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Lakshmipathy D, Fritz C, Harris J, Athni T, Go B, Moreira A, Giordano C, Rajasekaran K. Systematic evaluation of Merkel cell carcinoma clinical practice guidelines using the AGREE II instrument. Arch Dermatol Res 2024; 316:130. [PMID: 38662106 PMCID: PMC11045602 DOI: 10.1007/s00403-024-02853-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 02/01/2024] [Accepted: 03/30/2024] [Indexed: 04/26/2024]
Abstract
Merkel cell carcinoma (MCC) is a rare type of skin cancer that requires a multidisciplinary approach with a variety of specialists for management and treatment. Clinical practice guidelines (CPGs) have recently been established to standardize management algorithms. The objective of this study was to appraise such CPGs via the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. Eight CPGs were identified via systematic literature search following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. Four appraisers trained in AGREE II protocols evaluated each CPG and deemed two CPGs as high quality, five as moderate quality, and one as low quality. Intraclass correlation coefficients (ICCs) were calculated to verify reviewer consistency as excellent, good, and moderate across four, one, and one domain, respectively. The majority of MCC CPGs are lacking in specifying stakeholder involvement, applicability, and rigor of development. The two high quality CPGs are from the Alberta Health Services (AHS) and the collaboration between the European Dermatology Forum, the European Association of Dermato-Oncology, and the European Organization of Research and Treatment of Cancer (EDF/EADO/EORTC). The EDF/EADO/EORTC CPG had the highest overall score with no significant deficiencies across any domain. An important limitation is that the AGREE II instrument is not designed to evaluate the validity of each CPG's recommendations; conclusions therefore can only be drawn about each CPG's developmental quality. Future MCC CPGs may benefit from garnering public perspectives, inviting external expert review, and considering available resources and implementation barriers during their developmental stages.
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Affiliation(s)
- Deepak Lakshmipathy
- Department of Otorhinolaryngology-Head & Neck Surgery, University of Pennsylvania, 800 Walnut Street, 18th Floor, Philadelphia, PA, 19107, USA
| | - Christian Fritz
- Department of Otorhinolaryngology-Head & Neck Surgery, University of Pennsylvania, 800 Walnut Street, 18th Floor, Philadelphia, PA, 19107, USA
| | - Jacob Harris
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Tejas Athni
- Harvard Medical School, Harvard University, Boston, MA, USA
| | - Beatrice Go
- Department of Otorhinolaryngology-Head & Neck Surgery, University of Pennsylvania, 800 Walnut Street, 18th Floor, Philadelphia, PA, 19107, USA
| | - Alvaro Moreira
- Department of Pediatrics, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Cerrene Giordano
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology-Head & Neck Surgery, University of Pennsylvania, 800 Walnut Street, 18th Floor, Philadelphia, PA, 19107, USA.
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA.
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
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2
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Juan HY, Khachemoune A. A review of Merkel cell carcinoma. JAAPA 2023; 36:11-16. [PMID: 37820270 DOI: 10.1097/01.jaa.0000979460.69305.b7] [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: 10/13/2023]
Abstract
ABSTRACT Merkel cell carcinoma (MCC) is a rare and aggressive type of metastatic, nonmelanoma skin cancer derived from Merkel cells in the epidermis. MCC can be induced by sun exposure or via Merkel cell polyomavirus (MCV) gene expression. MCV is found in most patients with MCC and is associated with a lower recurrence rate of MCC. MCC has a wide range of clinical presentations that make diagnosis challenging. Histologic examination is performed using unique markers to differentiate it from other diagnoses. This article reviews the pathogenesis, clinical presentation, histopathology, differential diagnosis, and treatment of MCC.
