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Keller N, Haemmerle B, Schmid S. A rare case of Merkel cell carcinoma with ovarian metastasis. Gynecol Oncol Rep 2019; 28:76-78. [PMID: 30963085 PMCID: PMC6434058 DOI: 10.1016/j.gore.2019.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 03/10/2019] [Accepted: 03/18/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction Merkel cell carcinoma (MCC) is a rare cutaneous malignancy that normally occurs in sun-exposed areas of the skin. Risk factors are immundeficency and Merkel cell polyomavirus. Treatment options are surgery, radiotherapy, chemotherapy and immunotherapy in clinical trials. Case report We describe a case of an 80-year-old woman with ovarian metastasis of MCC six years after excision of a cutaneous MCC on the cheek. Discussion To our knowledge only three cases with ovarian metastasis of MCC have been described so far. Our case is the second with distant metastasis to the ovary spreading from a primary tumor in the skin of the head, in the other two cases the primary tumor was in the inguinal skin. Conculsion MCC is a highly aggressive cutaneous and mucosal malignancy with frequent recurrence, lymph node and distant metastases. There is no clear consensus how to treat metastatic disease. MCC is a rare malignancy. Recurrence and metastases are frequent. There is little knowledge of treatments for metastatic MCC.
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Affiliation(s)
- Nicole Keller
- Gynecology and Obstetrics, Hospital Grabs, Spitalstrasse 44, CH-9472 Grabs, Switzerland
| | - Beatrix Haemmerle
- Gynecology and Obstetrics, Hospital Grabs, Spitalstrasse 44, CH-9472 Grabs, Switzerland
| | - Seraina Schmid
- Gynecology and Obstetrics, Hospital Grabs, Spitalstrasse 44, CH-9472 Grabs, Switzerland
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Patibandla JR, Fehniger JE, Levine DA, Jelinic P. Small cell cancers of the female genital tract: Molecular and clinical aspects. Gynecol Oncol 2018; 149:420-427. [PMID: 29458976 DOI: 10.1016/j.ygyno.2018.02.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 02/06/2018] [Accepted: 02/10/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Extra-pulmonary small cell carcinomas of the gynecologic tract (EPSCC-GTs) are a rare group of aggressive malignancies associated with poor prognoses and limited treatment options. Here, we review the clinical and molecular aspects of EPSCC-GTs and discuss how understanding their molecular features can assist in their diagnosis and the identification of novel effective treatments. METHODS We searched PubMed and Scopus for articles using the following keywords: "small cell carcinoma" in combination with "neuroendocrine", "ovary", "vagina", "fallopian tube", "vulva", "endometrium", "uterus", "cervix", or "gynecologic". Articles were limited to those published in English from January 1984 to October 2017. RESULTS EPSCC-GTs account for 2% of all gynecologic malignancies. The molecular features of EPSCC-GTs are largely understudied and unknown, with the exception of small cell carcinoma (SCC) of the ovary, hypercalcemic type (SCCOHT) and SCC of the cervix (SCCC). In nearly all cases, SCCOHT displays mutation in a single gene, SMARCA4, a member of the SWI/SNF chromatin remodeling complex. The loss of expression of the SWI/SNF protein SMARCA2 is another feature of SCCOHT. Dual negative staining for SMARCA2 and SMARCA4 is specific for SCCOHT and is generally used by gynecologic pathologists for the accurate diagnosis of this malignancy. Mutational analysis of SCCC has shown alterations in PIK3CA, KRAS and TP53, of which the last is the most common, although other actionable mutations have been identified. The molecular features of other EPSCC-GTs are largely unknown. CONCLUSIONS Due to their rarity, the majority of EPSCC-GTs are understudied and poorly understood. As demonstrated in the case of SCCOHT, unraveling the mutational profiles of these tumors can lead to improved diagnosis and the identification of novel therapeutic targets.
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Affiliation(s)
- Jay R Patibandla
- Gynecologic Oncology, Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, NY 10016, United States
| | - Julia E Fehniger
- Gynecologic Oncology, Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, NY 10016, United States
| | - Douglas A Levine
- Gynecologic Oncology, Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, NY 10016, United States
| | - Petar Jelinic
- Gynecologic Oncology, Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, NY 10016, United States.
