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Pokhrel A, Wu R, Wang JC. Review of Merkel cell carcinoma with solitary pancreatic metastases mimicking primary neuroendocrine tumor of the pancreas. Clin J Gastroenterol 2023; 16:641-662. [PMID: 37421584 DOI: 10.1007/s12328-023-01821-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 06/05/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVE/BACKGROUND Merkel cell carcinoma (MCC) but metastases to the pancreas are very rare. There are only a few cases of isolated metastases of MCC to the pancreas. Because of this rarity, it can be wrongly diagnosed as a neuroendocrine tumor of the pancreas(pNET), especially the poorly differentiated neuroendocrine carcinoma (PNEC) subtype, in which the treatment is vastly different than that of MCC with isolated metastases of the pancreas. METHODS An electronic search of the PubMed and google scholar databases was performed to obtain the literature on MCC with pancreatic metastases, using the following search terms: Merkel cell carcinoma, pancreas, and metastases. Results are limited to the following available article types: case reports and case series. We identified 45 cases of MCC with pancreatic metastases from the PubMed and Google Scholar database search and examined their potential relevance. Only 22 cases with isolated pancreatic metastases were taken for review including one case that we encountered. RESULTS The results from our review of cases of isolated pancreatic metastases of MCC were compared to the characteristics of the poorly differentiated pancreatic neuroendocrine tumor (PNEC). We found the following: (a) MCC with isolated pancreatic metastases occurred at an older age than PNEC and with male gender predominance (b) Most of the metastases occurred within 2 years of initial diagnosis of MCC (c) Resection of pancreatic mass was the first line treatment in case of resectable PNECs whereas resection of metastases was infrequently performed in MCC with pancreatic metastases.
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Affiliation(s)
- Akriti Pokhrel
- Department of Internal Medicine, Brookdale University Hospital Medical Center, Brooklyn, NY, USA
- Department of Hematology and Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY, USA
| | - Richard Wu
- Department of Pathology, Division of Hematology/Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY, USA
- Department of Hematology and Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY, USA
| | - Jen Chin Wang
- Department of Pathology, Division of Hematology/Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY, USA.
- Department of Hematology and Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY, USA.
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2
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DeCoste RC, Carter MD, Ly TY, Gruchy JR, Nicolela AP, Pasternak S. Merkel cell carcinoma: an update. Hum Pathol 2023; 140:39-52. [PMID: 36898590 DOI: 10.1016/j.humpath.2023.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/06/2023] [Indexed: 03/11/2023]
Abstract
Merkel cell carcinoma (MCC) is an uncommon primary cutaneous neuroendocrine carcinoma associated with an adverse prognosis. In recent years, our understanding of MCC biology has markedly progressed. Since the discovery of the Merkel cell polyomavirus, it has become clear that MCC represents an ontogenetically dichotomous group of neoplasms with overlapping histopathology. Specifically, most MCCs arise secondary to viral oncogenesis, while a smaller subset is the direct result of UV-associated mutations. The distinction of these groups bears relevance in their immunohistochemical and molecular characterization, as well as in disease prognosis. Further recent developments relate to the landmark utilization of immunotherapeutics in MCC, providing optimistic options for the management of this aggressive disease. In this review, we discuss both fundamental and emerging concepts in MCC, with a particular focus on topics of practical relevance to the surgical or dermatopathologist.
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Affiliation(s)
- Ryan C DeCoste
- Department of Pathology and Laboratory Medicine, QEII Health Science Centre, Nova Scotia Health, Halifax, Nova Scotia, B3H 1V8, Canada; Department of Pathology, Dalhousie University, Halifax, Nova Scotia, B3H 1V8, Canada.
| | - Michael D Carter
- Department of Pathology and Laboratory Medicine, QEII Health Science Centre, Nova Scotia Health, Halifax, Nova Scotia, B3H 1V8, Canada; Department of Pathology, Dalhousie University, Halifax, Nova Scotia, B3H 1V8, Canada
| | - Thai Yen Ly
- Department of Pathology and Laboratory Medicine, QEII Health Science Centre, Nova Scotia Health, Halifax, Nova Scotia, B3H 1V8, Canada; Department of Pathology, Dalhousie University, Halifax, Nova Scotia, B3H 1V8, Canada
| | - Jennette R Gruchy
- Department of Pathology and Laboratory Medicine, QEII Health Science Centre, Nova Scotia Health, Halifax, Nova Scotia, B3H 1V8, Canada; Department of Pathology, Dalhousie University, Halifax, Nova Scotia, B3H 1V8, Canada
| | - Anna P Nicolela
- Department of Biomedical and Molecular Sciences, Queens University, Kingston, Ontario, K7L 3N6, Canada
| | - Sylvia Pasternak
- Department of Pathology and Laboratory Medicine, QEII Health Science Centre, Nova Scotia Health, Halifax, Nova Scotia, B3H 1V8, Canada; Department of Pathology, Dalhousie University, Halifax, Nova Scotia, B3H 1V8, Canada
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3
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Ouyang K, Zheng DX, Agak GW. T-Cell Mediated Immunity in Merkel Cell Carcinoma. Cancers (Basel) 2022; 14:cancers14246058. [PMID: 36551547 PMCID: PMC9775569 DOI: 10.3390/cancers14246058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/01/2022] [Accepted: 12/04/2022] [Indexed: 12/13/2022] Open
Abstract
Merkel cell carcinoma (MCC) is a rare and frequently lethal skin cancer with neuroendocrine characteristics. MCC can originate from either the presence of MCC polyomavirus (MCPyV) DNA or chronic ultraviolet (UV) exposure that can cause DNA mutations. MCC is predominant in sun-exposed regions of the body and can metastasize to regional lymph nodes, liver, lungs, bone, and brain. Older, light-skinned individuals with a history of significant sun exposure are at the highest risk. Previous studies have shown that tumors containing a high number of tumor-infiltrating T-cells have favorable survival, even in the absence of MCPyV DNA, suggesting that MCPyV infection enhances T-cell infiltration. However, other factors may also play a role in the host antitumor response. Herein, we review the impact of tumor infiltrating lymphocytes (TILs), mainly the CD4+, CD8+, and regulatory T-cell (Tregs) responses on the course of MCC, including their role in initiating MCPyV-specific immune responses. Furthermore, potential research avenues related to T-cell biology in MCC, as well as relevant immunotherapies are discussed.
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Affiliation(s)
- Kelsey Ouyang
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH 44195, USA
| | - David X. Zheng
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH 44106, USA
| | - George W. Agak
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
- Correspondence:
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DeCoste RC, Walsh NM, Gaston D, Ly TY, Pasternak S, Cutler S, Nightingale M, Carter MD. RB1-deficient squamous cell carcinoma: the proposed source of combined Merkel cell carcinoma. Mod Pathol 2022; 35:1829-1836. [PMID: 36075957 DOI: 10.1038/s41379-022-01151-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 07/05/2022] [Accepted: 08/12/2022] [Indexed: 12/24/2022]
Abstract
Merkel cell carcinoma (MCC) is an aggressive cutaneous neuroendocrine (NE) carcinoma arising from integration of Merkel cell polyomavirus (MCPyV) DNA into a host cell or from ultraviolet light-induced genetic damage (proportions vary geographically). Tumors in the latter group include those with "pure" NE phenotype and those "combined" with other elements, most often squamous cell carcinoma (SCC). We performed comprehensive genomic profiling (CGP) of MCPyV+ and MCPyV- (pure and combined) tumors, to better understand their mutational profiles and shed light on their pathogenesis. Supplemental immunohistochemistry for Rb expression was also undertaken. After eliminating low quality samples, 37 tumors were successfully analyzed (14 MCPyV+, 8 pure MCPyV- and 15 combined MCPyV-). The SCC and NE components were sequenced separately in 5 combined tumors. Tumor mutational burden was lower in MCPyV+ tumors (mean 1.66 vs. 29.9/Mb, P < 0.0001). MCPyV- tumors featured frequent mutations in TP53 (95.6%), RB1 (87%), and NOTCH family genes (95.6%). No recurrently mutated genes were identified in MCPyV+ tumors. Mutational overlap in the NE and SCC components of combined tumors was substantial ('similarity index' >24% in 4/5 cases). Loss of Rb expression correlated with RB1 mutational (P < 0.0001) and MCPyV- status (P < 0.0001) in MCCs and it was observed more frequently in the SCC component of combined MCC than in a control group of conventional cutaneous SCC (P = 0.0002). Our results (i) support existing evidence that MCPyV+ and MCPyV- MCCs are pathogenetically distinct entities (ii) concur with earlier studies linking the NE and SCC components of combined MCCs via shared genetic profiles and (iii) lend credence to the proposal that an Rb-deficient subset of SCC's is the source of phenotypically divergent combined MCCs.