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Affiliation(s)
- Hui Yu Juan
- At the time this article was written, Hui Yu Juan was a student in the Virginia Commonwealth University School of Medicine in Richmond, Va. Amor Khachemoune practices at the Brooklyn (N.Y.) VA Medical Center and SUNY Downstate's Department of Dermatology, also in Brooklyn, N.Y. The authors have disclosed no potential conflicts of interest, financial or otherwise
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3
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Duarte‐Bateman D, Shen A, Bullock T, Sadeghi P, Escandón JM, Dedkova E, Gastman BR. Best practices in surgical and nonsurgical management of head and neck Merkel cell carcinoma: An update. Mol Carcinog 2023; 62:101-112. [PMID: 36367533 PMCID: PMC10098483 DOI: 10.1002/mc.23483] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 10/16/2022] [Accepted: 10/18/2022] [Indexed: 11/13/2022]
Abstract
Merkel cell carcinoma (MCC) is a rare, highly aggressive cutaneous neuroendocrine carcinoma. Controversy exists regarding optimal management of MCC as high-quality randomized studies and clinical trials are limited, and physicians are bound to interpret highly heterogeneous, retrospective literature in their clinical practice. Furthermore, the rising incidence and notably poor prognosis of MCC urges the establishment of best practices for optimal management of the primary tumor and its metastases. Herein, we summarized the relevant evidence and provided an algorithm for decision-making in MCC management based on the latest 2021 National Comprehensive Cancer Network guidelines. Additionally, we report current active MCC clinical trials in the United States. The initial management of MCC is dependent upon the pathology of the primary tumor and presence of metastatic disease. Patients with no clinical evidence of regional lymph node involvement generally require sentinel node biopsy (SLNB) while clinically node-positive patients should undergo fine needle aspiration (FNA) or core biopsy and full imaging workup. If SLNB or FNA/core biopsy are positive, a multidisciplinary team should be assembled to discuss if additional node dissection or adjuvant therapy is necessary. Wide local excision is optimal for primary tumor management and SLNB remains the preferred staging and predictive tool in MCC. The management of MCC has progressively improved in the last decade, particularly due to the establishment of immunotherapy as a new treatment option in advanced MCC. Ongoing trials and prospective studies are needed to further establish the best practices for MCC management.
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Affiliation(s)
- Daniela Duarte‐Bateman
- Lerner Research InstituteCleveland ClinicClevelandOhioUSA
- Department of Plastic SurgeryCleveland ClinicClevelandOhioUSA
| | - Alan Shen
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve UniversityClevelandOhioUSA
| | - Taylor Bullock
- Department of DermatologyCleveland ClinicClevelandOhioUSA
| | - Payam Sadeghi
- Department of Plastic SurgeryCleveland ClinicClevelandOhioUSA
| | - Joseph M. Escandón
- Division of Plastic and Reconstructive Surgery, Strong Memorial HospitalUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Eliska Dedkova
- Lerner Research InstituteCleveland ClinicClevelandOhioUSA
| | - Brian R. Gastman
- Lerner Research InstituteCleveland ClinicClevelandOhioUSA
- Department of Plastic SurgeryCleveland ClinicClevelandOhioUSA
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4
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Lewis DJ, Sobanko JF, Etzkorn JR, Shin TM, Giordano CN, McMurray SL, Walker JL, Zhang J, Miller CJ, Higgins HW. Merkel Cell Carcinoma. Dermatol Clin 2022; 41:101-115. [DOI: 10.1016/j.det.2022.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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5
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Babadzhanov M, Doudican N, Wilken R, Stevenson M, Pavlick A, Carucci J. Current concepts and approaches to merkel cell carcinoma. Arch Dermatol Res 2020; 313:129-138. [PMID: 32666149 DOI: 10.1007/s00403-020-02107-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 06/26/2020] [Accepted: 07/01/2020] [Indexed: 02/07/2023]
Abstract
Merkel cell carcinoma (MCC) is an aggressive and rare cutaneous cancer of the mechanoreceptor unit of the skin with a neuroendocrine origin. MCC incidence has been on the rise over the past two decades. Risk factors include old age, chronic UV exposure, and immunosuppression. Although MCC is a cutaneous malignancy that is often misdiagnosed as a benign nodule at the time of diagnosis, it has an aggressive disease course due to its high recurrence and metastatic potential. The PD-1/PD-L1 checkpoint blockade has recently shown promising results in the management of advanced MCC. Avelumab and pembrolizumab are considered the new standard of care for metastatic MCC. Despite advances in the field, studies are needed to elucidate the role of immunotherapy for patients who are resistant to treatment. Most ongoing clinical trials aim to assess the efficacy of checkpoint inhibitor combination therapies. This article reviews the most current literature on the surgical and medical management of MCC.
