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Okonkwo PC, Henning A, Plaza J, Agrawal A, Contreras CM. A rare tonsillar metastasis of Merkel cell carcinoma: A case report. Clin Case Rep 2023; 11:e7063. [PMID: 36950672 PMCID: PMC10025251 DOI: 10.1002/ccr3.7063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/02/2023] [Accepted: 02/20/2023] [Indexed: 03/22/2023] Open
Abstract
Merkel cell carcinoma (MCC) metastasis to the tonsil is extremely rare with five published cases. We report the case of a patient with palatine tonsillar MCC metastasis, who presented without oropharyngeal symptoms, which contrast prior reported cases.
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Affiliation(s)
| | - Ania Henning
- The Ohio State Wexner Medical CenterColumbusOhioUSA
| | - Jose Plaza
- The Ohio State Wexner Medical CenterColumbusOhioUSA
| | - Amit Agrawal
- The Ohio State Wexner Medical CenterColumbusOhioUSA
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2
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Lowenstein SE, Lohman ME, Yu SS. A Case Report of Two Patients Developing Multiple Merkel Cell Carcinomas – Using Comparative Genomic Hybridization to Elucidate Tumor Relationship. JAAD Case Rep 2022; 22:21-23. [PMID: 35282160 PMCID: PMC8904380 DOI: 10.1016/j.jdcr.2022.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
| | | | - Siegrid S. Yu
- Correspondence to: Siegrid S. Yu, MD, Department of Dermatology, University of California, San Francisco, 1701 Divisadero, San Francisco, CA 94143.
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3
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DeGiovanni JC, Kuo CC, Tokarz EL, Shah AT, OLeary M. Not Your Typical Tonsil: Metastatic Merkel Cell Carcinoma or Primary Disease? Cureus 2021; 13:e14604. [PMID: 34040905 PMCID: PMC8139134 DOI: 10.7759/cureus.14604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Merkel cell carcinoma (MCC) is a rare, aggressive neuroendocrine tumor that almost always presents as a cutaneous lesion in the sun-exposed areas on the bodies of elderly white males. Metastasis to lymph nodes in the presence or absence of a known primary site and occurrence of these tumors in non-sun-exposed sites have also been described; however, an incidence of recurrent disease arising in the palatine tonsil in the absence of any detectable primary lesion has never been reported in the literature. In this report, we discuss a case of a 72-year-old female who was found to have a single axillary lymph node, which was resected and proved to be positive forMCC of unknown primary (MCCUP). Since there was no evidence of additional disease, the patient elected not to pursue adjuvant therapies. Six and a half months later, she presented with a complaint of dysphagia and a right-sided exophytic tonsillar mass. Tonsillectomy revealed MCC with no detectable primary cutaneous lesion. She received adjuvant therapy with avelumab and demonstrated a complete response after one year of bi-weekly treatments. Seven months following cessation of adjuvant treatments, surveillance positron emission tomography (PET) revealed enlarged retroperitoneal, pretracheal, periaortic, and left axillary lymph nodes concerning for recurrence. She elected to forgo additional biopsies and restarted avelumab the following month. She continues to be followed up on a monthly basis.
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Affiliation(s)
- Jason C DeGiovanni
- Otolaryngology - Head and Neck Surgery, University at Buffalo-State University of New York, Buffalo, USA
| | - Cathleen C Kuo
- Otolaryngology - Head and Neck Surgery, University at Buffalo-State University of New York, Buffalo, USA
| | - Ellen L Tokarz
- Otolaryngology - Head and Neck Surgery, University at Buffalo-State University of New York, Buffalo, USA
| | - Ameer T Shah
- Otolaryngology - Head and Neck Surgery, Tufts Medical Center, Boston, USA
| | - Miriam OLeary
- Otolaryngology - Head and Neck Surgery, Tufts Medical Center, Boston, USA
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4
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de Arruda JAA, Mesquita RA, Canedo NHS, Agostini M, Abrahão AC, de Andrade BAB, Romañach MJ. Merkel cell carcinoma of the lower lip: A case report and literature review. Oral Oncol 2020; 113:105019. [PMID: 32988749 DOI: 10.1016/j.oraloncology.2020.105019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 09/17/2020] [Indexed: 10/23/2022]
Abstract
Merkel cell carcinoma (MCC) is an aggressive primary cutaneous neuroendocrine carcinoma that predominantly affects the sun-damaged skin of the head and neck region, extremities, and trunk of white older individuals. Microscopically, small to intermediate round blue cells show granular nuclei with a salt-and-pepper chromatin pattern, and are usually positive for epithelial and neuroendocrine markers, particularly for cytokeratin 20 in a perinuclear dot-like staining. The 5-year overall survival rate for individuals with localized MCC is 51% and the most common treatment choice is surgery with adjuvant radiotherapy. As far as we know, 23 cases of MCC of the lips have been reported to date in the English-language literature. We herein contribute by reporting a case of MCC affecting the lower lip of an 81-year-old male patient from Rio de Janeiro, Brazil, which likely represents the first reported case from Latin America. A review of the current literature is also included in an effort to familiarize providers with this rare, but potentially lethal neuroendocrine tumor.