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Açıkalın A, Paydaş S, Güleç ÜK, Uğuz A, Gümürdülü D. A unique case of merkel cell carcinoma with ovarian metastasis. Balkan Med J 2015; 31:356-9. [PMID: 25667793 DOI: 10.5152/balkanmedj.2014.14117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 08/14/2014] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Merkel cell carcinoma (MCC) is a rare cutaneous/mucosal malignancy with very aggressive biology and increasing incidence. Ovarian metastasis is an exceptionally rare site for MCC, and only two cases have been reported in the literature. CASE REPORT We report MCC with ovarian metastasis. A 34 year-old female with previously excised MCC from preauricular skin presented with a pelvic mass 15 months after first diagnosis. Anti-cytokeratin (CK) 20 positivity, LCA (leucocyte common antigen), and TTF-1 (Thyroid transcription factor-1) negativity confirmed metastatic ovarian MCC. There was no evidence of recurrence or metastasis at 12 months after salpingooopherectomy. CONCLUSION MCC should be considered in the differential diagnosis of primary and metastatic undifferentiated small round cell tumors of the ovary.
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Affiliation(s)
- Arbil Açıkalın
- Department of Pathology, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Semra Paydaş
- Department of Medical Oncology, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Ümran Küçükgöz Güleç
- Department of Gynecology and Obstetrics, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Aysun Uğuz
- Department of Pathology, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Derya Gümürdülü
- Department of Pathology, Çukurova University Faculty of Medicine, Adana, Turkey
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Abstract
Small cell carcinoma (SCC) of the female genital tract is rare, constituting less than 2% of all gynecologic malignancies. It occurs most frequently in the cervix but can also occur in the endometrium, ovary, fallopian tube, vagina, and vulva. SCC of the genital tract is microscopically indistinguishable from that of the lung. Neuroendocrine differentiation is often manifested by a histologic growth pattern, argyrophilia, ultrastructural demonstration of secretory granules, and expression of neuroendocrine markers. Patients with SCC of the female genital tract may be asymptomatic but usually present with localized pain, vaginal bleeding, abdominal bloating or a mass, or symptoms of metastasis disease to the liver, bone, lung, or regional lymph nodes. Ectopic Cushing's syndrome has been reported in SCC of the vagina, and hypercalcemia and inappropriate secretion of antidiuretic hormone have been noted with SCC of the ovary. In general, these tumors have an aggressive clinical course with a propensity for extensive local invasion and distant metastases. Therapy has included surgery, radiation, and chemotherapy akin to those regimens used for SCC of the lung. Although there are no randomized clinical trials, it appears that multimodality therapy is associated with the best results and is the treatment of choice for most patients. Despite aggressive therapy, however, the prognosis for SCC of the female genital tract is poor, with only a minority of patients enjoying a prolonged survival. Indeed, the majority of patients have an early demise with extensive distant disease. We review the clinical features, evaluation, and management of SCC of the female genital tract based on a comprehensive review of the literature.
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Affiliation(s)
- Sara Crowder
- Mid-Missouri Gynecologic Oncology, Columbia, MO 65201, USA.
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Ohi S, Niimi S, Okada N, Yamada K, Tachibana T, Hashimoto H, Nakajima M, Yasuda M, Tanaka T, Sato K, Ishikawa H. Establishment and characterization of a human ovarian small cell carcinoma, hypercalcemic type, cell line (OS-1) secreting PTH, PthrP and ACTH--special reference to the susceptibility of anti-cancer drugs. Hum Cell 2005; 17:203-9. [PMID: 16035505 DOI: 10.1111/j.1749-0774.2004.tb00044.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We successfully established a novel cell line (OS-1) derived from human ovarian small cell carcinoma, hypercalcemic type secreted PTH, PTH-rP and ACTH. The OS-1 cell line was established from metastatic focus of uterus. A patient was 25-year-old Japanese woman. The first she received left ovariectomy on April 2002. The histopathological diagnosis was ovarian small cell carcinoma, pT2c, Nx, Mx. Then on June 2003, metastatic focus of uterus was ectomied. A part of the recurrent tumor of uterus was cut into small pieces with razor blades, and dissociated with 0.1% trypsin-0.02% EDTA/ PBS(-) solution at room temperature. The single cells and small cell clusters were seeded into 60mm dishes and cultured in growth medium (GM: DMEM/F12 supplemented with 20% fetal bovine serum and 0.1% non-essential amino acids solution) at 37 degrees C, 4.7% CO2 in humidified air. Medium was exchanged twice a week. The OS-1 cells grew as floating cultures in the dishes. Radioimmunoassay of the conditioned media was revealed that the cultures secreted large amount of PTH, PTHrP and ACTH simultaneously. Susceptibilities of anti-cancer drugs to the OS-1 cells were examined using oxygen electrode meter (Daikin), and the results suggested VLB and TXL were effective, and CDDP, CPT-11, VP-16, VCR, CPA, MMC and CBDCA were not effective. In our knowledge, it is the first report that the cell line secreting PTH, PTHrP and ACTH was successfully established from ovarian small cell carcinoma, hypercalcemic type. We expect that OS-1 cell line contribute to study on the mechanism of ectopic hormone secretion and susceptibility of anti cancer drugs to the small cell carcinoma.