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Affiliation(s)
| | | | - Reason Wilken
- Dermatology, NYU Langone Med Center, New York, NY, USA
| | | | - Anna Pavlick
- Dermatology, NYU Langone Med Center, New York, NY, USA
| | - John Carucci
- Dermatology, NYU Langone Med Center, New York, NY, USA.
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6
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Rastrelli M, Del Fiore P, Buja A, Vecchiato A, Rossi CR, Chiarion Sileni V, Tropea S, Russano F, Zorzi M, Spina R, Cappellesso R, Mazzarotto R, Cavallin F, Bassetto F, Bezzon E, Ferrazzi B, Alaibac M, Mocellin S. A Therapeutic and Diagnostic Multidisciplinary Pathway for Merkel Cell Carcinoma Patients. Front Oncol 2020; 10:529. [PMID: 32351898 PMCID: PMC7174780 DOI: 10.3389/fonc.2020.00529] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 03/25/2020] [Indexed: 12/19/2022] Open
Abstract
Merkel Cell Carcinoma (MCC) is a highly aggressive neuroendocrine neoplasm of the skin. Due to its rarity, the management of MCC is not standardized across centers. In this article, we present the experience of the Veneto region in the North-East of Italy, where a committee of skin cancer experts has proposed a clinical pathway for the diagnosis and treatment of MCC. Putting together the evidence available in the international literature, we outlined the best approach to the management of patients affected with this malignancy step- by- step for each possible clinical situation. Crucial in this pathway is the role of the multidisciplinary team to deal with the lack of robust information on each aspect of the management of this disease.
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Affiliation(s)
- Marco Rastrelli
- Surgical Oncology Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Paolo Del Fiore
- Surgical Oncology Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Alessandra Buja
- Department of Cardiological, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Antonella Vecchiato
- Surgical Oncology Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Carlo Riccardo Rossi
- Surgical Oncology Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy.,Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padua, Padua, Italy
| | | | - Saveria Tropea
- Surgical Oncology Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Francesco Russano
- Surgical Oncology Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Manuel Zorzi
- Veneto Tumour Registry, Azienda Zero, Padua, Italy
| | - Romina Spina
- Surgical Oncology Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Rocco Cappellesso
- Surgical Pathology and Cytopathology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Renzo Mazzarotto
- Department of Surgery and Oncology, Unit of Radiotherapy, Hospital Trust of Verona, Verona, Italy
| | | | - Franco Bassetto
- Clinic of Plastic Surgery, Department of Neuroscience, Padua University Hospital, University of Padua, Padua, Italy
| | - Elisabetta Bezzon
- Radiology Unit, Department of Imaging and Medical Physics, Istituto Oncologico Veneto IOV IRCSS, Padua, Italy
| | - Beatrice Ferrazzi
- Postgraduate School of Occupational Medicine, University of Verona, Verona, Italy
| | - Mauro Alaibac
- Unit of Dermatology, University of Padua, Padua, Italy
| | - Simone Mocellin
- Surgical Oncology Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy.,Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padua, Padua, Italy
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7
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Schmerling RA, Casas JG, Cinat G, Ospina FEG, Kassuga LEBP, Tlahuel JLM, Mazzuoccolo LD. Burden of Disease, Early Diagnosis, and Treatment of Merkel Cell Carcinoma in Latin America. J Glob Oncol 2019; 4:1-11. [PMID: 30085832 PMCID: PMC6223512 DOI: 10.1200/jgo.18.00041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Rafael A Schmerling
