Scrotal cancer
Introduction
Introduction to scrotal cancer Squamous cell carcinoma scrotum, also known as scrotal cancer (carcinoma of scrotum). The cause is unknown, there are many long-term exposures of soot, phenolic oil and other substances, so it is related to occupational factors, more common in 50 to 70 years old. Multiple lymphatic metastasis. basic knowledge The proportion of illness: 0.001@ Susceptible people: male, more common in 50 to 70 years old Mode of infection: non-infectious Complications: tongue cancer prostate cancer bladder cancer lung cancer colon cancer kidney cancer adrenal tumor
Cause
Sinus cancer cause
(1) Causes of the disease
Scrotal squamous cell carcinoma is the first example of human occupational cancer caused by environmental carcinogenic factors. It is the basis for the initiation of chemical carcinogenesis experiments. In 1774, British surgeon Pott noticed some teenagers who had been cleaning chimney assistants since childhood. Some people often develop ulcers in the scrotum after adulthood, and the pathology proves to be cancerous, thus suggesting the relationship between scrotal cancer and occupation. In 1784, Bell further discovered that workers who work in ash and dust operations also have such cancers. In 1922, Southan reported 141 cases of scrotal cancer, 69 cases of fine spinning, and 22 cases of long-term exposure to asphalt or paraffin. At this time, due to the elimination of chimney sweeping work, only one case was a chimney sweeper, and reports have been added since then. It proves that scrotal cancer is related to occupations such as petroleum, tar, asphalt, worsted, machinery, etc. Due to lack of labor protection, the skin of the scrotum, perineum, penis, etc. is easily deposited by various mineral oils and dust pollution on the skin wrinkles with strong sebum secretion. Medium, long-term exposure to the main carcinogen 3,4 benzopyrene and cause cancer.
Since exposure to carcinogens to cancer is a multi-factor, multi-link process, the occurrence of scrotal cancer often takes a long time. Take chimney sweepers as an example. Juvenile exposure to middle-aged and old-aged diseases is usually ten. For many years, the longest is 68 years, and the occurrence of cancer is also thought to have a certain relationship with sensitivity, genetic and genetic mutations. In recent years, it has been useful in penile scrotal squamous cell carcinoma and precancerous lesions (Queyrat erythema). The PCR method was used to detect the reports of human papillomavirus (HPV) types 16, 18 and 6/11 (Burmer, 1993). Therefore, it has been considered that HPV may be the causative factor of scrotal cancer, but most still think that this factor is more Small (Orihuela, 1995), scrotal cancer is still more related to occupational and environmental factors.
(two) pathogenesis
Squamous cell carcinoma (squamous cell carcinoma) is also known as epidermoid carcinoma. Carcinogenesis originates from epidermal keratinocytes and often occurs on the basis of chronic skin diseases and precancerous lesions, such as chronic inflammation. Chemical substances and sun damage can occur in the skin mucosa of any part of the body.
The histopathological changes of scrotal squamous cell carcinoma are similar to those of other parts of the body. The tumor consists of irregularly proliferating squamous cells invading the dermis. The cells within the mass are cells of different degrees of differentiation, but only observed under the microscope. The abnormality is not obvious. The degree of canceration and malignancy is still mainly infiltration. According to the differentiation and depth of tissue infiltration, scrotal squamous cell carcinoma is usually classified into grade I~IV. The cancer infiltrates mainly on the skin, and rarely invades the scrotum. Things.
About 1/2 to 3/4 of patients with scrotal cancer have an inguinal lymphadenopathy, but most of them are caused by inflammation. Only less than half of them are cancer metastasis. From the discovery of primary cancer to lymph node metastasis, it is generally 6~ 12 months, in the advanced stage, there may be para-vascular lymph node metastasis.
In situ epithelial carcinoma of the scrotal skin is called Bowen's disease, which is a low-grade squamous cell carcinoma. It is associated with ultraviolet radiation and exposure to chemical carcinogens, and sometimes it should be differentiated from erythroplasia of queyrat. The pathological changes were mainly thickening of the epithelial layer, prolongation of the skin process, atypical hyperplasia of the cells, abnormal nuclear division, giant cells of the tumor and dyskeratocytes.
Prevention
Scrotal cancer prevention
The prevention of this disease is to improve the working environment, avoid carcinogens, and keep clean, to avoid or reduce the occurrence of scrotal cancer.
1 Minimize infection and avoid exposure to radiation and other harmful substances, especially drugs that have an inhibitory effect on immune function.