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Affiliation(s)
- Ryan C DeCoste
- Department of Pathology and Laboratory Medicine, QEII Health Sciences Centre, Nova Scotia Health (Central Zone), Halifax, NS, Canada. .,Department of Pathology, Dalhousie University, Halifax, NS, Canada.
| | - Noreen M Walsh
- Department of Pathology and Laboratory Medicine, QEII Health Sciences Centre, Nova Scotia Health (Central Zone), Halifax, NS, Canada.,Department of Pathology, Dalhousie University, Halifax, NS, Canada.,Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Daniel Gaston
- Department of Pathology and Laboratory Medicine, QEII Health Sciences Centre, Nova Scotia Health (Central Zone), Halifax, NS, Canada.,Department of Pathology, Dalhousie University, Halifax, NS, Canada
| | - Thai Yen Ly
- Department of Pathology and Laboratory Medicine, QEII Health Sciences Centre, Nova Scotia Health (Central Zone), Halifax, NS, Canada.,Department of Pathology, Dalhousie University, Halifax, NS, Canada
| | - Sylvia Pasternak
- Department of Pathology and Laboratory Medicine, QEII Health Sciences Centre, Nova Scotia Health (Central Zone), Halifax, NS, Canada.,Department of Pathology, Dalhousie University, Halifax, NS, Canada
| | - Sam Cutler
- Department of Pathology, Dalhousie University, Halifax, NS, Canada
| | - Mat Nightingale
- Department of Pathology, Dalhousie University, Halifax, NS, Canada
| | - Michael D Carter
- Department of Pathology and Laboratory Medicine, QEII Health Sciences Centre, Nova Scotia Health (Central Zone), Halifax, NS, Canada.,Department of Pathology, Dalhousie University, Halifax, NS, Canada
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Gruchy JR, Pasternak S, Ly TY, DeCoste RC, Fleming KE, Moss PM, Carter MD, Walsh NM. Morphological patterns of metastases from combined Merkel cell carcinomas: study of an eastern Canadian cohort of cases. Hum Pathol 2022; 129:47-55. [PMID: 35944612 DOI: 10.1016/j.humpath.2022.07.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/25/2022] [Indexed: 12/14/2022]
Abstract
Combined Merkel cell carcinomas are hybrid tumors composed of neuroendocrine and other phenotypic (usually squamous) elements. They form a minority of Merkel cell carcinomas (MCCs) as a whole, are usually Merkel cell polyomavirus-negative, and have rarely been segregated for specific study. Sporadic reports have indicated that metastases from these tumors can show a combined phenotype. We retrospectively studied 38 cases (24 men [63%], 14 women [37%], mean age 78 years [range, 46-99 years]) of combined MCC. Metastases occurred in 20 patients (53%) (at presentation and/or in follow-up [mean 38 months (range, 0.6-185 months)]). Those from 17 individuals (45%) were examined microscopically. These were mainly nodal in distribution. In 12 patients (71%), the secondary deposits were of pure neuroendocrine type, whereas in 5 (29%), combined deposits were identified. Squamous elements were the most common divergent component, in the primary and secondary tumors. The combined metastases varied from obvious squamous nests in a neuroendocrine background to scattered bizarre tumor giant cells expressing CK5/6 on immunohistochemistry. In one case, individual nodes within a single basin displayed purely squamous or purely neuroendocrine deposits. The mean overall survival in the cohort was 48 months (range, 30-67 months) and the mortality was 82%. Our work sheds light on the frequency and patterns of metastases in combined MCCs. In concert with the poor outcome data documented by others, it also raises a question as to the potential prognostic significance of a combined phenotype per se, independent of a virus-negative status and other variables. This issue deserves further study.
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Affiliation(s)
- Jennette R Gruchy
- Department of Pathology and Laboratory Medicine, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority (Central Zone), Halifax, Nova Scotia, B3H 1V8, Canada; Department of Pathology, Dalhousie University, Halifax, Nova Scotia, B3H 1V8, Canada.
| | - Sylvia Pasternak
- Department of Pathology and Laboratory Medicine, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority (Central Zone), Halifax, Nova Scotia, B3H 1V8, Canada; Department of Pathology, Dalhousie University, Halifax, Nova Scotia, B3H 1V8, Canada; Department of Medicine, Dalhousie University, Halifax, Nova Scotia, B3H 1V8, Canada
| | - Thai Yen Ly
- Department of Pathology and Laboratory Medicine, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority (Central Zone), Halifax, Nova Scotia, B3H 1V8, Canada; Department of Pathology, Dalhousie University, Halifax, Nova Scotia, B3H 1V8, Canada
| | - Ryan C DeCoste
- Department of Pathology and Laboratory Medicine, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority (Central Zone), Halifax, Nova Scotia, B3H 1V8, Canada; Department of Pathology, Dalhousie University, Halifax, Nova Scotia, B3H 1V8, Canada
| | - Kirsten E Fleming
- Department of Pathology and Laboratory Medicine, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority (Central Zone), Halifax, Nova Scotia, B3H 1V8, Canada; Department of Pathology, Dalhousie University, Halifax, Nova Scotia, B3H 1V8, Canada; Department of Pathology, Nanaimo Regional General Hospital, 1200 Dufferin Crescent, Nanaimo, British Columbia, V9S 2B7, Canada
| | - Phillip M Moss
- Department of Pathology and Laboratory Medicine, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority (Central Zone), Halifax, Nova Scotia, B3H 1V8, Canada; Department of Pathology, Dalhousie University, Halifax, Nova Scotia, B3H 1V8, Canada
| | - Michael D Carter
- Department of Pathology and Laboratory Medicine, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority (Central Zone), Halifax, Nova Scotia, B3H 1V8, Canada; Department of Pathology, Dalhousie University, Halifax, Nova Scotia, B3H 1V8, Canada
| | - Noreen M Walsh
- Department of Pathology and Laboratory Medicine, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority (Central Zone), Halifax, Nova Scotia, B3H 1V8, Canada; Department of Pathology, Dalhousie University, Halifax, Nova Scotia, B3H 1V8, Canada; Department of Medicine, Dalhousie University, Halifax, Nova Scotia, B3H 1V8, Canada
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6
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Yang A, Wijaya WA, Yang L, He Y, Cen Y, Chen J. The impact of merkel cell polyomavirus positivity on prognosis of merkel cell carcinoma: A systematic review and meta-analysis. Front Oncol 2022; 12:1020805. [PMID: 36248985 PMCID: PMC9562919 DOI: 10.3389/fonc.2022.1020805] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 09/08/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction There are numerous findings over the past decade have indicated that Merkel cell carcinoma (MCC) may have two pathways of pathogenesis: one related to ultraviolet irradiation and the other to the Merkel cell polyomavirus (MCPyV). However, the predictive and clinicopathological value of MCPyV positivity in MCC patients is still debatable. This article aims to examine the most recent data regarding this issue. Methods The thorough literature searches were conducted in the Medline Ovid, PubMed, Web of Science, the Cochrane CENTRAL Databases, and Embase Databases until December 31, 2021. The associations between overall survival (OS), Merkel cell carcinoma-specific survival (MSS), recurrence-free survival (RFS), progression-free survival (PFS), clinicopathologic features, and MCPyV positivity were examined in our meta-analysis. Results This meta-analysis included a total of 14 studies involving 1595 patients. Our findings demonstrated a significant correlation between MCPyV positivity and improved OS (HR=0.61, 95%CI:0.39-0.94, P=0.026) and improved PFS (HR=0.61, 95% CI: 0.45-0.83, P=0.002). MCPyV positivity did not, however, appear to be associated with either MSS (HR=0.61, 95%CI: 0.28-1.32, P=0.209) or RFS (HR= 0.93, 95%CI: 0.37-2.34, P=0.873). Pooled results revealed a correlation between MCPyV positivity with gender (male vs. female, OR=0.606, 95%CI: 0.449-0.817, P=0.001), histopathological stage (AJCC I-II vs. III-IV, OR=1.636, 95%CI: 1.126-2.378, P=0.010) and primary site (head and neck vs. other sites, OR=0.409, 95%CI: 0.221-0.757, P=0.004). Conclusion These results imply that MCPyV positivity may present a promising predictive biomarker for human MCC and call for further study.