- Rafael A. Schmerling, Beneficiência Portugesa de São Paulo, São Paulo; Luiza E.B.P. Kassuga, National Cancer Institute, Rio de Janeiro, Brazil; Jose G. Casas, Hospital Alemán de Buenos Aires; Gabriela Cinat, University of Buenos Aires; Luis Daniel Mazzuoccolo, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Fabio Ernesto Grosso Ospina, Centro Nacional de Oncología de Colombia, Bogotá, Colombia; and Jorge Luis Martinez Tlahuel, National Cancer Institute, Mexico City, Mexico
| | - Jose G Casas
- Rafael A. Schmerling, Beneficiência Portugesa de São Paulo, São Paulo; Luiza E.B.P. Kassuga, National Cancer Institute, Rio de Janeiro, Brazil; Jose G. Casas, Hospital Alemán de Buenos Aires; Gabriela Cinat, University of Buenos Aires; Luis Daniel Mazzuoccolo, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Fabio Ernesto Grosso Ospina, Centro Nacional de Oncología de Colombia, Bogotá, Colombia; and Jorge Luis Martinez Tlahuel, National Cancer Institute, Mexico City, Mexico
| | - Gabriela Cinat
- Rafael A. Schmerling, Beneficiência Portugesa de São Paulo, São Paulo; Luiza E.B.P. Kassuga, National Cancer Institute, Rio de Janeiro, Brazil; Jose G. Casas, Hospital Alemán de Buenos Aires; Gabriela Cinat, University of Buenos Aires; Luis Daniel Mazzuoccolo, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Fabio Ernesto Grosso Ospina, Centro Nacional de Oncología de Colombia, Bogotá, Colombia; and Jorge Luis Martinez Tlahuel, National Cancer Institute, Mexico City, Mexico
| | - Fabio Ernesto Grosso Ospina
- Rafael A. Schmerling, Beneficiência Portugesa de São Paulo, São Paulo; Luiza E.B.P. Kassuga, National Cancer Institute, Rio de Janeiro, Brazil; Jose G. Casas, Hospital Alemán de Buenos Aires; Gabriela Cinat, University of Buenos Aires; Luis Daniel Mazzuoccolo, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Fabio Ernesto Grosso Ospina, Centro Nacional de Oncología de Colombia, Bogotá, Colombia; and Jorge Luis Martinez Tlahuel, National Cancer Institute, Mexico City, Mexico
| | - Luiza E B P Kassuga
- Rafael A. Schmerling, Beneficiência Portugesa de São Paulo, São Paulo; Luiza E.B.P. Kassuga, National Cancer Institute, Rio de Janeiro, Brazil; Jose G. Casas, Hospital Alemán de Buenos Aires; Gabriela Cinat, University of Buenos Aires; Luis Daniel Mazzuoccolo, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Fabio Ernesto Grosso Ospina, Centro Nacional de Oncología de Colombia, Bogotá, Colombia; and Jorge Luis Martinez Tlahuel, National Cancer Institute, Mexico City, Mexico
| | - Jorge Luis Martinez Tlahuel
- Rafael A. Schmerling, Beneficiência Portugesa de São Paulo, São Paulo; Luiza E.B.P. Kassuga, National Cancer Institute, Rio de Janeiro, Brazil; Jose G. Casas, Hospital Alemán de Buenos Aires; Gabriela Cinat, University of Buenos Aires; Luis Daniel Mazzuoccolo, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Fabio Ernesto Grosso Ospina, Centro Nacional de Oncología de Colombia, Bogotá, Colombia; and Jorge Luis Martinez Tlahuel, National Cancer Institute, Mexico City, Mexico
| | - Luis Daniel Mazzuoccolo
- Rafael A. Schmerling, Beneficiência Portugesa de São Paulo, São Paulo; Luiza E.B.P. Kassuga, National Cancer Institute, Rio de Janeiro, Brazil; Jose G. Casas, Hospital Alemán de Buenos Aires; Gabriela Cinat, University of Buenos Aires; Luis Daniel Mazzuoccolo, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Fabio Ernesto Grosso Ospina, Centro Nacional de Oncología de Colombia, Bogotá, Colombia; and Jorge Luis Martinez Tlahuel, National Cancer Institute, Mexico City, Mexico
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8
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9
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Abstract
Merkel cell carcinoma (MCC) is a rare malignant tumor with a neuroendocrine phenotype. The authors report a case of MCC of the left cheek region in an 85-year-old Caucasian woman who also received sentinel node biopsy using both Technectium-99m-labeled (99mTc) lymphoscintigraphy and indocyanine green lymphography.