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Affiliation(s)
- José Alcides Almeida de Arruda
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
| | - Ricardo Alves Mesquita
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
| | - Nathalie Henriques Silva Canedo
- Department of Pathology, Clementino Fraga Filho University Hospital, School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
| | - Michelle Agostini
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
| | - Aline Corrêa Abrahão
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
| | | | - Mário José Romañach
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
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5
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Merkel Cell Carcinoma of the Maxillary Sinus: An Unusual Presentation of a Common Tumor. Head Neck Pathol 2020; 15:691-697. [PMID: 32915383 PMCID: PMC8134595 DOI: 10.1007/s12105-020-01219-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/27/2020] [Accepted: 08/29/2020] [Indexed: 12/17/2022]
Abstract
Merkel cell carcinoma is most commonly seen in the skin of sun exposed areas, particularly the head and neck and is associated with Merkel cell polyomavirus. Merkel cell carcinoma at an extracutaneous mucosal site of the head and neck is rare. We report a case of a 74-year-old women who presented with an enlarging thyroid mass found to be neuroendocrine carcinoma consistent with Merkel cell carcinoma (positive for synaptophysin, chromogranin, CK20). Subsequent work up revealed a maxillary sinus mass with extension into the nasal cavity. Biopsy was diagnostic for Merkel cell carcinoma (positive for synaptophysin, chromogranin, CK20 and Merkel cell polyomavirus). There are only case reports and small case series of Merkel cell carcinoma arising in the mucosal sites of the head and neck most commonly in the oral cavity, rarely the sinonasal mucosa. Merkel cell carcinoma metastasizing to the thyroid has only been reported in three other case reports, all from skin primaries. In addition to our case, we review the literature of extracutaneous sinonasal Merkel cell carcinoma and metastases to the thyroid.
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6
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Hwang W, Kang MS, Kim JW. Two separate nodules of Merkel cell carcinoma occurring concomitantly on one cheek. Arch Craniofac Surg 2019; 20:203-206. [PMID: 31256560 PMCID: PMC6615417 DOI: 10.7181/acfs.2018.02236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 11/12/2018] [Indexed: 11/11/2022] Open
Abstract
Merkel cell carcinoma (MCC) is a rare and highly aggressive neuroectodermal carcinoma arising from mechanoreceptor Merkel cells. Multiple MCCs are even rarer. We report a case of two independent MCCs simultaneously present in the cheek of a patient, which were effectively and esthetically treated using a cheek flap. Punch biopsy performed in a 60-year-old woman admitted with a chief complaint of two skin-colored hard nodules in her left cheek, accompanied by an itching sensation, was suggestive of MCC. Accordingly, we performed sentinel lymph node biopsy through the modified Blair incision under general anesthesia, in cooperation with the head and neck surgery department. The defect was covered with a cheek flap by slightly extending the existing incision following wide excision with a safety margin of 1 cm. This paper is significant in that it introduces an effective reconstruction technique that maintains function using a cheek flap for the management of this rare case. In addition, this paper is the first to classify multiple MCCs according to the time of onset. We believe that this paper presents an effective alternative reconstruction technique with sentinel node biopsy through the modified Blair incision.