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Affiliation(s)
- Aimin Yang
- Department of Burn and Plastic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Wilson Adrian Wijaya
- Department of Burn and Plastic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Lei Yang
- West China School of Stomatology Sichuan University, Chengdu, China
| | - Yinhai He
- Department of Burn and Plastic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Ying Cen
- Department of Burn and Plastic Surgery, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Ying Cen, ; Junjie Chen,
| | - Junjie Chen
- Department of Burn and Plastic Surgery, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Ying Cen, ; Junjie Chen,
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Mete O, Wenig BM. Update from the 5th Edition of the World Health Organization Classification of Head and Neck Tumors: Overview of the 2022 WHO Classification of Head and Neck Neuroendocrine Neoplasms. Head Neck Pathol 2022; 16:123-142. [PMID: 35312985 PMCID: PMC9018952 DOI: 10.1007/s12105-022-01435-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 02/21/2022] [Indexed: 12/17/2022]
Abstract
This review article provides a brief overview of the new WHO classification by adopting a question-answer model to highlight the spectrum of head and neck neuroendocrine neoplasms which includes epithelial neuroendocrine neoplasms (neuroendocrine tumors and neuroendocrine carcinomas) arising from upper aerodigestive tract and salivary glands, and special neuroendocrine neoplasms including middle ear neuroendocrine tumors (MeNET), ectopic or invasive pituitary neuroendocrine tumors (PitNET; formerly known as pituitary adenoma) and Merkel cell carcinoma as well as non-epithelial neuroendocrine neoplasms (paragangliomas). The new WHO classification follows the IARC/WHO nomenclature framework and restricts the diagnostic term of neuroendocrine carcinoma to poorly differentiated epithelial neuroendocrine neoplasms. In this classification, well-differentiated epithelial neuroendocrine neoplasms are termed as neuroendocrine tumors (NET), and are graded as G1 NET (no necrosis and < 2 mitoses per 2 mm2; Ki67 < 20%), G2 NET (necrosis or 2-10 mitoses per 2 mm2, and Ki67 < 20%) and G3 NET (> 10 mitoses per 2 mm2 or Ki67 > 20%, and absence of poorly differentiated cytomorphology). Neuroendocrine carcinomas (> 10 mitoses per 2 mm2, Ki67 > 20%, and often associated with a Ki67 > 55%) are further subtyped based on cytomorphological characteristics as small cell and large cell neuroendocrine carcinomas. Unlike neuroendocrine carcinomas, head and neck NETs typically show no aberrant p53 expression or loss of RB reactivity. Ectopic or invasive PitNETs are subtyped using pituitary transcription factors (PIT1, TPIT, SF1, GATA3, ER-alpha), hormones and keratins (e.g., CAM5.2). The new classification emphasizes a strict correlation of morphology and immunohistochemical findings in the accurate diagnosis of neuroendocrine neoplasms. A particular emphasis on the role of biomarkers in the confirmation of the neuroendocrine nature of a neoplasm and in the distinction of various neuroendocrine neoplasms is provided by reviewing ancillary tools that are available to pathologists in the diagnostic workup of head and neck neuroendocrine neoplasms. Furthermore, the role of molecular immunohistochemistry in the diagnostic workup of head and neck paragangliomas is discussed. The unmet needs in the field of head and neck neuroendocrine neoplasms are also discussed in this article. The new WHO classification is an important step forward to ensure accurate diagnosis that will also form the basis of ongoing research in this field.
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Affiliation(s)
- Ozgur Mete
- Department of Pathology, University Health Network, 200 Elizabeth Street, 11th floor, Toronto, ON, Canada.
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.
- Endocrine Oncology Site, The Princess Margaret Cancer Center, Toronto, ON, Canada.
| | - Bruce M Wenig
- Department of Pathology Moffitt Cancer Center, Tampa, FL, USA
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DeCoste RC, Carter MD, Pasternak S, Fleming KE, Gaston D, Legge A, Ly TY, Walsh NM. Relationship between p63 and p53 expression in Merkel cell carcinoma and corresponding abnormalities in TP63 and TP53: a study and a proposal. Hum Pathol 2021; 117:31-41. [PMID: 34391748 DOI: 10.1016/j.humpath.2021.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/06/2021] [Accepted: 08/07/2021] [Indexed: 02/05/2023]
Abstract
Merkel cell carcinoma (MCC) is a rare, aggressive cutaneous neuroendocrine carcinoma. Oncogenesis occurs via Merkel cell polyomavirus-mediated (MCPyV+) and/or ultraviolet radiation-associated (MCPyV-) pathways. Advanced clinical stage and an MCPyV- status are important adverse prognostic indicators. There is mounting evidence that p63 expression is a negative prognostic indicator in MCC and that it correlates with MCPyV- status. p63 is a member of the p53 family of proteins among which complex interactions occur. It has two main isoforms (proapoptotic TAp63 and oncogenic ΔNp63). Paradoxically, TAp63 predominates in MCC. To explore this quandary, we examined relationships between p63 and p53 expression and corresponding abnormalities in the TP63 and TP53 genes in MCC. A cohort of 26 MCCs (12 MCPyV+ and 14 MCPyV-) was studied. Comparative immunohistochemical expression of p63 and p53 was evaluated semiquantitatively (H scores) and qualitatively (aberrant patterns). The results were compared with genetic abnormalities in TP63 and TP53 via next-generation sequencing. p63 was positive in 73% of cases. p53 showed "wild-type" expression in 69%, with "aberrant" staining in 31%. TP63 mutations (predominantly low-level copy gains; 23% of cases) and mainly pathogenic mutations in TP53 (50% of cases) featured in the MCPyV- subset of cases. p63 expression correlated quantitatively with p53 expression and qualitatively with aberrant patterns of the latter. Increased expression of p63 and p53 and aberrant p53 staining correlated best with TP53 mutation. We propose that p63 expression (ie, proapoptotic TAp63) in MCC is most likely functionally driven as a compensatory response to defective p53 tumor suppressor activity.
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Affiliation(s)
- Ryan C DeCoste
- Department of Pathology and Laboratory Medicine, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority (Central Zone), Halifax, Nova Scotia, B3H 1V8, Canada
| | - Michael D Carter
- Department of Pathology and Laboratory Medicine, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority (Central Zone), Halifax, Nova Scotia, B3H 1V8, Canada; Department of Pathology, Dalhousie University, Halifax, Nova Scotia, B3H 1V8, Canada
| | - Sylvia Pasternak
- Department of Pathology and Laboratory Medicine, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority (Central Zone), Halifax, Nova Scotia, B3H 1V8, Canada; Department of Pathology, Dalhousie University, Halifax, Nova Scotia, B3H 1V8, Canada
| | - Kirsten E Fleming
- Department of Pathology and Laboratory Medicine, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority (Central Zone), Halifax, Nova Scotia, B3H 1V8, Canada; Department of Pathology, Dalhousie University, Halifax, Nova Scotia, B3H 1V8, Canada
| | - Daniel Gaston
- Department of Pathology and Laboratory Medicine, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority (Central Zone), Halifax, Nova Scotia, B3H 1V8, Canada; Department of Pathology, Dalhousie University, Halifax, Nova Scotia, B3H 1V8, Canada
| | - Alexandra Legge
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, B3H 1V8, Canada
| | - Thai Yen Ly
- Department of Pathology and Laboratory Medicine, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority (Central Zone), Halifax, Nova Scotia, B3H 1V8, Canada; Department of Pathology, Dalhousie University, Halifax, Nova Scotia, B3H 1V8, Canada
| | - Noreen M Walsh
- Department of Pathology and Laboratory Medicine, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority (Central Zone), Halifax, Nova Scotia, B3H 1V8, Canada; Department of Pathology, Dalhousie University, Halifax, Nova Scotia, B3H 1V8, Canada; Department of Medicine, Dalhousie University, Halifax, Nova Scotia, B3H 1V8, Canada.
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Shinogi T, Nagase K, Inoue T, Sato K, Onita A, Takamori A, Narisawa Y. Merkel cell carcinoma: A systematic review of the demographic and clinical characteristics of 847 cases in Japan. J Dermatol 2021; 48:1027-1034. [PMID: 33847013 DOI: 10.1111/1346-8138.15875] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 03/07/2021] [Accepted: 03/14/2021] [Indexed: 01/05/2023]
Abstract
Merkel cell carcinoma (MCC) is a rare but aggressive neuroendocrine carcinoma of the skin associated with Merkel cell polyomavirus and immunosuppression. Although MCC incidence is rising worldwide, MCC has not been sufficiently investigated in Japan. This study aimed to determine MCC demographics in Japan, including incidence, age, sex, location, spontaneous regression, and pure/combined MCC. Using PubMed and Igaku Chuo Zasshi, 847 MCC cases between 1985 and 2015 were extracted, and the main epidemiological characteristics were described. The mean age of all patients was 77.5 years. Regarding the characterized lesions, 63.0% were located on the head and neck, 5.2% on the trunk, 12.6% on the upper limb, 15.1% on the lower limb, 3.5% on the buttocks, and 0.6% on the genitals. Histopathological information regarding the presence of other malignancies could be retrieved in 611 cases, and a coexisting malignancy, mainly squamous cell carcinoma and Bowen's disease, was present in 14.2%. Subcutaneous MCC was observed in 31 patients with a male : female ratio of 1.07 (16 men/15 women). Nodal lesions with unknown primary tumor location were described in 19 patients with a male : female ratio of 0.9 (nine men/10 women) and a mean age of 77.7 years. Of 640 evaluable cases, spontaneous regression developed in 9.1%. Among those 58 patients, the male : female ratio was 1:2.1 in 56 evaluable cases (18 men/38 women). Merkel cell polyomavirus was assessed in 180 patients, and the virus was detected in 31.1% and not detected in 68.9% of the patients. MCC is a rare disease in Japan, with incidence rates and male : female ratios differing from those in the USA and European countries. Besides, this study reveals the high frequency of subcutaneous MCC and MCC with divergent differentiation patterns and spontaneous regression in Japan compared to other countries.