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10
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Nagase K, Kimura-Kaku H, Inoue T, Shinogi T, Narisawa Y. Usefulness of ulceration and hyperkeratosis as clinical predictors of Merkel cell polyomavirus-negative and combined Merkel cell carcinoma: A retrospective study. J Dermatol 2018; 46:103-109. [DOI: 10.1111/1346-8138.14743] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 11/13/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Kotaro Nagase
- Division of Dermatology; Department of Internal Medicine; Faculty of Medicine; Saga University; Saga Japan
| | - Hiromi Kimura-Kaku
- Division of Dermatology; Department of Internal Medicine; Faculty of Medicine; Saga University; Saga Japan
| | - Takuya Inoue
- Division of Dermatology; Department of Internal Medicine; Faculty of Medicine; Saga University; Saga Japan
| | - Taro Shinogi
- Division of Dermatology; Department of Internal Medicine; Faculty of Medicine; Saga University; Saga Japan
| | - Yutaka Narisawa
- Division of Dermatology; Department of Internal Medicine; Faculty of Medicine; Saga University; Saga Japan
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11
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Coutinho F, Horta M, Rocha E, Vasconcelos C, Araújo A. Merkel cell carcinoma and the challenge in its approach: a review based on a clinical context of immunosuppression. Porto Biomed J 2018; 3:e11. [PMID: 31595235 PMCID: PMC6726304 DOI: 10.1016/j.pbj.0000000000000011] [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: 04/24/2018] [Accepted: 05/04/2018] [Indexed: 12/03/2022] Open
Abstract
Merkel cell carcinoma (MCC) is a rare and aggressive neuroendocrine cancer with high rate to local relapse and metastasis. Its connection to immunosuppression is well known, with reported association to human immunodeficiency virus (HIV). The authors present an 87-year-old woman, infected by HIV type 2 at advanced stage of the disease, whom presented a painless papule on left cheek in 2011. After its total excision, the histopathology confirmed MCC “in situ,” with no regional or distant metastases. Simultaneously, she revealed a viral load of 2220 copies/mL and 224 CD4/mm3. Five months later, the patient presented a local and distance relapse with an aggressive behavior and positive regional lymph node. Stage IV disease was confirmed due to presence of liver metastases. Concurrently to the relapse, it was detected low CD4 levels. In our multidisciplinary team decision meeting, it has been decided conservative treatment due to low Karnofsky status, comorbidities, and stage of disease.
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Affiliation(s)
| | | | | | - Carlos Vasconcelos
- Unit of Clinical Immunology; Centro Hospitalar do Porto, Oporto, Portugal
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12
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Kong FW, Zhang M, Wang H, Lu CT, Wu WB, Liu YY. A rare case of Merkel cell carcinoma presenting as a giant intra-thoracic mass: A case report and review of the literature. Medicine (Baltimore) 2017; 96:e8743. [PMID: 29145324 PMCID: PMC5704869 DOI: 10.1097/md.0000000000008743] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
RATIONALE Merkel cell carcinoma (MCC) is an aggressive neuroendocrine-derived cutaneous cancer. Ectopic or single metastatic MCC located in thorax is extremely rare; meanwhile, its definite management has not been elucidated yet. PATIENT CONCERNS A 64-year-old female patient with a giant mass located in her left thorax was presented for stuffy pain of left chest for 6 months and fever for half a month. She underwent radical resection of vulvar MCC 10 years ago. DIAGNOSES Computed tomography (CT)-guided biopsy of the intrathoracic mass revealed a diagnosis of MCC, without synchronous urogenital lesions on pelvic CT images. INTERVENTIONS This bulky tumor was completely resected via thoracotomy, along with the adjacent pulmonary lobe, pericardium, pleura, and diaphragm. OUTCOMES The patient survived without local-regional recurrence or distant metastasis during the follow-up of 1 year up to now. LESSONS Ectopic or single metastatic MCC should be considered in the differential diagnosis of intrathoracic tumors, especially in patients with a history of MCC. Besides, a timely surgery combined with chemotherapy is effective for this disease.