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Affiliation(s)
- Woosuk Hwang
- Department of Plastic and Reconstructive Surgery, Inje University School of Medicine, Busan, Korea
| | - Mi Seon Kang
- Department of Pathology, Inje University School of Medicine, Busan, Korea
| | - Jin Woo Kim
- Department of Plastic and Reconstructive Surgery, Inje University School of Medicine, Busan, Korea
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7
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A case of combined Merkel cell carcinoma and squamous cell carcinoma: Molecular insights and diagnostic pitfalls. JAAD Case Rep 2018; 4:996-999. [PMID: 30417062 PMCID: PMC6216094 DOI: 10.1016/j.jdcr.2018.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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Hanner S, Wieland U, Hartschuh W, Enk A, Toberer F. Merkel cell polyomavirus integration-PCR in bilateral metachronous Merkel cell carcinoma on the nose. J Eur Acad Dermatol Venereol 2018; 33:e16-e18. [PMID: 29888815 DOI: 10.1111/jdv.15113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- S Hanner
- Department of Dermatology, Venerology and Allergology, University Medical Center, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - U Wieland
- Institute of Virology, National Reference Center for Papilloma- and Polyomaviruses, University of Cologne, Cologne, Germany
| | - W Hartschuh
- Department of Dermatology, Venerology and Allergology, University Medical Center, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - A Enk
- Department of Dermatology, Venerology and Allergology, University Medical Center, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - F Toberer
- Department of Dermatology, Venerology and Allergology, University Medical Center, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
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Patel P, Modi C, McLellan B, Ohri N. Radiotherapy for inoperable Merkel cell carcinoma: a systematic review and pooled analysis. Dermatol Pract Concept 2018; 8:149-157. [PMID: 29785334 PMCID: PMC5955084 DOI: 10.5826/dpc.0802a15] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 03/02/2018] [Indexed: 12/26/2022] Open
Abstract
Background Cumulative data on radiation monotherapy for Merkel cell carcinoma (MCC) is lacking. Objective We sought to synthesize all available data on treatment outcomes for radiation monotherapy for inoperable stage I-III MCC. Methods We performed a systematic review of the current literature. Articles published in English in the PubMed database up to July 29, 2016, were evaluated. Results Eight case reports, 4 case series, and 6 retrospective studies, yielding 68 patients, were included in our analysis. Of the 24 stage I/II patients treated with local irradiation, 6 (25%) relapsed and 1 (4%) died from MCC. Of the 24 stage I/II patients treated with local and regional nodal irradiation, 5 (21%) relapsed and 2 (8%) died from MCC. Of the 20 stage III patients treated with local and regional nodal irradiation, 12 (60%) relapsed and 7 (35%) died from MCC. Conclusions Radiation monotherapy appears to be a reasonable treatment modality for patients with inoperable stage I-III MCC. Further investigation with prospective studies is needed to draw definitive conclusions.
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Affiliation(s)
- Parth Patel
- Department of Medicine, Division of Dermatology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Chirag Modi
- Department of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Beth McLellan
- Department of Medicine, Division of Dermatology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Nitin Ohri
- Department of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
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10
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Abstract
Merkel cell carcinoma (MCC) is an uncommon relatively aggressive neuroendocrine dermal neoplasm first described in 1972 as a tumor of the sun exposed skin. Although most MCC affect the skin of the head and neck, rare primarily oral mucosal cases have been documented. Merkel cells are nondendritic neuroendocrine cells that are found not only in the skin but also the oral mucosa and give rise to MCC. Neuroendocrine cells may be found as aggregates in organs or as diffuse or isolated cells within organs and their epithelial lining. They contain peptide hormones and biogenic amines and occur in two forms: dendritic, which are not associated with nerve fibers and non-dendritic, which are associated with nerve fibers. Merkel cells as well as MCC express simple epithelium-type Cytokeratins (8, 18, 19, 20), neurosecretory substances; chromogranin A, synaptophysin, neuron-specific enolase (NSE), adhesion molecules, and villin (intermediate filament). Though weakly, they also express neural markers such as S-100 protein. Cytokeratin 20, and Cluster of differentiation 56, are the two key diagnostic markers for Merkel cells and MCC. Etiology includes UV radiation, the recently described Merkel cell polyomavirus, and long term systemic immunosuppression. The cutaneous and mucosal variants of MCC are considered aggressive tumors with a high risk for local recurrence and metastasis and should be considered in the differential diagnosis of head and neck mucosal lesions. We present two cases of primary Merkel cell carcinoma, one on the buccal mucosa and the other on the lower lip, and discuss the salient histologic, immunohistochemical and clinical features.