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Affiliation(s)
- Taro Shinogi
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Kotaro Nagase
- 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
| | - Keiko Sato
- Clinical Research Center, Saga University Hospital, Saga, Japan
| | - Ayako Onita
- Clinical Research Center, Saga University Hospital, Saga, Japan
| | - Ayako Takamori
- Clinical Research Center, Saga University Hospital, Saga, Japan
| | - Yutaka Narisawa
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
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10
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Walsh NM, Cerroni L. Merkel cell carcinoma: A review. J Cutan Pathol 2020; 48:411-421. [PMID: 33128463 DOI: 10.1111/cup.13910] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/16/2020] [Accepted: 10/25/2020] [Indexed: 12/17/2022]
Abstract
Merkel cell carcinoma has been a focus of active scientific investigation in recent years and new information on the topic has emerged. Although uncommon, this primary cutaneous neuroendocrine carcinoma, usually involving the head/neck of elderly individuals, has a poor prognosis. Within the past two decades, an increase in the incidence of the tumor and the discovery of its link to the Merkel cell polyomavirus have focused medical attention on the lesion. The resulting studies have improved our understanding of the biology of the neoplasm and contributed to clinical care. Specifically, two pathogenic subsets of the tumor have come to light, the majority due to Merkel cell polyomavirus and the minority caused by ultraviolet radiation-induced genetic damage. This dichotomy carries prognostic implications favoring the former subset. In addition, having capitalized on the known susceptibility of the tumor to immune influences, investigators have recently discovered its responsiveness to immune checkpoint inhibition. This revelation has constituted a therapeutic milestone at the clinical level. Herein we provide an overview of the topic, outline updates in the field and place an emphasis on dermatopathologic aspects of Merkel cell carcinoma.
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Affiliation(s)
- Noreen M Walsh
- Department of Pathology, Queen Elizabeth II Health Sciences Center, Nova Scotia Health Authority (Central Zone), Halifax, Nova Scotia, Canada.,Departments of Pathology and Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Lorenzo Cerroni
- Research Unit of Dermatopathology, Department of Dermatology, Medical University of Graz, Graz, Austria
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11
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Farah M, Reuben A, Spassova I, Yang RK, Kubat L, Nagarajan P, Ning J, Li W, Aung PP, Curry JL, Torres-Cabala CA, Hudgens CW, Ugurel S, Schadendorf D, Gumbs C, Little LD, Futreal A, Wistuba II, Prieto VG, Wang L, Wong MK, Wargo JA, Becker JC, Tetzlaff MT. T-Cell Repertoire in Combination with T-Cell Density Predicts Clinical Outcomes in Patients with Merkel Cell Carcinoma. J Invest Dermatol 2020; 140:2146-2156.e4. [PMID: 32304704 DOI: 10.1016/j.jid.2020.02.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 02/09/2020] [Accepted: 02/12/2020] [Indexed: 02/03/2023]
Abstract
The integrity of the immune system represents a pivotal risk factor and prognostic biomarker for Merkel cell carcinoma. A higher density of tumor-associated T cells correlates with improved Merkel cell carcinoma-specific survival, but the prognostic importance of the T-cell infiltrate reactivity is unknown. We evaluated the T-cell receptor repertoire associated with 72 primary Merkel cell carcinomas and correlated metrics of the T-cell receptor repertoire with clinicopathologic characteristics and patient outcomes. We showed that a high Simpson's Dominance index (SDom) was significantly associated with fewer metastases (P = 0.01), lower stage at presentation (P = 0.02), lower final stage at last follow-up (P = 0.05), and longer time to first lymph node metastasis (P = 0.04). These correlations were mostly preserved in the Merkel cell polyomavirus-negative subgroup. Combining SDom with CD3+ or CD8+ T-cell density revealed three distinct prognostic groups with respect to disease-specific survival. Patients with both high SDom and high CD3+ or CD8+ T-cell density had markedly improved disease-specific survival compared with patients with low SDom and low CD3+ or CD8+ T-cell density (P = 0.002 and P = 0.03, respectively). Patients with either high SDom or high CD3+ or CD8+ had intermediate disease-specific survival. Our findings demonstrate that the quality of the tumor-associated T-cell infiltrate informs patient prognosis in primary Merkel cell carcinoma beyond the T-cell density.
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Affiliation(s)
- Maya Farah
- Department of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Alexandre Reuben
- Department of Thoracic/Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ivelina Spassova
- Translational Skin Cancer Research, University Clinic Essen, Essen, Germany
| | - Richard K Yang
- Department of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Linda Kubat
- Translational Skin Cancer Research, University Clinic Essen, Essen, Germany
| | - Priyadharsini Nagarajan
- Department of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jing Ning
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Wen Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Phyu P Aung
- Department of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jonathan L Curry
- Department of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Carlos A Torres-Cabala
- Department of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Courtney W Hudgens
- Department of Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Selma Ugurel
- Department of Dermatology, University Clinic Essen, Essen, Germany
| | - Dirk Schadendorf
- Department of Dermatology, University Clinic Essen, Essen, Germany
| | - Curtis Gumbs
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Latasha D Little
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Andrew Futreal
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ignacio I Wistuba
- Department of Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Victor G Prieto
- Department of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Linghua Wang
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Michael K Wong
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jennifer A Wargo
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jürgen C Becker
- Translational Skin Cancer Research, University Clinic Essen, Essen, Germany; Department of Dermatology, University Clinic Essen, Essen, Germany; German Cancer Consortium, German Cancer Center, Heidelberg, Germany
| | - Michael T Tetzlaff
- Department of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
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12
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Pietropaolo V, Prezioso C, Moens U. Merkel Cell Polyomavirus and Merkel Cell Carcinoma. Cancers (Basel) 2020; 12:E1774. [PMID: 32635198 PMCID: PMC7407210 DOI: 10.3390/cancers12071774] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 06/26/2020] [Accepted: 06/28/2020] [Indexed: 12/12/2022] Open
Abstract
Viruses are the cause of approximately 15% of all human cancers. Both RNA and DNA human tumor viruses have been identified, with Merkel cell polyomavirus being the most recent one to be linked to cancer. This virus is associated with about 80% of Merkel cell carcinomas, a rare, but aggressive cutaneous malignancy. Despite its name, the cells of origin of this tumor may not be Merkel cells. This review provides an update on the structure and life cycle, cell tropism and epidemiology of the virus and its oncogenic properties. Putative strategies to prevent viral infection or treat virus-positive Merkel cell carcinoma patients are discussed.
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Affiliation(s)
- Valeria Pietropaolo
- Department of Public Health and Infectious Diseases, “Sapienza” University, 00185 Rome, Italy; (V.P.); (C.P.)
| | - Carla Prezioso
- Department of Public Health and Infectious Diseases, “Sapienza” University, 00185 Rome, Italy; (V.P.); (C.P.)
- IRCSS San Raffaele Pisana, Microbiology of Chronic Neuro-Degenerative Pathologies, 00166 Rome, Italy
| | - Ugo Moens
- Molecular Inflammation Research Group, Department of Medical Biology, Faculty of Health Sciences, University of Tromsø—The Arctic University of Norway, 9037 Tromsø, Norway
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13
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Hoang MP, Donizy P, Wu CL, Kopczynski J, Pieniazek M, Miller DM, Ryś J. TdT Expression Is a Marker of Better Survival in Merkel Cell Carcinoma, and Expression of B-Cell Markers Is Associated With Merkel Cell Polyomavirus. Am J Clin Pathol 2020; 154:38-47. [PMID: 32134459 DOI: 10.1093/ajcp/aqaa017] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Merkel cell carcinoma is a rare but very aggressive cutaneous tumor. We evaluated the prognostic potential of B-cell markers (terminal deoxynucleotidyl transferase [TdT], PAX5, CD117), follicular stem cell markers (CK15, CK19), p63, p53, RB, and Merkel cell polyomavirus (MCPyV; CM2B4) in 136 primary cutaneous Merkel cell carcinomas. METHODS Clinical, histopathologic, and immunohistochemical analyses were performed. The results were correlated with patient outcomes by Fisher exact test, log-rank tests, and Cox multivariate models. RESULTS By Fisher exact test, although TdT significantly correlated with both lack of progression (P = .0087) and alive status (P = .0056), MCPyV status correlated only with alive status (P = .031). In univariate analyses, TdT, MCPyV, and RB significantly correlated with improved overall survival, whereas p63 and CK15 correlated with worse overall survival. However, in multivariate analyses, only TdT expression remained as an independent predictor of improved overall survival, Merkel cell carcinoma-specific survival, and progression-free survival. By linear regression analyses, significant correlations between MCPyV vs TdT, PAX5, and CD117 were observed. CONCLUSIONS TdT expression is a potential marker of better survival in Merkel cell carcinoma. Expression of B-cell markers is associated with MCPyV, suggesting that clonal viral integration might play a role in the expression of these markers.