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Affiliation(s)
- Feng-Wei Kong
- Department of General Surgery, Xuzhou Infectious Disease Hospital
| | | | | | | | | | - Yuan-Yuan Liu
- Department of Respiratory Medicine, Xuzhou Central Hospital Affiliated to Southeast University, Xuzhou, China
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13
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Abstract
Merkel cell carcinoma (MCC) is a rare but highly aggressive skin cancer with neuroendocrine features. MCC pathogenesis is associated with either the presence of Merkel cell polyomavirus or chronic exposure to ultraviolet light (UV), which can cause a characteristic pattern of multiple DNA mutations. Notably, in the Northern hemisphere, the majority of MCC cases are of viral aetiology; by contrast, in areas with high UV exposure, UV-mediated carcinogenesis is predominant. The two aetiologies share similar clinical, histopathological and prognostic characteristics. MCC presents with a solitary cutaneous or subcutaneous nodule, most frequently in sun-exposed areas. In fact, UV exposure is probably involved in both viral-mediated and non-viral-mediated carcinogenesis, by contributing to immunosuppression or DNA damage, respectively. Confirmation of diagnosis relies on analyses of histological features and immunological marker expression profiles of the lesion. At primary diagnosis, loco-regional metastases are already present in ∼30% of patients. Excision of the tumour is the first-line therapy; if not feasible, radiotherapy can often effectively control the disease. Chemotherapy was the only alternative in advanced-stage or refractory MCC until several clinical trials demonstrated the efficacy of immune-checkpoint inhibitors.
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14
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Barksdale SK. Advances in Merkel cell carcinoma from a pathologist's perspective. Pathology 2017; 49:568-574. [DOI: 10.1016/j.pathol.2017.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 06/28/2017] [Accepted: 07/17/2017] [Indexed: 12/11/2022]
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15
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Stoos-Veic T, Tadic M, Aralica G, Milicic V, Tomasovic-Loncaric C. EUS-FNA of the Merkel cell carcinoma metastasis to the pancreas: Cytomorphology and immunocytochemistry on direct cytological smears. Cytopathology 2017; 28:307-311. [PMID: 28685876 DOI: 10.1111/cyt.12425] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To report two cases of Merkel cell carcinoma (MCC) metastatic to the pancreas diagnosed with endoscopic ultrasound-guided-fine needle aspiration (EUS-FNA) and to add the case of concomitant chronic lymphocytic leukaemia/small lymphocytic lymphoma (CLL/SLL) and MCC to the literature. The aim is to alert the cytopathologists once more to the problems of differential diagnosis of pancreatic metastasis of MCC and to describe the possibilities of ancillary methods performed on direct cytological smears. METHODS EUS-FNA procedures were performed according to standard institution protocol, using 22-G needles with cytopathologist on-site. Based on rapid on-site evaluation (ROSE), additional passes were made for immunocytochemistry (ICC). A mini panel of antibodies was used to aid the differential diagnosis. RESULTS Smears revealed a dispersed pattern of small round cells with scant cytoplasm, round nuclei with inconspicuous nucleoli and occasional nuclear moulding, suspicious of small cell carcinoma. Results of ICC applied to the direct cytological smears were as follows: LCA negative, Cytokeratin (clone MNF116) positive, TTF-1 negative, CD 56 positive, NSE weakly positive, Chromogranin A weakly positive and CK20 positive, in one case in a dot-like perinuclear pattern. The diagnosis of MCC was made. CONCLUSION Increasing incidence of MCC warrants the inclusion of MCC in the differential diagnosis of tumours of small round blue cell morphology even in unusual sites. The cytomorphological features coupled with an ICC panel are usually enough to make a confident diagnosis of MCC. EUS-FNA is a minimally invasive technique which enables sampling adequate tissue for all the ancillary methods eventually needed to support the diagnosis.
