Perfil clínico, histopatológico, imuno-histoquímico e de infecção por HPV de carcinoma de células escamosas de pênis usuais com áreas de aspecto basaloide

Abstract

Introduction: Penile cancer is a rare disease with high morbidity and mortality, affecting preferentially lower socioeconomic regions. The diagnosis and its prognostic profile is defined through morphological examinations and surgery is still the main treatment. Objective: To characterize the clinical-histopathological, immunohistochemical and human papillomavirus infection profile in patients from the state of Maranhão, Brazil, diagnosed with squamous cell carcinoma of the penis (SCC), the usual subtype with areas of basaloid aspect and to show its relationship with tumor aggressiveness. Methods: Retrospective study, with 96 cases of Squamous cell carcinoma of the penis diagnosed in the state of Maranhão,Brazil, in the period between 2007 and 2021, separated into two groups, the group without areas of basaloid aspect (N=68) and the usual with areas of basaloid aspect (n=28), represented by groups of rounded cells, with higher nucleus-cytoplasm ratio, without necrosis and that did not involve > 20% of the tumor surface. Their clinical-epidemiological, histological and immunohistochemical (Ki67, p16 and p53) and HPV infection characteristics were observed. Considered significant the result with p<0.05. Results: Comparing the usual groups with and without areas of basaloid appearance, similarity was observed in the sociodemographic variables related to age over 60 years, origin of rural residence and northern region of the state, brown skin colour and married marital status, as well as no or low education and occupation farmer. There were no statistically significant differences between the two groups in relation to lifestyle and habits of life, nor to the symptoms reported, such as smoking, alcoholism, history of sexually transmitted infections (STIs) and age at first sexual intercourse less than 18 years. Most of the population presented HPV detection, absence of angio lymphatic invasion and involvement of corpora cavernosa and tunica albuginea, as well as presence of perineural invasion, involvement of corpus spongiosum and urethra, presence of peri-tumoral lymphocytic infiltrate and association with carcinoma in situ. The usual group with basaloid aspect areas showed differences with statistical significance in the degree of differentiation (p =0.001) and applied staging (p=0.0042), with predominance of stage II and III. This group also presented more cases with the presence of angio lymphatic and perineural invasion, involvement of corpora cavernosa and tunica albuginea, association with carcinoma in situ and lymph node involvement. The range of disease-free time, in cases that could be followed up, was shorter in the usual group with basaloid areas than in the usual group without basaloid areas, from 0 to 31 months and from 0 to 62 months, respectively. Conclusion: the usual SCCs, unlike the other subtypes of SCCs, have a variable predictive prognostic profile and need to gather a lot of information to better manage the patient's follow up. The basaloid aspect did not bring results with statistical significance in our population, despite having shown higher percentage of socio-demographic risk factors and positivity for histological criteria said to be more aggressive, such as invasion of corpora cavernosa and tunica albuginea, presence of angio-lymphatic and perineural invasion, lymph node involvement. New researches are necessary in the search for predictive criteria of this high morbidity and mortality disease.