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Affiliation(s)
- Mai P Hoang
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Piotr Donizy
- Department of Pathomorphology and Oncological Cytology, Wroclaw Medical University, Wroclaw, Poland
| | - Cheng-Lin Wu
- Department of Pathology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Janusz Kopczynski
- Department of Surgical Pathology, Holy Cross Cancer Center, Kielce, Poland
| | - Malgorzata Pieniazek
- Department of Clinical Oncology, Tadeusz Koszarowski Regional Oncology Center, Opole, Poland
| | - David M Miller
- Departments of Dermatology and Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Janusz Ryś
- Department of Pathology, Center of Oncology, M. Sklodowska-Curie Memorial Institute, Krakow, Poland
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14
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Nirenberg A, Steinman H, Dixon J, Dixon A. Merkel cell carcinoma update: the case for two tumours. J Eur Acad Dermatol Venereol 2020; 34:1425-1431. [DOI: 10.1111/jdv.16158] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 11/26/2019] [Indexed: 01/03/2023]
Affiliation(s)
- A. Nirenberg
- Australasian College of Cutaneous Oncology Docklands Vic. Australia
| | - H. Steinman
- Campbell University of School of Osteopathic Medicine Lillington NC USA
- US Dermatology Partners Grapevine TX USA
| | - J. Dixon
- Baker Heart and Diabetes Institute Melbourne Vic. Australia
| | - A. Dixon
- Australasian College of Cutaneous Oncology Docklands Vic. Australia
- American Osteopathic College of Dermatology Kirskville MO USA
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15
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Walsh NM, Saggini A, Pasternak S, Carter MD, Fleming K, Ly TY, Doucette S. p63 expression in Merkel cell carcinoma: comparative immunohistochemistry invokes TAp63 as the dominant isoform involved. Hum Pathol 2020; 97:60-67. [PMID: 31978504 DOI: 10.1016/j.humpath.2020.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 01/08/2020] [Accepted: 01/10/2020] [Indexed: 12/11/2022]
Abstract
The literature suggests that p63 expression in Merkel cell carcinoma (MCC) is associated with a poor prognosis. p63 immunohistochemistry marks the 2 main isoforms of this transcriptional protein: TAp63 (tumor suppressor-like properties) and ∆Np63 (oncogenic properties). Little information about the isoform of relevance in MCC exists. p40 immunohistochemistry specifically marks ∆Np63, and using comparative, semiquantitative expression of p63 and p40, we sought to clarify the issue. Our cohort of 53 cases (28 men and 25 women, median age 79 years, interquartile range 71-88) was stratified by morphology and viral status. Immunohistochemistry (p63, p40, and cytokeratin 5/6) was performed, H-scores for nuclear expression of p63 and p40 were derived (2 observers; positivity ≥ 10), and interobserver agreement was evaluated. Clinical, pathological, and outcome data were documented. The results were analyzed statistically. Mortality amounted to 57% (median follow-up 686 days, interquartile range 292-1599). Positivity for Merkel cell polyomavirus was observed in 29 (55%) of cases. Expression of p63 and p40 was present in 36 (69%) and 4 (8%) of cases, respectively. Increased age (P = .0241), negative Merkel cell polyomavirus status (P = .0185), and p63 positivity (P = .0012) were significantly associated with mortality. The latter 2 variables were highly correlated (P = .004). The interclass correlation between the 2 sets of H-scores was 0.95. Our findings support an association between p63 expression and reduced overall survival in MCC and show consistency in scoring this prognostic parameter. TAp63 is the dominant isoform of the protein involved. The paradoxical tumor suppressor-like activity of this isoform in p63-positive MCCs with reduced overall survival requires further study.
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Affiliation(s)
- Noreen M Walsh
- Department of Pathology, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, Central Zone, Halifax, Nova Scotia, Canada B3H 1V8; Dalhousie University, Halifax, Nova Scotia, Canada B3H 1V8; Department of Medicine, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, Central Zone, Halifax, Nova Scotia, Canada B3H 1V8.
| | - Andrea Saggini
- Anatomic Pathology, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy 00133
| | - Sylvia Pasternak
- Department of Pathology, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, Central Zone, Halifax, Nova Scotia, Canada B3H 1V8; Dalhousie University, Halifax, Nova Scotia, Canada B3H 1V8; Department of Medicine, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, Central Zone, Halifax, Nova Scotia, Canada B3H 1V8
| | - Michael D Carter
- Department of Pathology, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, Central Zone, Halifax, Nova Scotia, Canada B3H 1V8; Dalhousie University, Halifax, Nova Scotia, Canada B3H 1V8
| | - Kirsten Fleming
- Department of Pathology, Abbotsford Regional Hospital and Cancer Centre, Fraser Health Authority, Abbotsford, British Columbia, Canada V2S 0C2; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada V6T 1Z3
| | - Thai Yen Ly
- Department of Pathology, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, Central Zone, Halifax, Nova Scotia, Canada B3H 1V8; Dalhousie University, Halifax, Nova Scotia, Canada B3H 1V8
| | - Steve Doucette
- Dalhousie University, Halifax, Nova Scotia, Canada B3H 1V8; Research Methods Unit, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada B3H 1V7
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16
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Danger is only skin deep: aggressive epidermal carcinomas. An overview of the diagnosis, demographics, molecular-genetics, staging, prognostic biomarkers, and therapeutic advances in Merkel cell carcinoma. Mod Pathol 2020; 33:42-55. [PMID: 31676786 DOI: 10.1038/s41379-019-0394-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/27/2019] [Accepted: 10/14/2019] [Indexed: 12/19/2022]
Abstract
Merkel cell carcinoma (MCC) is a high grade primary cutaneous neuroendocrine carcinoma and is among the most aggressive cutaneous malignancies. The rising incidence of MCC, together with its often rapidly aggressive course, underscore a critical need to recognize the histopathologic and the immunohistochemical features that inform its accurate diagnosis. In the current review, we summarize the current state of knowledge regarding the accurate diagnosis of MCC and the exclusion of other entities in the differential diagnosis. We provide a comprehensive review of genomic studies that identified the molecular-genetic drivers of MCC as well as a summary of studies identifying prognostic biomarkers that can facilitate risk stratification. Importantly, Merkel cell polyomavirus (MCPyV) appears to be causative in most cases of MCC and represents both a diagnostic and prognostic marker. Finally, as staging of MCC has undergone critical refinements with the introduction of the 8th Edition of the American Joint Committee on Cancer staging system, we provide an update on MCC staging. In particular, the prognostic significance of the sentinel lymph node (SLN) in MCC necessitates a systematic approach to its evaluation and diagnosis to ensure accurate and consistent risk stratification for patients, and we therefore provide a comprehensive overview of SLN evaluation in MCC. Finally, the intimate relationship between MCC and the integrity of the host immune system has led to paradigm-shifting therapeutic advances with the successful application of immune checkpoint blockade to treat patients with advanced disease, and we therefore summarize those studies and the correlative studies in which predictive biomarkers have been identified.
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17
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Portilla N, Alzate JP, Sierra FA, Parra‐Medina R. A Systematic review and Meta‐Analysis of the survival and clinicopathological features of p63 expression in Merkel cell carcinoma. Australas J Dermatol 2019; 61:e276-e282. [DOI: 10.1111/ajd.13211] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 10/22/2019] [Accepted: 11/09/2019] [Indexed: 01/09/2023]
Affiliation(s)
- Nataly Portilla
- Dermatology Department Clínica Erasmo ValleduparColombia
- Research Institute Fundación Universitaria de Ciencias de la Salud BogotaColombia
| | - Juan P. Alzate
- Research Institute Fundación Universitaria de Ciencias de la Salud BogotaColombia
| | - Fabio A. Sierra
- Research Institute Fundación Universitaria de Ciencias de la Salud BogotaColombia
| | - Rafael Parra‐Medina
- Research Institute Fundación Universitaria de Ciencias de la Salud BogotaColombia
- Pathology Department Fundación Universitaria de Ciencias de la Salud Bogota Colombia
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18
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Smirnov A, Anemona L, Novelli F, Piro CM, Annicchiarico-Petruzzelli M, Melino G, Candi E. p63 Is a Promising Marker in the Diagnosis of Unusual Skin Cancer. Int J Mol Sci 2019; 20:E5781. [PMID: 31744230 PMCID: PMC6888618 DOI: 10.3390/ijms20225781] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 11/07/2019] [Accepted: 11/15/2019] [Indexed: 01/02/2023] Open
Abstract
Skin cancer is the most common type of cancer worldwide. Ozone depletion and climate changes might cause a further increase in the incidence rate in the future. Although the early detection of skin cancer enables it to be treated successfully, some tumours can evolve and become more aggressive, especially in the case of melanoma. Therefore, good diagnostic and prognostic markers are needed to ensure correct detection and treatment. Transcription factor p63, a member of the p53 family of proteins, plays an essential role in the development of stratified epithelia such as skin. In this paper, we conduct a comprehensive review of p63 expression in different types of skin cancer and discuss its possible use in the diagnosis and prognosis of cutaneous tumours.
