[Penile cancer: flow cytometry study of ploidies in 90 patients]. / Cancer du pénis: étude de la ploïdie par cytométrie de flux chez 90 patients.

OBJECTIVE: To evaluate prospectively 90 consecutive cases of squamous cell carcinoma of penis, referred to our Institute, by flow cytometry analysis of cellular DNA content. To compare deoxyribonucleic acid (DNA) flow cytometry with clinical and pathological variables to determine the prognostic significance of this analysis to guide the selection of patients at high risk for development of lymph node metastases. PATIENTS AND METHODS: We determined the nuclear DNA of tissues in fresh biopsy specimens of 80 patients diagnosed histologically as invasive squamous cell penile carcinoma and in fresh biopsy specimens of 10 patients with verrucous carcinoma of penis. Samples were analyzed with a FACScan flow cytometer, equipped with a doublet discrimination module, using the CellFIT software package for data acquisition and analysis. RESULTS: The DNA pattern was diploid in all samples excised from patients with verrucous carcinoma. According to histological type the frequency of aneuploidy was 5.5% (1 of 18) in well differentiated carcinoma, 28.8% (17 of 59) in moderately differentiated carcinoma and 66.6% (2 of 3) in poorly differentiated carcinoma. CONCLUSION: The frequency of DNA aneuploidy showed correlation with histological type of invasive squamous cell carcinoma of the penis. Preliminary analysis suggests that patients with high DNA index may be at increased risk of metastatic involvement.

[The value of biopsy of the inguinal lymph nodes in patients with epidermoid carcinoma of the penis]. / Intérêt des biopsies des ganglions inguinaux chez les patients atteints d'un carcinome épidermoïde de verge.

Twenty-four inguinal biopsies were performed in 16 patients with invasive squamous cell carcinoma of the penis. All patients had suspicion of inguinal metastatic involvement. Five patients (31.25%) had inguinal lymph nodes involved with tumor. Among 11 patients with negative biopsies, 8 were evaluated during careful follow-up. Only 3 patients remained free of tumor at 57.61 and 80 months respectively after negative biopsy.

Verrucous carcinoma of the penis: retrospective analysis of 32 cases.

Between 1972 and 1987, 34 patients with verrucous carcinoma of the penis were referred to our national cancer institute. We analyzed retrospectively the followup of 32 patients treated by surgery, exclusive radiotherapy and neoadjuvant chemotherapy. No patient died or had recurrent verrucous penile carcinoma. Lymph nodes removed from 15 patients without previous treatment did not reveal metastatic invasion. Neoadjuvant chemotherapy allowed for more limited surgery in 3 of 6 patients treated.

Surgical treatment of invasive squamous cell carcinoma of the penis: retrospective analysis of 350 cases.

Between 1960 and 1987, 414 patients with invasive squamous cell carcinoma of the penis were referred to the Brazilian National Cancer Institute. Inguinal metastases were demonstrated by lymphadenectomy in 39% of the 23 patients with stage N0, 49% of 92 with stages N1 and N2, and 100% of 18 with stage N3 disease. We analyzed the followup of 350 patients who underwent surgical treatment. In 224 patients (64%) amputation or some form of penile surgery was done initially, while 102 (29%) underwent amputation and lymphadenectomy, and 24 (7%) underwent palliative surgery for advanced squamous cell carcinoma. The statistics revealed a better 5-year survival rate for the patients who underwent lymphadenectomy concomitantly with penile surgery compared to those who underwent delayed lymphadenectomy (p < 0.001). Patients in whom systematic lymphadenectomy was negative had a better prognosis than those with positive systematic lymphadenectomy results (p < 0.001). The latter patients had a better prognosis compared with those in whom delayed lymphadenectomy was positive (p = 0.0103). Patients with well and moderately differentiated carcinoma had a higher survival rate at 5 years than did those with poorly differentiated carcinoma (p < 0.001 and p = 0.003, respectively). All deaths from metastatic disease occurred within 24 months among the patients who underwent systematic lymphadenectomy and within 5 years after simple penile surgery. In the short term, surgical debulking combined with reconstruction techniques allowed for improved quality of life in patients with advanced local-regional disease.