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Affiliation(s)
- Satoshi Ohi
- Department of Anatomy II, Jikei University of Medicine
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Abstract
Merkel cell carcinoma (MCC) is a rare primary cutaneous neuroendocrine carcinoma. It has a propensity for both locoregional and distant recurrence despite treatment. We describe the case of a 51-year-old man diagnosed with MCC of the left forehead. At 14 months post surgery and adjuvant radiotherapy he developed an isolated deposit of metastatic MCC in the paraspinal soft tissues of his lower back. This atypical site of metastatic disease was treated with radiotherapy and combination chemotherapy. Atypical and isolated sites of metastatic MCC, although infrequently reported, highlight the often bizarre nature of this aggressive skin cancer. Treatment in such cases needs to be individualized.
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Affiliation(s)
- Wei Wang
- Head and Neck Cancer Service, Westmead Hospital, Sydney, New South Wales, Australia
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Bakshi NA, Wojno KJ. Pathologic quiz case: a 76-year-old man with abdominal pain and rapidly progressive course. Arch Pathol Lab Med 2001; 125:1251-2. [PMID: 11520286 DOI: 10.5858/2001-125-1251-pqcayo] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- N A Bakshi
- Department of Pathology, St John Hospital and Medical Center, Detroit, MI, USA
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Abstract
Small cell tumors of the ovary are uncommon but represent an important group to recognize in the differential diagnosis of primary and metastatic ovarian neoplasms. In some cases the correct diagnosis cannot be confidently made on the basis of clinical setting, routine light microscopy, and immunohistochemistry, and electron microscopy may be supportive or definitive in establishing cell type. The cell type is often important in choosing optimal therapy and in predicting prognosis. The authors performed electron microscopy on a moderate number of ovarian small cell tumors and here describe and illustrate the diagnostic features of representative examples of various types. The ultrastructural features of the metastatic tumors, such as embryonal rhabdomyosarcoma, neuroblastoma, and melanoma, are identical to those of their respective primary tumors, are well known, and usually pose no problem in diagnosis. On the other hand, the ultrastructural features of some primary ovarian small cell tumors may present a more difficult differential diagnosis, because they have features that are subtle and/or in common. Exemplary of tumors in this category are diffuse adult granulosa cell tumor, endometrial stromal sarcoma, and small cell carcinomas of the hypercalcemic and pulmonary (oat cell) types. Distinguishing among them may be difficult but is possible, and electron microscopy may be a valuable supplement to the diagnostic information obtained from the clinical presentation, light microscopy, immunohistochemistry and, in some tumors, cytometric analysis of these neoplasms.
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Affiliation(s)
- G R Dickersin
- Department of Pathology, Harvard Medical School, Massachusetts General Hospital, Boston 02114, USA
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Hauschild A, Rademacher D, Röwert J, Christophers E. Merkel-Zell-Karzinom: Verlaufsbericht von 10 Patienten. Langenbecks Arch Surg 1997. [DOI: 10.1007/bf02391864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Brousse C, Baumelou E, Moisson P, Epardeau B, Mignot L. [Merkel cell carcinoma: primary cutaneous neuroendocrine tumor]. Rev Med Interne 1996; 17:1025-8. [PMID: 9008751 DOI: 10.1016/s0248-8663(97)80847-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Merkel cell carcinoma is a neuroendocrine primitive tumor of the skin. We report a case who develops node and visceral metastasis, and dead. The clinical presentation, diagnosis, histology, immunocytochemistry, treatment and prognosis of this tumor will be discussed.
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Affiliation(s)
- C Brousse
- Service d'oncologie et d'hématologie, hôpital Foch, Suresnes, France
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