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Affiliation(s)
- Artem Smirnov
- Department of Experimental Medicine, TOR, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Lucia Anemona
- Department of Experimental Medicine, TOR, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Flavia Novelli
- Department of Experimental Medicine, TOR, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Cristina M. Piro
- Department of Experimental Medicine, TOR, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | | | - Gerry Melino
- Department of Experimental Medicine, TOR, University of Rome “Tor Vergata”, 00133 Rome, Italy
- MRC-Toxicology Unit, University of Cambridge, Cambridge CB2 1QP, UK
| | - Eleonora Candi
- Department of Experimental Medicine, TOR, University of Rome “Tor Vergata”, 00133 Rome, Italy
- Istituto Dermopatico dell’Immacolata-IRCCS, 00163 Rome, Italy
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19
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20
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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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21
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Pasternak S, Carter MD, Ly TY, Doucette S, Walsh NM. Immunohistochemical profiles of different subsets of Merkel cell carcinoma. Hum Pathol 2018; 82:232-238. [PMID: 30067951 DOI: 10.1016/j.humpath.2018.07.022] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 07/13/2018] [Accepted: 07/19/2018] [Indexed: 11/30/2022]
Abstract
The literature records many examples of Merkel cell carcinoma (MCC) exhibiting aberrant immunohistochemical profiles. These can lead to diagnostic difficulty. The objectives of the current study were (1) to examine the immunohistochemical profile of different subsets of MCC to determine whether predictable subset-specific patterns exist and (2) to establish whether shared immunophenotypic patterns might reveal links between individual subsets, as demonstrated previously at a genetic level. In 52 cases of MCC, stratified by viral status and morphology, we studied 5 markers commonly used in the diagnostic evaluation of these tumors (CK20, CK7, chromogranin, neurofilament and TTF-1). Expression of these proteins was recorded as quantitative (H-scores) and absolute (positive vs negative) variables. In general, our data indicate that the "classical" or expected panel (CK20+, NF+, Chromo+, TTF-1, CK7-) is observed significantly more often in pure Merkel cell polyomavirus (MCPyV)-positive than in MCPyV-negative cases (78% vs 25%; P = .002). Neurofilament was less frequently encountered in MCPyV-negative than in MCPyV-positive tumors (66.7% vs 100%; P = .001) and expression of TTF-1 (37.5% vs 3.6%; P = .003) and CK7 (45.8 vs 14.3; P = .02) was more frequent. No significant immonophenotypic differences were observed between pure and combined MCPyV-negative tumors. Recognition of the more aberrant immunohistochemical profile of MCPyV-negative MCC should inform the diagnostic approach to this tumor. Moreover, the shared aberrant immunophenotype in pure and combined MCPyV-negative tumors supports a link between these entities and serves to separate them from MCPyV-positive tumors.
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Affiliation(s)
- Sylvia Pasternak
- Department of Pathology, Queen Elizabeth II Health Sciences Center, Nova Scotia Health Authority, Central Zone, Halifax, NS, B3H 1V8, Canada; Dalhousie University, Halifax, NS, B3H 1V8, Canada; Department of Medicine, Queen Elizabeth II Health Sciences Center, Nova Scotia Health Authority, Central Zone, Halifax, NS, B3H 1V8, Canada.
| | - Michael D Carter
- Department of Pathology, Queen Elizabeth II Health Sciences Center, Nova Scotia Health Authority, Central Zone, Halifax, NS, B3H 1V8, Canada; Dalhousie University, Halifax, NS, B3H 1V8, Canada
| | - Thai Yen Ly
- Department of Pathology, Queen Elizabeth II Health Sciences Center, Nova Scotia Health Authority, Central Zone, Halifax, NS, B3H 1V8, Canada; Dalhousie University, Halifax, NS, B3H 1V8, Canada
| | - Steve Doucette
- Dalhousie University, Halifax, NS, B3H 1V8, Canada; Research Methods Unit, Capital District Health Authority, Halifax, NS, B3H 1V7, Canada
| | - Noreen M Walsh
- Department of Pathology, Queen Elizabeth II Health Sciences Center, Nova Scotia Health Authority, Central Zone, Halifax, NS, B3H 1V8, Canada; Dalhousie University, Halifax, NS, B3H 1V8, Canada; Department of Medicine, Queen Elizabeth II Health Sciences Center, Nova Scotia Health Authority, Central Zone, Halifax, NS, B3H 1V8, Canada
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22
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Al-Rohil RN, Milton DR, Nagarajan P, Curry JL, Feldmeyer L, Torres-Cabala CA, Ivan D, Prieto VG, Tetzlaff MT, Aung PP. Intratumoral and peritumoral lymphovascular invasion detected by D2-40 immunohistochemistry correlates with metastasis in primary cutaneous Merkel cell carcinoma. Hum Pathol 2018; 77:98-107. [PMID: 29601841 DOI: 10.1016/j.humpath.2018.03.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 03/12/2018] [Accepted: 03/19/2018] [Indexed: 12/21/2022]
Abstract
Primary cutaneous Merkel cell carcinoma (MCC) is an aggressive neuroendocrine malignancy in which lymphovascular invasion (LVI) correlates with more aggressive phenotype. The prognostic significance of LVI detected by D2-40 immunohistochemistry (IHC) in MCC remains controversial. We aimed to determine how LVI detected by D2-40 IHC compares with LVI detected by hematoxylin and eosin (H&E) staining in predicting MCC metastasis. Clinical and histopathologic features of MCCs diagnosed and treated in 2002 to 2015 were assembled and included 58 MCC tumors from 58 patients. H&E-stained tissue sections and D2-40 IHC studies were reviewed. When LVI was present, the location (peritumoral or intratumoral) and the size of the largest invaded vessel were recorded. LVI findings by H&E staining and D2-40 IHC were compared with each other and with histologic features and clinical outcomes. H&E staining showed LVI in 37 of 58 cases; D2-40 IHC confirmed LVI in 30 of these cases but failed to confirm LVI in 7. D2-40 IHC also detected 14 cases of LVI not identified on H&E staining. Histologically, D2-40-detected LVI was associated with infiltrative growth pattern and nonbrisk lymphoid infiltrate (P = .005 and P = .055, respectively). There was a statistically significant difference between the frequency of detection of peritumoral LVI by H&E in comparison to D2-40 IHC (P = .0009). MCCs in which D2-40 IHC-detected both intratumoral and peritumoral LVI were typically larger than MCCs without (mean, 24.5 mm versus 17.3 mm; P = .03) and more frequently metastasized (87% versus 51%; P = .03). D2-40 IHC detection of both intratumoral and peritumoral LVI is associated with metastasis.
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Affiliation(s)
- Rami N Al-Rohil
- Department of Pathology, Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Denái R Milton
- Department of Biostatistics, Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Priyadharsini Nagarajan
- Department of Pathology, Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jonathan L Curry
- Department of Pathology, Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; Department of Dermatology, Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Laurence Feldmeyer
- Department of Pathology, Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Carlos A Torres-Cabala
- Department of Pathology, Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; Department of Dermatology, Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Doina Ivan
- Department of Pathology, Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; Department of Dermatology, Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Victor G Prieto
- Department of Pathology, Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; Department of Dermatology, Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Michael T Tetzlaff
- Department of Pathology, Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
| | - Phyu P Aung
- Department of Pathology, Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
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Abstract
Merkel cell carcinoma (MCC) is an aggressive cutaneous neuroendocrine carcinoma. Incidence of MCC continues to rise, and risk factors include advanced age, pale skin, chronic sun exposure, and immune suppression. Diagnosing MCC utilizes a combination of morphology and immunohistochemistry. Merkel cell polyomavirus (MCPyV) is present in approximately 70-80% of MCCs and represents a key pathogenic driver in those MCCs. In contrast, MCPyV-negative MCCs arise through progressive accumulation of ultraviolet-light induced somatic mutations. Staging of MCC proceeds according to the American Joint Commission on Cancer (AJCC) 8th Edition, which utilizes features of the primary tumor together with regional lymph node(s) (clinically and/or pathologically detected) and/or distant metastases. Many potentially useful biomarkers have been studied to refine risk stratification in MCC. In recent years, the host immune infiltrate has been leveraged as immune checkpoint blockade has emerged as an efficacious mode of treatment for patients with advanced MCC.
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Affiliation(s)
- Michael T. Tetzlaff
- 0000 0001 2291 4776grid.240145.6Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 85, Houston, TX 77030 USA ,0000 0001 2291 4776grid.240145.6Department of Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 85, Houston, TX 77030 USA
| | - Priyadharsini Nagarajan
- 0000 0001 2291 4776grid.240145.6Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 85, Houston, TX 77030 USA
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24
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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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25
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Carter MD, Gaston D, Huang WY, Greer WL, Pasternak S, Ly TY, Walsh NM. Genetic profiles of different subsets of Merkel cell carcinoma show links between combined and pure MCPyV-negative tumors. Hum Pathol 2017; 71:117-125. [PMID: 29079179 DOI: 10.1016/j.humpath.2017.10.014] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 10/06/2017] [Accepted: 10/13/2017] [Indexed: 01/31/2023]
Abstract
Tumorigenesis in Merkel cell carcinoma (MCC) is driven by (1) clonal integration of the Merkel cell polyomavirus (MCPyV) in neoplastic cells and/or (2) genetic damage by ultraviolet (UV) light. A higher mutational burden, a UV-mutational signature, and many mutations in the TP53 and RB1 genes characterize the virus-negative subset. MCPyV-negative MCCs include combined (often squamous and neuroendocrine) and pure (neuroendocrine) tumors. Because a combined morphology could elude detection microscopically, we sought a genetic link between combined and pure virus-negative tumors. From a global cohort of 46 cases, 9 pure MCPyV-positive, 9 pure MCPyV-negative, and 10 combined MCPyV-negative MCCs were studied by genome-wide microarray in search of copy number aberrations. The entire cohort (n=46) was evaluated by next-generation sequencing for mutations in selected tumor suppressor genes and oncogenes. More copy number aberrations and a greater fraction of the genome were changed in combined and pure MCPyV-negative tumors relative to MCPyV-positive cases (P<.01 for all comparisons). No difference in these parameters was found between the 2 MCPyV-negative groups. Copy number loss of RB1 or an inactivating RB1 mutation (either or both) was common in combined (8/10, 80%) and pure (7/9, 78%) MCPyV-negative tumors but not MCPyV-positive cases (1/9, 11%). A similar trend was seen for TP53 (combined [2/10, 20%] and pure virus-negative tumors [5/9, 56%] showed gene copy number loss or mutations contrasted with pure virus-positive cases [0/9, 0%]). The shared genetic profiles of combined and pure MCPyV-negative tumors link these subsets and separate them from MCPyV-positive tumors.