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Affiliation(s)
- T Stoos-Veic
- Department of Pathology and Cytology, University Hospital Dubrava, Zagreb, Croatia.,Faculty of Medicine, University of Osijek, Osijek, Croatia
| | - M Tadic
- Department of Gastroenterology, University Hospital Dubrava, Zagreb, Croatia.,Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | - G Aralica
- Department of Pathology and Cytology, University Hospital Dubrava, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
| | - V Milicic
- Department of Cytology, University Hospital Center Osijek, Osijek, Croatia.,Faculty of Medicine, University of Osijek, Osijek, Croatia
| | - C Tomasovic-Loncaric
- Department of Pathology and Cytology, University Hospital Dubrava, Zagreb, Croatia
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16
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Vandeven N, Nghiem P. Rationale for immune-based therapies in Merkel polyomavirus-positive and -negative Merkel cell carcinomas. Immunotherapy 2017; 8:907-21. [PMID: 27381685 DOI: 10.2217/imt-2016-0009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Merkel cell carcinoma (MCC) is a rare but often deadly skin cancer that is typically caused by the Merkel cell polyomavirus (MCPyV). Polyomavirus T-antigen oncoproteins are persistently expressed in virus-positive MCCs (˜80% of cases), while remarkably high numbers of tumor-associated neoantigens are detected in virus-negative MCCs, suggesting that both MCC subsets may be immunogenic. Here we review mechanisms by which these immunogenic tumors evade multiple levels of host immunity. Additionally, we summarize the exciting potential of diverse immune-based approaches to treat MCC. In particular, agents blocking the PD-1 axis have yielded strikingly high response rates in MCC as compared with other solid tumors, highlighting the potential for immune-mediated treatment of this disease.
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Affiliation(s)
- Natalie Vandeven
- Department of Medicine (Pathology & Dermatology), University of Washington, USA
| | - Paul Nghiem
- Department of Medicine (Pathology & Dermatology), University of Washington, USA
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Kadiri S, Aissa A, Berhili S, Khmou M, Elmajjaoui S, Kebdani T, El Khannoussi B, Elkacemi H, Benjaafar N. Merkel cell carcinoma occurring in a black woman: a case report. J Med Case Rep 2017; 11:25. [PMID: 28143624 PMCID: PMC5282901 DOI: 10.1186/s13256-016-1189-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 12/27/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Merkel cell carcinoma is a rare, very aggressive neuroectodermal tumor of the skin. It is typically located on sun-exposed skin and frequently found in white men aged between 70 and 80 years. CASE PRESENTATION We report a case of a 58-year-old black woman diagnosed with Merkel cell carcinoma of the posterior face of the right elbow. She had biopsy excision and was lost to follow-up. Four months later, she presented with recurrent disease on the inferior third of the right arm with three ipsilateral axillary lymph node metastases. Amputation of the right arm and ipsilateral axillary lymph node dissection were performed, followed by adjuvant radiotherapy. Six months later, the patient died as a result of respiratory failure caused by lung metastasis. To the best of our knowledge, no specific studies have been done comparing the course and the characteristics of Merkel cell carcinoma in white and black populations, and no similar case has been reported in the literature. CONCLUSIONS The Merkel cell carcinoma is very rare in black people. As described elsewhere in the literature, our patient had a poor outcome despite radical management. To date, to the best of our knowledge, there has been no comparison of the prognosis of this tumor in white and black populations.
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Affiliation(s)
- Selma Kadiri
- Department of Radiotherapy, National Institute of Oncology, Rabat, Morocco
| | - Abdellah Aissa
- Department of Radiotherapy, National Institute of Oncology, Rabat, Morocco
| | - Soufiane Berhili
- Department of Radiotherapy, National Institute of Oncology, Rabat, Morocco
| | - Mouna Khmou
- Department of Cytopathology, National Institute of Oncology, Rabat, Morocco
| | - Sanaa Elmajjaoui
- Department of Radiotherapy, National Institute of Oncology, Rabat, Morocco
| | - Tayeb Kebdani
- Department of Radiotherapy, National Institute of Oncology, Rabat, Morocco
| | | | - Hanan Elkacemi
- Department of Radiotherapy, National Institute of Oncology, Rabat, Morocco
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