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11
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Harms KL, Lazo de la Vega L, Hovelson DH, Rahrig S, Cani AK, Liu CJ, Fullen DR, Wang M, Andea AA, Bichakjian CK, Johnson TM, Tomlins SA, Harms PW. Molecular Profiling of Multiple Primary Merkel Cell Carcinoma to Distinguish Genetically Distinct Tumors From Clonally Related Metastases. JAMA Dermatol 2017; 153:505-512. [PMID: 28403382 DOI: 10.1001/jamadermatol.2017.0507] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance Merkel cell carcinoma (MCC) is an aggressive cutaneous neuroendocrine carcinoma. In rare cases, the development of an additional cutaneous MCC tumor is clinically consistent with a second primary MCC tumor rather than a cutaneous metastasis, which has important treatment and prognostic implications. Objective To evaluate genetic relatedness in 4 cases with the clinical diagnosis of multiple primary MCCs. Design, Setting, and Participants In this case series, 7 cases of clinically designated multiple primary MCC were identified; 4 cases met inclusion criteria for next-generation sequencing (NGS) analysis. Mutations, copy number alterations, and Merkel cell polyomavirus (MCPyV) sequence were analyzed and compared between clinically designated multiple primary tumors to characterize genetic relatedness and hence assess clonality. Patients with clinically designated multiple primary MCC were identified from the multidisciplinary MCC Program at the University of Michigan, a tertiary care center. Main Outcomes and Measures Four cases of clinically designated multiple primary MCC were characterized by tumor sequencing and targeted MCPyV sequencing to distinguish independent primary tumors from related metastases. Results Overall, 4 patients in their 70s or 80s were included and analyzed. Cases 1 and 4 were verified as genetically distinct primary tumors and did not harbor similar copy number alterations or demonstrate significant mutational overlap. Cases 2 and 3 were designated as clonally related based on overlapping copy number alterations. In clonally related tumors, chromosomal copy number changes were more reliable than mutations for demonstrating clonality. Regardless of clonality, we found that MCPyV status was concordant for all tumor pairs and MCPyV positive tumors harbored predominatly subclonal mutations. Conclusions and Relevance Our findings suggest that patients with MCC may develop a second genetically distinct primary tumor; in this case, the subsequent tumor is likely to develop through similar mechanisms of pathogenesis, either MCPyV-mediated or ultraviolet light-mediated. Next-generation sequencing analysis of chromosomal copy number changes and mutations is useful in distinguishing multiple primary MCCs from progression of MCC clinically resembling multiple primaries, allowing appropriate staging of the patient.
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Affiliation(s)
- Kelly L Harms
- Department of Dermatology, University of Michigan Medical School, Ann Arbor2Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor
| | - Lorena Lazo de la Vega
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor4Department of Pathology, University of Michigan Medical School, Ann Arbor
| | - Daniel H Hovelson
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor4Department of Pathology, University of Michigan Medical School, Ann Arbor
| | - Samantha Rahrig
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor4Department of Pathology, University of Michigan Medical School, Ann Arbor
| | - Andi K Cani
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor4Department of Pathology, University of Michigan Medical School, Ann Arbor
| | - Chia-Jen Liu
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor4Department of Pathology, University of Michigan Medical School, Ann Arbor
| | - Douglas R Fullen
- Department of Dermatology, University of Michigan Medical School, Ann Arbor4Department of Pathology, University of Michigan Medical School, Ann Arbor
| | - Min Wang
- Department of Pathology, University of Michigan Medical School, Ann Arbor
| | - Aleodor A Andea
- Department of Dermatology, University of Michigan Medical School, Ann Arbor4Department of Pathology, University of Michigan Medical School, Ann Arbor
| | - Christopher K Bichakjian
- Department of Dermatology, University of Michigan Medical School, Ann Arbor2Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor
| | - Timothy M Johnson
- Department of Dermatology, University of Michigan Medical School, Ann Arbor2Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor
| | - Scott A Tomlins
- Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor3Michigan Center for Translational Pathology, University of Michigan, Ann Arbor4Department of Pathology, University of Michigan Medical School, Ann Arbor5Department of Urology, University of Michigan Medical School, Ann Arbor
| | - Paul W Harms
- Department of Dermatology, University of Michigan Medical School, Ann Arbor3Michigan Center for Translational Pathology, University of Michigan, Ann Arbor4Department of Pathology, University of Michigan Medical School, Ann Arbor
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12
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Eluri M, Feneran A, Bordeaux JS, Ruben B, Ostrowski S, Bastian BC, Honda K. Multiple Merkel cell carcinomas: Late metastasis or multiple primary tumors? A molecular study. JAAD Case Rep 2017; 3:131-134. [PMID: 28367486 PMCID: PMC5361867 DOI: 10.1016/j.jdcr.2017.01.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Madhulika Eluri
- Department of Dermatology, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Ashley Feneran
- Department of Dermatology, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Jeremy S Bordeaux
- Department of Dermatology, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Beth Ruben
- Department of Dermatology, University of California, San Francisco, California
| | - Stephen Ostrowski
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Boris C Bastian
- Department of Dermatology, University of California, San Francisco, California
| | - Kord Honda
- Department of Dermatology, University Hospitals Case Medical Center, Cleveland, Ohio
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13
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Sparks J, Sparks M, Malone JC. Cutaneous Merkel cell carcinoma: multiple asynchronous primary lesions in a patient on immunosuppressive therapy. J Cutan Pathol 2016; 44:309-312. [PMID: 27990669 DOI: 10.1111/cup.12860] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 11/01/2016] [Accepted: 11/06/2016] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Janine C Malone
- Department of Medicine, Division of Dermatology and Department of Pathology and Laboratory Medicine, University of Louisville, Louisville, KY 40241, USA
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14
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Dousset L, Dutriaux C, Taïeb A, Chibon F, Foulongne V, Frouin E, Jullié ML, Jouary T. Genomic and viral findings in two different primary Merkel cell carcinomas in a 76-year-old woman. J Eur Acad Dermatol Venereol 2016; 31:e42-e43. [PMID: 27027702 DOI: 10.1111/jdv.13669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- L Dousset
- Service de Dermatologie, Hopital Saint André, CHU Bordeaux, Bordeaux, France
| | - C Dutriaux
- Service de Dermatologie, Hopital Saint André, CHU Bordeaux, Bordeaux, France
| | - A Taïeb
- Service de Dermatologie, Hopital Saint André, CHU Bordeaux, Bordeaux, France
| | - F Chibon
- INSERM U916 Department of Pathology, Institut Bergonié, Bordeaux, France
| | - V Foulongne
- Laboratoire de Virologie, INSERM U1058, CHU de Montpellier, Université de Montpellier 1, Montpellier, France
| | - E Frouin
- Service d'Anatomie et de Cytologie Pathologiques, CHU de Poitiers, Poitiers, France
| | - M L Jullié
- Service d'Anatomie Pathologique, Hôpital Haut-Lévêque, Pessac, France
| | - T Jouary
- Service de Dermatologie, Hopital Saint André, CHU Bordeaux, Bordeaux, France
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15
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Vasileiadis I, Sofopoulos M, Arnogiannaki N, Georgopoulos S. A Merkel-cell carcinoma metastatic to the tonsil: a case report and review of the literature. J Oral Maxillofac Surg 2013; 71:1812.e1-6. [PMID: 23911145 DOI: 10.1016/j.joms.2013.06.196] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 05/25/2013] [Accepted: 06/09/2013] [Indexed: 10/26/2022]
Abstract
Metastatic tumors to the palatine tonsils are extremely rare, with nearly 100 cases reported. Only 3 cases of Merkel cell carcinoma of the skin metastasizing to the palatine tonsil have been reported. We present the interesting case of a 61-year-old man with an enlargement of the left palatine tonsil that caused a moderate narrowing of the oropharynx. Three years previously he had been treated for Merkel cell carcinoma (MCC) on skin of his left shoulder. A tonsillectomy followed by palatoplasty was performed. Immunohistochemical staining demonstrated a pronounced reaction for cytokeratin 20, chromogranin, and CD56 histodiagnostic markers. Immunohistochemical studies are useful diagnostic tools in the establishment of the diagnosis of MCC. Treatment includes wide local surgical excision of the tumor, radiotherapy, and chemotherapy. Considering the aggressiveness of MCC, an early diagnosis is critical to enable the choice of adequate therapy at an early stage.