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Affiliation(s)
- Michael D Carter
- Department of Pathology and Laboratory Medicine (DPLM), Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority (Central Zone), Halifax, Nova Scotia, Canada B3H 1V8; Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada B3H 1V8.
| | - Dan Gaston
- Department of Pathology and Laboratory Medicine (DPLM), Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority (Central Zone), Halifax, Nova Scotia, Canada B3H 1V8; Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada B3H 1V8
| | - Weei-Yuarn Huang
- Department of Pathology and Laboratory Medicine (DPLM), Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority (Central Zone), Halifax, Nova Scotia, Canada B3H 1V8; Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada B3H 1V8
| | - Wenda L Greer
- Department of Pathology and Laboratory Medicine (DPLM), Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority (Central Zone), Halifax, Nova Scotia, Canada B3H 1V8; Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada B3H 1V8
| | - Sylvia Pasternak
- Department of Pathology and Laboratory Medicine (DPLM), Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority (Central Zone), Halifax, Nova Scotia, Canada B3H 1V8; Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada B3H 1V8
| | - Thai Yen Ly
- Department of Pathology and Laboratory Medicine (DPLM), Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority (Central Zone), Halifax, Nova Scotia, Canada B3H 1V8; Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada B3H 1V8
| | - Noreen M Walsh
- Department of Pathology and Laboratory Medicine (DPLM), Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority (Central Zone), Halifax, Nova Scotia, Canada B3H 1V8; Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada B3H 1V8; Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada B3H 1V8
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26
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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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27
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Abstract
Merkel cell carcinoma (MCC) encompasses neuroendocrine carcinomas primary to skin and occurs most commonly in association with clonally integrated Merkel cell polyomavirus with related retinoblastoma protein sequestration or in association with UV radiation-induced alterations involving the TP53 gene and mutations, heterozygous deletion, and hypermethylation of the Retinoblastoma gene. Molecular genetic signatures may provide therapeutic guidance. Morphologic features, although patterned, are associated with predictable diagnostic pitfalls, usually resolvable by immunohistochemistry. Therapeutic options for MCC, traditionally limited to surgical intervention and later chemotherapy and radiation, are growing, given promising early results of immunotherapeutic regimens.
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Affiliation(s)
- Melissa Pulitzer
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA.
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28
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Merkel Cell Carcinoma: An Update of Key Imaging Techniques, Prognostic Factors, Treatment, and Follow-up. ACTAS DERMO-SIFILIOGRAFICAS 2017. [DOI: 10.1016/j.adengl.2016.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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29
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Llombart B, Kindem S, Chust M. Merkel Cell Carcinoma: An Update of Key Imaging Techniques, Prognostic Factors, Treatment, and Follow-up. ACTAS DERMO-SIFILIOGRAFICAS 2016; 108:98-107. [PMID: 27919405 DOI: 10.1016/j.ad.2016.07.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Revised: 07/01/2016] [Accepted: 07/29/2016] [Indexed: 02/06/2023] Open
Abstract
Merkel cell carcinoma, though rare, is one of the most aggressive tumors a dermatologist faces. More than a third of patients with this diagnosis die from the disease. Numerous researchers have attempted to identify clinical and pathologic predictors to guide prognosis, but their studies have produced inconsistent results. Because the incidence of Merkel cell carcinoma is low and it appears in patients of advanced age, prospective studies have not been done and no clear treatment algorithm has been developed. This review aims to provide an exhaustive, up-to-date account of Merkel cell carcinoma for the dermatologist. We describe prognostic factors and the imaging techniques that are most appropriate for evaluating disease spread. We also discuss current debates on treating Merkel cell carcinoma.
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Affiliation(s)
- B Llombart
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España.
| | - S Kindem
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - M Chust
- Servicio de Radioterapia, Instituto Valenciano de Oncología, Valencia, España
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30
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Feldmeyer L, Hudgens CW, Ray-Lyons G, Nagarajan P, Aung PP, Curry JL, Torres-Cabala CA, Mino B, Rodriguez-Canales J, Reuben A, Chen PL, Ko JS, Billings SD, Bassett RL, Wistuba II, Cooper ZA, Prieto VG, Wargo JA, Tetzlaff MT. Density, Distribution, and Composition of Immune Infiltrates Correlate with Survival in Merkel Cell Carcinoma. Clin Cancer Res 2016; 22:5553-5563. [PMID: 27166398 DOI: 10.1158/1078-0432.ccr-16-0392] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 05/04/2016] [Accepted: 05/05/2016] [Indexed: 02/07/2023]
Abstract
PURPOSE Merkel cell carcinoma (MCC) is an aggressive cancer with frequent metastasis and death with few effective therapies. Because programmed death ligand-1 (PD-L1) is frequently expressed in MCC, immune checkpoint blockade has been leveraged as treatment for metastatic disease. There is therefore a critical need to understand the relationships between MCPyV status, immune profiles, and patient outcomes. EXPERIMENTAL DESIGN IHC for CD3, CD8, PD-1, PD-L1, and MCPyV T-antigen (to determine MCPyV status) was performed on 62 primary MCCs with annotated clinical outcomes. Automated image analysis quantified immune cell density (positive cells/mm2) at discrete geographic locations (tumor periphery, center, and hotspot). T-cell receptor sequencing (TCRseq) was performed in a subset of MCCs. RESULTS No histopathologic variable associated with overall survival (OS) or disease-specific survival (DSS), whereas higher CD3+ (P = 0.004) and CD8+ (P = 0.037) T-cell density at the tumor periphery associated with improved OS. Higher CD8+ T-cell density at the tumor periphery associated with improved DSS (P = 0.049). Stratifying MCCs according to MCPyV status, higher CD3+ (P = 0.026) and CD8+ (P = 0.015) T-cell density at the tumor periphery associated with improved OS for MCPyV+ but not MCPyV- MCC. TCRseq revealed clonal overlap among MCPyV+ samples, suggesting an antigen-specific response against a unifying antigen. CONCLUSIONS These findings establish the tumor-associated immune infiltrate at the tumor periphery as a robust prognostic indicator in MCC and provide a mechanistic rationale to further examine whether the immune infiltrate at the tumor periphery is relevant as a biomarker for response in ongoing and future checkpoint inhibitor trials in MCC. Clin Cancer Res; 22(22); 5553-63. ©2016 AACR.
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Affiliation(s)
- Laurence Feldmeyer
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Courtney W Hudgens
- Department of Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Genevieve Ray-Lyons
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Phyu P Aung
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jonathan L Curry
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Carlos A Torres-Cabala
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Barbara Mino
- Department of Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jaime Rodriguez-Canales
- Department of Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Alexandre Reuben
- Department of Surgical Oncology The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Pei-Ling Chen
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Surgical Oncology The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jennifer S Ko
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio
| | | | - Roland L Bassett
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ignacio I Wistuba
- Department of Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Zachary A Cooper
- Department of Surgical Oncology The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Victor G Prieto
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jennifer A Wargo
- Department of Surgical Oncology The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michael T Tetzlaff
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas. .,Department of Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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31
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Walsh NM, Fleming KE, Hanly JG, Dakin Hache K, Doucette S, Ferrara G, Cerroni L. A morphological and immunophenotypic map of the immune response in Merkel cell carcinoma. Hum Pathol 2016; 52:190-6. [PMID: 26980039 DOI: 10.1016/j.humpath.2016.02.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 02/01/2016] [Accepted: 02/04/2016] [Indexed: 11/25/2022]
Abstract
The susceptibility of Merkel cell carcinoma to the host immune response has prompted a search for effective immunotherapy. CD8-positive T lymphocytes are considered key effectors of this response, but the cellular infiltrates also harbor tumor-protective agents. By developing a comprehensive morphological and immunophenotypic map of tumor-infiltrating lymphocytes (TILS) in Merkel cell carcinoma, we aimed to establish a useful template for future studies. Twenty-two cases (mean age, 79years [range, 52-95]; male-female ratio, 10:12) were studied. TILS were categorized as brisk (7), nonbrisk (9), and absent(6). Merkel cell polyomavirus (MCPyV)-positive (16) and -negative (6) cases were included, as were those with pure (18) and combined (4) morphologies. One MCPyV+ case had undergone spontaneous regression. Immunohistochemical markers included CD3, CD4, CD8, CD20, CD68, FoxP3, PD-1, and CD123. Statistical analysis used Fisher exact tests and Spearman correlations. There was a significant correlation between brisk TILs and MCPyV+ status (P=.025). CD8+ T lymphocytes predominated, were present in significantly higher proportions in brisk infiltrates (P=.003), and showed a significant predilection for the intratumoral environment (P=.003). Immune inhibitors including T regulatory cells (FOXP3+) and PD-1+ "exhausted" immunocytes were present in lower proportions. Our findings support (1) the link between a brisk immune response and MCPyV positivity, (2) the supremacy of CD8+ cells in effecting immunity, and (3) the incorporation of immune inhibitors within the global infiltrate. Efforts to therapeutically arm the "effectors" and disarm the "detractors" are well focused. These will likely have the greatest impact on MCPyV-positive cases.
