruited among acquaintances of the cancer registry registrars. The participants completed a questionnaire that included questions on occupational exposures, naked sunbathing, use of sunbeds, skin diseases and their treatments, treatments for cancer and sexually transmitted diseases. Age-adjusted odds-ratios (ORs) were calculated. RESULTS Forty-seven scrotal cancer patients and 125 controls completed the questionnaire. The patients were categorized according to histology of the scrotal tumours. Having had a skin disease (OR = 6.3, 95% CI = 1.8-22), especially psoriasis (OR = 8.7), increased the risk of squamous cell carcinomas (SCC) of the scrotum. A previous cancer diagnosis may affect the risk of scrotal basal cell carcinomas (BCC; OR = 4.9, 95% CI = 0.9-27.3). Furthermore, an association between the number of sexual partners and the occurrence of scrotal sarcoma was found. CONCLUSION Scrotal SCCs may be related with skin diseases or skin disease treatments. Having had cancer may be a risk factor for a BCC of the scrotum. Scrotal sarcomas seem to be correlated with the number of sexual partners. This study suggests that scrotal cancer has characteristics of both cutaneous and genital carcinogenesis.
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Affiliation(s)
- R H A Verhoeven
- Eindhoven Cancer Registry/Comprehensive Cancer Centre South, EindhovenDepartment of Research & Registration, Comprehensive Cancer Centre The Netherlands, UtrechtDepartment of Health Evidence, Radboud University Medical CentreDepartment of Dermatology, Radboud University Medical Centre, NijmegenDepartment of Public Health, Erasmus University Medical Centre, RotterdamDepartment of Urology, Radboud University Medical Centre, Nijmegen, The Netherlands
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Abstract
The scrotal and perineal area serves a special function. It is the pelvic outlet for the gastrointestinal tract, urinary system, and sexual function. In the male, the scrotum allows testicular mobility to reduce trauma and allow optimal thermal regulation for spermatogenesis. Trauma, infection, and cancer resection create defects that require reconstruction. The reconstructive goal here is to obtain durable coverage, function, and lastly aesthetic outcome. Pedicled local and regional flaps are the mainstay for this area. Due to the special function and appearance of the scrotum, reconstructive options for total scrotal defect always fall far short of the native scrotum. On the other hand, perineal reconstruction is overall satisfactory.
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Affiliation(s)
- Nho V Tran
- Division of Plastic Surgery, Mayo Clinic, Rochester, Minnesota
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28
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Peng W, Feng G, Lu H, Chen J, Chen K, Hao Y, Cao Y. A case report of scrotal carcinoma and review of the literature. Case Rep Oncol 2012; 5:434-8. [PMID: 22949906 PMCID: PMC3433011 DOI: 10.1159/000341942] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Scrotal carcinoma is a rare tumor. We report one case of such disease in a 60-year-old man presenting with an ulcerated-bleeding lesion on the left side of the scrotum and an enlarged lymph node in the left inguinal region. Biopsy of the ulcerated lesion found squamous cell carcinoma of the scrotum. He underwent initial tumor resection and left inguinal lymph node biopsy followed by postoperative concurrent chemoradiotherapy. Postoperative pathological examination confirmed well-differentiated squamous cell carcinoma of the scrotum and lymph node metastasis. Five months after the treatment, the size of the lymph node was dramatically decreased, with no signs of tumor progression. Surgical treatment combined with concurrent chemoradiotherapy may be an appropriate management approach to achieve palliative symptom relief for this disease.
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Affiliation(s)
- Wei Peng
- Department of Medical Oncology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning City, PR China
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Using the Surveillance, Epidemiology, and End Results Database to Investigate Rare Cancers, Second Malignancies, and Trends in Epidemiology, Treatment, and Outcomes. Curr Probl Cancer 2012; 36:191-9. [DOI: 10.1016/j.currproblcancer.2012.03.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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30
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Scrotal cancer survival is influenced by histology: a SEER study. World J Urol 2012; 31:585-90. [PMID: 22418823 DOI: 10.1007/s00345-012-0834-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2011] [Accepted: 01/24/2012] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Due to the scrotum's multiple layers of different tissues, scrotal cancer can present with several unique histologies. Historically, outcome arising from these different sources has been historically aggregated together. However, it remains unclear whether survival differs by histology of scrotal cancer. METHODS We queried the seventeen registries of the Surveillance, Epidemiology, and End Results database for patients diagnosed with primary scrotal cancer from 1973 to 2006. Patients were initially grouped by the following histologies: basal cell carcinoma, Extramammary Paget's Disease (EMPD), sarcoma, melanoma, squamous cell carcinoma, and adnexal skin tumors. For some analyses, the former three histologies were reclassified as Low-Risk scrotal cancer and the latter three histologies as High-Risk scrotal cancer. Kaplan-Meier survival analyses were conducted to assess the impact of histology on overall survival (OS). RESULTS The cohort consisted of 766 patients. Median (95% CI) OSs by histologies were basal cell carcinoma--143 (116-180), EMPD--165 (139-190), sarcoma--180 (141-219), melanoma--136 (70-203), squamous cell carcinoma--115 (97-133), and adnexal skin tumors--114 (55-174). Patients with Low-Risk scrotal cancer experienced a median (95% CI) OS of 166 (145-188) months, while patients with High-Risk scrotal cancer experienced a median (95% CI) OS of 118 (101-135) months. CONCLUSIONS Survival of scrotal cancer depends on tumor histology. Classification of histologies into Low and High Risk can be clinically useful for counseling and clinical decisions.