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Affiliation(s)
- Ioannis Vasileiadis
- Resident Doctor, Department of Otolaryngology/Head and Neck Surgery, Venizeleio-Pananeio General Hospital, Herakleion, Greece.
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16
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Bates T, McQueen A, Iqbal MS, Kelly C, Robinson M. Small cell neuroendocrine carcinoma of the oropharynx harbouring oncogenic HPV-infection. Head Neck Pathol 2013; 8:127-31. [PMID: 23838856 PMCID: PMC3950381 DOI: 10.1007/s12105-013-0471-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 06/27/2013] [Indexed: 01/16/2023]
Abstract
Small cell carcinoma/neuroendocrine carcinoma (SCNEC) of the oropharynx is uncommon. Recently, an association has been reported between oropharyngeal SCNEC and high-risk human papillomavirus (HPV) infection. While HPV infection confers a better prognosis for oropharyngeal squamous cell carcinoma, HPV infection does not appear to influence the biological behaviour of SCNECs, which are generally associated with poor clinical outcomes. We document two cases of SCNEC arising in the oropharynx with evidence of high-risk HPV infection. The cases highlight the expanding range of malignant oropharyngeal neoplasms that harbour oncogenic HPV infection and support the concept that, irrespective of HPV infection, neuroendocrine differentiation portends a poor prognosis.
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Affiliation(s)
- Timothy Bates
- Department of Cellular Pathology, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, NE7 7DN UK
| | - Andrew McQueen
- Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, NE7 7DN UK
| | | | - Charles Kelly
- Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, NE7 7DN UK
| | - Max Robinson
- Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, NE7 7DN UK
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17
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Fehér LZ, Pocsay G, Krenács L, Zvara A, Bagdi E, Pocsay R, Lukács G, Győry F, Gazdag A, Tarkó E, Puskás LG. Amplification of thymosin beta 10 and AKAP13 genes in metastatic and aggressive papillary thyroid carcinomas. Pathol Oncol Res 2011; 18:449-58. [PMID: 22161024 DOI: 10.1007/s12253-011-9467-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Accepted: 09/30/2011] [Indexed: 12/16/2022]
Abstract
Papillary thyroid carcinoma (PTC) is the most common well-differentiated thyroid cancer. Although the great majority of the cases exhibit an indolent clinical course, some of them develop local invasion with distant metastasis, and a few cases transform into undifferentiated/anaplastic thyroid carcinoma with a rapidly lethal course. To identify gene copy number alterations predictive of metastatic potential or aggressive transformation, array-based comparative genomic hybridization (CGH-array) was performed in 43 PTC cases. Formalin-fixed and paraffin-embedded samples from primary tumours of 16 cases without metastasis, 14 cases with only regional lymph node metastasis, and 13 cases with distant metastasis, recurrence or extrathyroid extension were analysed. The CGH-array and confirmatory quantitative real-time PCR results identified the deletion of the EIF4EBP3 and TRAK2 gene loci, while amplification of thymosin beta 10 (TB10) and Tre-2 oncogene regions were observed as general markers for PTC. Although there have been several studies implicating TB10 as a specific marker based on gene expression data, our study is the first to report on genomic amplification. Although no significant difference could be detected between the good and bad prognosis cases in the A-kinase anchor protein 13 (AKAP13) gene region, it was discriminative markers for metastasis. Amplification in the AKAP13 region was demonstrated in 42.9% and 15.4% of the cases with local or with distant metastasis, respectively, while no amplification was detected in non-metastatic cases. AKAP13 and TB10 regions may represent potential new genomic markers for PTC and cancer progression.
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Affiliation(s)
- Liliána Z Fehér
- Laboratory of Functional Genomics, Biological Research Centre, Hungarian Academy of Sciences, P.O. Box 521, Szeged, 6701, Hungary
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18
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Abstract
Merkel cell carcinoma (MCC) typically presents as an isolated cutaneous lesion with a measurable risk of regional lymph node involvement. Uncommonly, synchronous or metachronous lesions have been described to be attributed to a field effect. This case report describes a patient presenting with metachronous lesions, separated by several years, which cannot be attributed to a field effect given the tumor distribution.