2 Appropriate exercise, enhance physical fitness and improve your disease resistance.
Complication
Scrotal cancer complications Complications tongue cancer prostate cancer bladder cancer lung cancer colon cancer kidney cancer adrenal tumor
About 30% to 40% of scrotal cancers can be multifocal, and can also be accompanied by other parts of skin cancer or deep tissue cancer, such as tongue cancer, prostate cancer, bladder cancer, lung cancer, colon cancer, kidney cancer and adrenal tumor. Etc., both at the same time as scrotal cancer, or in succession, should be considered in connection with the common carcinogenic factors.
Symptom
Scrotal cancer symptoms common symptoms inguinal lymphadenopathy painless scrotal mass scrotum itching papules eczema
Early painless scrotal mass, verrucous or papule-like, further can be cauliflower-like, hardened texture, individual growth rate of tumors varies greatly, and some can change little for many years and suddenly grow faster, the center of the tumor Necrosis and ulceration may occur, accompanied by pus and blood in the infection, odor, local pain, more than 50% of patients have ipsilateral inguinal lymph nodes, advanced tumors can invade the contents of the penis and scrotum, and blood transfer occurs. The systemic symptoms are not obvious.
Examine
Scrotal cancer examination
Biopsy: microscopically, the hyperplastic epithelium breaks through the basement membrane and infiltrates deep into the nest, forming an irregular cord-shaped cancer nest. In the well-differentiated cancer nest, cells corresponding to the basal layer are arranged in the outer layer of the cancer nest. As a cell corresponding to the spine cell layer, an intercellular bridge can be seen between the cells. A layered keratin can be seen in the center of the cancer nest, which is called a bead or cancer bead. The squamous bead is formed in a poorly differentiated cancer nest, and even There is no cell bridge.
Diagnosis
Diagnosis and differentiation of scrotal cancer
diagnosis
The diagnosis is mainly based on clinical manifestations, but it should be noted that the patient may have a history of scrotal itching or burning for several months or years before the occurrence of rash. For the long-term treatment of scrotal eczema, dermatitis, ulcers, the physician should be fully vigilant, considering the scrotal cancer The possibility of local histopathological biopsy is the most powerful diagnosis. For swollen inguinal lymph nodes, biopsy should also be performed to confirm that the diagnosis is inflammatory or true metastasis, although the transfer of scrotal cancer to the retroperitoneal lymph nodes is rare. However, once there is suspiciousness, B-ultrasound, CT, MRI and fine needle aspiration biopsy are also used to help diagnose and clear the stage.
There is no specific and sensitive tumor marker for the diagnosis of scrotal cancer, but in recent years immunohistochemistry and molecular biology diagnostic techniques have also begun to be used for the diagnosis and prognosis of scrotal cancer, and the incidence of human papilloma virus The relationship between (HPV16, etc.) is also noted and studied. For example, the expression of p21 protein of oncogene ras product in scrotal cancer, paracancerous tissues and normal tissues has been detected by immunohistochemistry in China, which is positively correlated with pathological grading and staging. It can be used as an indicator for diagnosing the early recurrence, metastasis and prognosis of scrotal cancer. For example, in the case of scrotal cancer, HPV16-positive tumor suppressor gene TP53 accumulation mutation, P16INK4A, P15INK4B homozygote genetic loss is available. Tumor markers for estimating prognosis of scrotal cancer (Garan, 1999).
Differential diagnosis
1. Testicular tumor: can directly invade the skin of the sheath or scrotum, or transfer to distant organs through blood, similar to scrotal reticular cell sarcoma, rhabdomyosarcoma, leiomyosarcoma, melanoma and other malignant tumors, but the tumor side testicular swelling The surface is smooth, the tumor is hard and heavy, loses its inherent elasticity, and nodules can appear on the surface; tumor cells can be seen by biopsy.
2. Scrotal inflammatory cancer: also known as scrotal skin eczema-like cancer, Paget disease, is a scrotum and nipple isola inflammatory carcinogenesis similar to the lesions, occurs in the age group over 50 years old, long course, scrotal skin redness, Erosion and erythema interlaced skin lesions, chronic inflammation induration, adhesion to the scrotal skin, biopsy see Paget cells, single or nested, along the sweat glands and their ducts, hair follicles, sebaceous glands; epidermal germinal layer The growth is widened, the dermis has round cell infiltration, there are many mitotic figures in the epidermis, the PAS reaction is positive, and the amylase-resistant low molecular weight keratin reaction is positive.