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31
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Dai B, Kong YY, Ye DW, Xu XW, Yao XD, Zhang SL. Basal cell carcinoma of the scrotum: clinicopathologic analysis of 10 cases. Dermatol Surg 2012; 38:783-90. [PMID: 22309181 DOI: 10.1111/j.1524-4725.2012.02356.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Basal cell carcinoma (BCC) located on the scrotum is rare. OBJECTIVE To analyze clinical and pathologic features, discuss therapeutic strategies, and identify prognostic factors of scrotal BCC in Chinese patients. MATERIALS AND METHODS Between 2000 and 2010, 10 patients with scrotal BCC were diagnosed and treated at our institution. A review was performed using the clinical records and dermatopathologic slides of these patients. RESULTS The median patient age was 70. Skin lesions presented as red nodules and brownish plaques. All patients were treated using wide excision without adjuvant therapy. After an average follow-up of 47 months, eight patients were in good health without any relapse. One patient developed left inguinal lymph node metastasis at 21 months that was successfully treated using bilateral inguinal lymphadenectomy. One patient developed bilateral pulmonary metastasis at 48 months and was palliatively treated with chemotherapy. The clinical and histopathologic risk factors predisposing to metastasis were large primary neoplasms; a long period of misdiagnosis; and infiltrating, morpheaform, spiky, irregular outline pathologic patterns. CONCLUSIONS BCC of the scrotum is rare. It can metastasize after a long period of initial therapy. Long-term surveillance including a complete metastatic examination is recommended for these patients.
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Affiliation(s)
- Bo Dai
- Department of Urology, Shanghai Cancer Center, Shanghai, China
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32
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Verhoeven RHA, Kiemeney LALM, Coebergh JWW, Weiderpass E, Kjaerheim K, Martinsen JI, Lynge E, Pukkala E. Occupation and scrotal cancer: results of the NOCCA study. Acta Oncol 2011; 50:1244-6. [PMID: 22023117 DOI: 10.3109/0284186x.2011.618509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Verhoeven RHA, Louwman WJ, Koldewijn EL, Demeyere TBJ, Coebergh JWW. Scrotal cancer: incidence, survival and second primary tumours in the Netherlands since 1989. Br J Cancer 2010; 103:1462-6. [PMID: 20877361 PMCID: PMC2990603 DOI: 10.1038/sj.bjc.6605914] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Since the 1970s there have been few epidemiological studies of scrotal cancer. We report on the descriptive epidemiology of scrotal cancer in the Netherlands. METHODS Data on all scrotal cancer patients were obtained from the Netherlands Cancer Registry (NCR) in the period 1989-2006 and age-standardised incidence rates were calculated also according to histology and stage. Relative survival was calculated and multiple primary tumours were studied. RESULTS The overall incidence rate varied around 1.5 per 1,000,000 person-years, most frequently being squamous cell carcinoma (27%), basal cell carcinoma (19%) and Bowen's disease (15%). Overall 5-year relative survival was 82%, being 77% and 95% for patients with squamous and basal cell carcinoma, respectively. In all, 18% of the patients were diagnosed with a second primary tumour. CONCLUSION The incidence rate of scrotal cancer did not decrease, although this was expected; affected patients might benefit from regular checkups for possible new cancers.
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Affiliation(s)
- R H A Verhoeven
- Department of Research, Eindhoven Cancer Registry, Comprehensive Cancer Centre South, PO Box 231, Eindhoven 5600 AE, The Netherlands.
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Guo J, Zhou S, Rao NP, Pez GH. Pleomorphic malignant fibrous histiocytoma/undifferentiated high-grade pleomorphic sarcoma of the scrotum in a patient presenting as fournier gangrene: a case report. Appl Immunohistochem Mol Morphol 2010; 18:473-8. [PMID: 20505510 DOI: 10.1097/pai.0b013e3181de57f6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Pleomorphic malignant fibrous histiocytoma (MFH), also known as undifferentiated high-grade pleomorphic sarcoma according to the latest World Health Organization classification, is a diagnosis of exclusion and extremely rare in adult scrotal/paratesticular region. Clinical presentation of scrotal/paratesticular pleomorphic MFH is usually a painless and gradual scrotal swelling. We report a case of scrotal MFH in a 63-year-old man who presented as Fournier gangrene after 10-month painful scrotal swelling and multiple procedures. The specimen of emergent debridement was submitted for pathologic and bacteriologic examination. Microscopically, the lesion had marked architectural and cytologic pleomorphism. The neoplastic cells were positive for vimentin, but negative for all lineage-specific markers. Fluorescence in-situ hybridization showed an aneuploid karyotype and negative results for lipomatous tumor abnormalities. Bacterial cultures of the specimen showed extensive growth of virulent polymicrobes. The diagnosis of scrotal/paratesticular pleomorphic MFH with concurrent Fournier gangrene was made. Thoracic computed tomography scan showed bilateral multiple pulmonary nodules. The patient died 1 month later.
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Affiliation(s)
- Juan Guo
- Department of Pathology, Keck School of Medicine, LAC and USC Medical Center, University of Southern California, CA, USA
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