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中华腔镜泌尿外科杂志(电子版) ›› 2026, Vol. 20 ›› Issue (02) : 231 -236. doi: 10.3877/cma.j.issn.1674-3253.2026.02.018

MDT精选病例

广东省医学会泌尿外科疑难病例多学科会诊(第28期)——阴茎癌并双侧腹股沟、髂外动脉旁淋巴结转移
周明宽, 罗程, 庄锦涛, 涂响安()   
  1. 510080 广州,中山大学附属第一医院泌尿外科
  • 收稿日期:2025-12-04 出版日期:2026-04-01
  • 通信作者: 涂响安

Multidisciplinary consultation on difficult cases in Guangdong Urological Association (Phase 28): penile cancer with lymph node metastases in the bilateral inguinal regions and beside the external iliac artery

Mingkuan Zhou, Cheng Luo, Jintao Zhuang, Xiang'an Tu()   

  1. Department of Urology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
  • Received:2025-12-04 Published:2026-04-01
  • Corresponding author: Xiang'an Tu
引用本文:

周明宽, 罗程, 庄锦涛, 涂响安. 广东省医学会泌尿外科疑难病例多学科会诊(第28期)——阴茎癌并双侧腹股沟、髂外动脉旁淋巴结转移[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2026, 20(02): 231-236.

Mingkuan Zhou, Cheng Luo, Jintao Zhuang, Xiang'an Tu. Multidisciplinary consultation on difficult cases in Guangdong Urological Association (Phase 28): penile cancer with lymph node metastases in the bilateral inguinal regions and beside the external iliac artery[J/OL]. Chinese Journal of Endourology(Electronic Edition), 2026, 20(02): 231-236.

本文报道一例晚期阴茎癌的病例。患者男性,44岁,因"阴茎溃烂3月,漏尿1月余"入院,查体示阴茎远端明显肿大,包皮不能外翻,包皮口溃疡面渗液;右侧腹股沟区可见一大小约4 cm×3 cm包块,质韧,活动度差,双侧腹股沟可触及肿大淋巴结。影像学检查提示阴茎癌并双侧腹股沟区、髂外动脉旁多发淋巴结转移。初步诊断阴茎癌并双侧腹股沟区、髂外动脉旁多发淋巴结转移。经广东省医学会泌尿外科疑难病例多学科会诊(MDT),专家组建议完善全身评估,先行新辅助治疗和免疫治疗,后行阴茎全切术,同期或分期进行腹股沟和盆腔淋巴结清扫,根据术后情况评估是否需要辅助治疗或放疗。告知患者MDT讨论意见,经充分沟通并取得知情同意后,行阴茎部分切除术,术后病理示非人乳头瘤状病毒(HPV)相关性鳞状细胞癌,低分化(肉瘤样鳞状细胞癌)。经4个周期的辅助化疗,淋巴结转移灶明显缓解,行双侧腹股沟淋巴结清扫术,术后定期复查无局部复发及淋巴结复发转移征象。本病例提示,对于晚期阴茎癌,手术治疗联合化疗、免疫治疗等综合治疗模式是提升治疗效果的关键。

This paper reports a case of advanced penile cancer. The patient was a 44-year-old male who was admitted to our hospital due to "penile ulceration for 3 months and urinary leakage for over 1 month." Physical examination revealed significant swelling at the distal end of the penis, with the foreskin being non - retractable and exudate from the ulcerated foreskin opening. A mass about 4 cm×3 cm in size, with a firm texture and poor mobility, was visible in the right inguinal region. Enlarged lymph nodes were palpable in both inguinal regions. Imaging examinations suggested penile cancer with multiple lymph node metastases in the bilateral inguinal regions and beside the external iliac artery. After multidisciplinary consultation by Guangdong Urological Association, the expert group recommended completing a comprehensive assessment of the whole body, followed by neoadjuvant therapy and immunotherapy. Then, a total penectomy should be performed, along with inguinal and pelvic lymph node dissection either simultaneously or in stages. The necessity for adjuvant therapy or radiotherapy would be assessed based on the postoperative situation. The patient was informed of the recommendations. After full communication and obtaining informed consent, a partial penectomy was carried out. The postoperative pathology showed non-HPV-related squamous cell carcinoma, poorly differentiated (sarcomatoid squamous cell carcinoma). Following four cycles of adjuvant chemotherapy, the lymph node metastases were significantly relieved. Subsequently, bilateral inguinal lymph node dissection was performed. Regular follow-up examinations after the operation showed no signs of local recurrence or lymph node recurrence and metastasis. This case indicated that for advanced penile cancer, a comprehensive treatment model combining surgical treatment with chemotherapy, immunotherapy, etc., is the key to significantly improving the therapeutic effect.

图1 阴茎癌患者阴茎肿块及腹股沟区包块注:红色箭头示右侧腹股沟区包块
图2 阴茎癌患者影像学检查示双侧腹股沟淋巴结肿大注:红色箭头为右侧腹股沟区融合淋巴结,蓝色箭头为左侧腹股沟区淋巴结
图3 阴茎癌患者行阴茎部分切除术
图4 阴茎癌患者肿瘤病理注:图片示鳞状上皮异型增生浸润至上皮下间质,肿瘤基底部细胞呈片状分布,细胞呈梭形、短梭形,胞浆丰富、透亮,异型性明显(HE×400)
图5 阴茎癌患者新辅助治疗后右侧腹股沟区淋巴结明显缩小注:红色箭头示化疗前融合淋巴结,蓝色箭头示化疗后缩小的淋巴结
图6 阴茎癌患者右侧腹股沟区淋巴结病理注:图示淋巴结内可见大量泡沫细胞聚集,伴胆固醇结晶沉积,并见多量吞噬角化物的异物巨细胞散在分布(HE×1 000)
图7 阴茎癌患者术后5个月MRI检查结果注:双侧腹股沟区水肿性改变,未见肿大淋巴结
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