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Affiliation(s)
| | - Thomas Caranosos
- Department of Surgery, West Virginia University, Morgantown, W. Va., USA
| | - E.P. Polack
- Clinical Professor of Surgery, West Virginia University, Morgantown, W. Va., USA
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19
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Ahronowitz IZ, Daud AI, Leong SP, Shue EH, Bastian BC, McCalmont TH, Yu SS. An isolated Merkel cell carcinoma metastasis at a distant cutaneous site presenting as a second 'primary' tumor. J Cutan Pathol 2011; 38:801-7. [PMID: 21883364 DOI: 10.1111/j.1600-0560.2011.01757.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Merkel cell carcinoma (MCC) is an aggressive neuroendocrine carcinoma of the skin. Disease progression usually occurs via lymphatic spread to regional lymphatic draining basins, followed by distant metastasis. We report the clinical course, histopathology and genetic analysis of a 69-year-old woman with likely hematogenous spread of cutaneous neuroendocrine carcinoma manifesting as a single metastatic lesion to a distant cutaneous site. Although the possibility of two cutaneous primary MCCs was considered, array comparative genomic hybridization (aCGH) identified identical distal amplification of a region of chromosome 12p, and synchronous loss of chromosomes 8p and 17p, effectively ruling out the possibility of independent primaries. We propose that this represents a primary cheek MCC with rapid, isolated cutaneous metastasis to the contralateral ankle via hematogenous spread. The distinction between a second primary MCC and a distant cutaneous metastasis clearly has important implications with regard to staging, treatment and prognosis. To our knowledge, this represents the first report of the use of aCGH to clarify the relationship of multiple synchronous cutaneous MCCs and the first report of a single distant cutaneous focus of hematogenous spread. Our data calls into question prior reports alleging multiple cutaneous primaries of this very rare tumor.
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Affiliation(s)
- Iris Z Ahronowitz
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
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20
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Manor E, Bellaiche E, Bodner L. Cytogenetic findings of a primary Merkel cell carcinoma. ACTA ACUST UNITED AC 2006; 169:78-80. [PMID: 16875943 DOI: 10.1016/j.cancergencyto.2006.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2006] [Revised: 02/03/2006] [Accepted: 02/06/2006] [Indexed: 11/19/2022]
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21
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Fehér LZ, Balázs M, Kelemen JZ, Zvara A, Németh I, Varga-Orvos Z, Puskás LG. Improved DOP-PCR-based representational whole-genome amplification using quantitative real-time PCR. ACTA ACUST UNITED AC 2006; 15:43-8. [PMID: 16531768 DOI: 10.1097/00019606-200603000-00007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In many cases, only a minute amount of partially degraded genomic DNA can be extracted from archived clinical samples. Diverse whole-genome amplification methods are applied to provide sufficient amount of DNA for comparative genome hybridization, single-nucleotide polymorphism, and microsatellite analyses. In these applications, the reliability of the amplification techniques is particularly important. In PCR-based approaches, the plateau effect can seriously alter the original relative copy number of certain chromosomal regions. To eliminate this distorting effect, we improved the standard degenerate oligonucleotide-primed PCR (DOP-PCR) technique by following the amplification status with quantitative real-time PCR (QRT-PCR). With real-time detection of the products, we could eliminate DNA overamplification. Probes were prepared from 10 different tumor samples: primary and metastatic melanoma tissues, epidermoid and bronchioloalveolar lung carcinomas, 2 renal cell carcinomas, 2 colorectal carcinomas, and a Conn and Cushing adenoma. Probes were generated by using nonamplified and amplified genomic DNA with DOP-PCR and DOP-PCR combined with QRT-PCR. To demonstrate the reliability of the QRT-PCR based amplification protocol, altogether 152 relative copy number changes of 44 regions were determined. There was 85.6% concordance in copy number alterations between the QRT-PCR protocol and the nonamplified samples, whereas this value was only 63.8% for the traditional DOP-PCR. Our results demonstrate that our protocol preserves the original copy number of different chromosomal regions in amplified genomic DNA than standard DOP-PCR techniques more accurately.
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Affiliation(s)
- Liliána Z Fehér
- Laboratory of Functional Genomics, Biological Research Center, Hungarian Academy of Sciences, Szeged, Hungary
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