2 Results

    2.1 Pathological Study

    2.1.1 Gross appearance The tumours of penis ranged from1to7.5cm in diameter.The tumours were verruˉcous or cauliflower in the67cases(88%).In the other9cases，they were nodular.

    2.1.2 Microscopic appearance The tumour was comˉposed of large well-differentiated squamous epithelial cells，showing papilloma-like upward growth and covˉered by thick parakeratic or hyperkeratic materials.And their epithelial retia showed spheroid or sharp downward expansion，below some of which the masses of well-difˉferentiated squamous cell could be observed.The adˉvancing margins of the epithelial retia with well-defined delimitation often pushed away the adjacent tissues and downward local invasion(Figure1).The tumour invaded tunica propriae in36cases，facia in10cases，tunica alˉbuginea in26cases and superficial cav

    ernosa in4cases.Pathological mitosis and mild atypia could be rarely seen.The basement membrane could be observed intact in the Gordon-Sweets staining(Figure2).Immunohisˉtochemical staining，Keratin were expressed in tumor cells，Laminin were expressed in basement membranes.

    In all cases，the inflammatory cells，more or less，infiltrated into the stroma，with immerging into or encirˉcling the nests of carcinoma in35cases(46%).The tuˉmor cells underwent degeneration and necrosis，and were phagocytized by phagocytes forming carcinolysis(Figure3).The metastasis were not found by pathological examiˉnation in all resection of the regional lymph nodes taking from38patients.(Figure1～3to be seen in attached page2)

    2.2 Follow-up The follow-up survey was made in all cases，but only succeed in65cases(85.5%).Among the succeeded ones，37patients took regional excision oftumor or partial amputation of penis and28cases did toˉtal amputation or enlarging radical operation.The survey showed that no patients died of this disease with a36years follow-up after surgical treatment and in good health.

    3 Discussion

    3.1 Pathogenesis Phimosis and redundant prepuce are the main causes of the disease.The ratio of verrucous carcinoma to carcinoma of penis varied in different reˉports [2～4] ，which might be related to the misdiagnosis as squamous cell carcinoma.The76cases in this article acˉcount for44.2%of the patients operated with carcinoma of penis in the same time(1966～2002).Verrucous carˉcinomahas a preference to originate in penis.

    3.2 Biological Behavior According to the pathological observation of these cases，verrucous carcinoma has the characteristics of verrucous or papillary appearance，propulsive local invasion，long course，slow growth，rare metastasis，favorable prognosis and low degree maligˉnant.

    3.3 Pathological Diagnosis Our study shows that the histopathological changes and biological behavior of the verrucous carcinoma differs from those of squamous cell carcinoma of penis.Our opinion is that difference should be made on thediagnosis and surgical treatment between verrucous and squamous cell carcinoma.In the past，some took it totally as squamous cell carcinoma，leading to the unnecessary enlargement of the field of operation.54cases out of all these had original pathological diagnoˉsis as squamous cell carcinoma，leading to the unnecesˉsary total amputation of the penis and grafting of the ureˉthra in28cases，excision of testicles in17ones，and disˉ section of regional lymph nodes in38ones.In order to avoid unnecessary enlargement of the field of operation，it is proper to differentiate verrucous carcinoma from squaˉmous cell carcinoma as a special type when diagnosing.