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Affiliation(s)
- Noreen M Walsh
- Department of Pathology, Queen Elizabeth II Health Sciences Center, Nova Scotia Health Authority (Central Zone), Halifax, Nova Scotia, B3H 1V8, Canada; Dalhousie University, Halifax, Nova Scotia, B3H 1V8, Canada; Department of Medicine, Queen Elizabeth II Health Sciences Center, Nova Scotia Health Authority (Central Zone), Halifax, Nova Scotia, B3H 1V8, Canada.
| | - Kirsten E Fleming
- Department of Pathology, Queen Elizabeth II Health Sciences Center, Nova Scotia Health Authority (Central Zone), Halifax, Nova Scotia, B3H 1V8, Canada; Dalhousie University, Halifax, Nova Scotia, B3H 1V8, Canada
| | - John G Hanly
- Department of Pathology, Queen Elizabeth II Health Sciences Center, Nova Scotia Health Authority (Central Zone), Halifax, Nova Scotia, B3H 1V8, Canada; Dalhousie University, Halifax, Nova Scotia, B3H 1V8, Canada; Department of Medicine, Queen Elizabeth II Health Sciences Center, Nova Scotia Health Authority (Central Zone), Halifax, Nova Scotia, B3H 1V8, Canada
| | - Kelly Dakin Hache
- Department of Pathology, Queen Elizabeth II Health Sciences Center, Nova Scotia Health Authority (Central Zone), Halifax, Nova Scotia, B3H 1V8, Canada; Dalhousie University, Halifax, Nova Scotia, B3H 1V8, Canada
| | - Steve Doucette
- Dalhousie University, Halifax, Nova Scotia, B3H 1V8, Canada; Research Methods Unit, Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, B3H 1V7, Canada
| | - Gerardo Ferrara
- Anatomic Pathology Unit, Gaetano Rummo Hospital, Benevento, Italy; Research Unit Dermatopathology, Department of Dermatology, Medical University of Graz, Graz, Austria
| | - Lorenzo Cerroni
- Research Unit Dermatopathology, Department of Dermatology, Medical University of Graz, Graz, Austria
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32
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Abraham KJ, Zhang X, Vidal R, Paré GC, Feilotter HE, Tron VA. Roles for miR-375 in Neuroendocrine Differentiation and Tumor Suppression via Notch Pathway Suppression in Merkel Cell Carcinoma. THE AMERICAN JOURNAL OF PATHOLOGY 2016; 186:1025-35. [PMID: 26877261 DOI: 10.1016/j.ajpath.2015.11.020] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 10/21/2015] [Accepted: 11/20/2015] [Indexed: 01/07/2023]
Abstract
Dysfunction of key miRNA pathways regulating basic cellular processes is a common driver of many cancers. However, the biological roles and/or clinical applications of such pathways in Merkel cell carcinoma (MCC), a rare but lethal cutaneous neuroendocrine (NE) malignancy, have yet to be determined. Previous work has established that miR-375 is highly expressed in MCC tumors, but its biological role in MCC remains unknown. Herein, we show that elevated miR-375 expression is a specific feature of well-differentiated MCC cell lines that express NE markers. In contrast, miR-375 is strikingly down-regulated in highly aggressive, undifferentiated MCC cell lines. Enforced miR-375 expression in these cells induced NE differentiation, and opposed cancer cell viability, migration, invasion, and survival, pointing to tumor-suppressive roles for miR-375. Mechanistically, miR-375-driven phenotypes were caused by the direct post-transcriptional repression of multiple Notch pathway proteins (Notch2 and RBPJ) linked to cancer and regulation of cell fate. Thus, we detail a novel molecular axis linking tumor-suppressive miR-375 and Notch with NE differentiation and cancer cell behavior in MCC. Our findings identify miR-375 as a putative regulator of NE differentiation, provide insight into the cell of origin of MCC, and suggest that miR-375 silencing may promote aggressive cancer cell behavior through Notch disinhibition.
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Affiliation(s)
- Karan J Abraham
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada
| | - Xiao Zhang
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada
| | - Ricardo Vidal
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada
| | - Geneviève C Paré
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada
| | - Harriet E Feilotter
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada
| | - Victor A Tron
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada.
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33
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Pulitzer MP, Brannon AR, Berger MF, Louis P, Scott SN, Jungbluth AA, Coit DG, Brownell I, Busam KJ. Cutaneous squamous and neuroendocrine carcinoma: genetically and immunohistochemically different from Merkel cell carcinoma. Mod Pathol 2015; 28:1023-32. [PMID: 26022453 PMCID: PMC4920599 DOI: 10.1038/modpathol.2015.60] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 02/10/2015] [Accepted: 02/11/2015] [Indexed: 12/30/2022]
Abstract
Cutaneous neuroendocrine (Merkel cell) carcinoma most often arises de novo in the background of a clonally integrated virus, the Merkel cell polyomavirus, and is notable for positive expression of retinoblastoma 1 (RB1) protein and low expression of p53 compared with the rare Merkel cell polyomavirus-negative Merkel cell carcinomas. Combined squamous and Merkel cell tumors are consistently negative for Merkel cell polyomavirus. Little is known about their immunophenotypic or molecular profile. Herein, we studied 10 combined cutaneous squamous cell and neuroendocrine carcinomas for immunohistochemical expression of p53, retinoblastoma 1 protein, neurofilament, p63, and cytokeratin 20 (CK20). We compared mutation profiles of five combined Merkel cell carcinomas and seven 'pure' Merkel cell carcinomas using targeted next-generation sequencing. Combined tumors were from the head, trunk, and leg of Caucasian males and one female aged 52-89. All cases were highly p53- and p63-positive and neurofilament-negative in the squamous component, whereas RB1-negative in both components. Eight out of 10 were p53-positive, 3/10 p63-positive, and 3/10 focally neurofilament-positive in the neuroendocrine component. Six out of 10 were CK20-positive in any part. By next-generation sequencing, combined tumors were highly mutated, with an average of 48 mutations per megabase compared with pure tumors, which showed 1.25 mutations per megabase. RB1 and p53 mutations were identified in all five combined tumors. Combined tumors represent an immunophenotypically and genetically distinct variant of primary cutaneous neuroendocrine carcinomas, notable for a highly mutated genetic profile, significant p53 expression and/or mutation, absent RB1 expression in the context of increased RB1 mutation, and minimal neurofilament expression.
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Affiliation(s)
- Melissa P Pulitzer
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - A Rose Brannon
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Michael F Berger
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Peter Louis
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Sasinya N Scott
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Achim A Jungbluth
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Daniel G Coit
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Isaac Brownell
- Dermatology Branch, National Cancer Institute, National Institute of Health, Washington, DC, USA
| | - Klaus J Busam
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Lai JH, Fleming KE, Ly TY, Pasternak S, Godlewski M, Doucette S, Walsh NM. Pure versus combined Merkel cell carcinomas: immunohistochemical evaluation of cellular proteins (p53, Bcl-2, and c-kit) reveals significant overexpression of p53 in combined tumors. Hum Pathol 2015; 46:1290-6. [PMID: 26099430 DOI: 10.1016/j.humpath.2015.05.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Revised: 05/04/2015] [Accepted: 05/08/2015] [Indexed: 01/29/2023]
Abstract
Merkel cell polyomavirus is of oncogenic significance in approximately 80% of Merkel cell carcinomas. Morphological subcategories of the tumor differ in regard to viral status, the rare combined type being uniformly virus negative and the predominant pure type being mainly virus positive. Indications that different biological subsets of the tumor exist led us to explore this diversity. In an Eastern Canadian cohort of cases (75 patients; mean age, 76 years [range, 43-91]; male/female ratio, 43:32; 51 [68%] pure and 24 [34%] combined tumors), we semiquantitatively compared the immunohistochemical expression of 3 cellular proteins (p53, Bcl-2, and c-kit) in pure versus combined groups. Viral status was known in a subset of cases. The significant overexpression of p53 in the combined group (mean [SD], 153.8 [117.8] versus 121.6 [77.9]; P = .01) and the increased epidermal expression of this protein (p53 patches) in the same group lend credence to a primary etiologic role for sun damage in these cases. Expression of Bcl-2 and c-kit did not differ significantly between the 2 morphological groups. A relative increase in c-kit expression was significantly associated with a virus-negative status (median [interquartile range], 100 [60-115] versus 70 [0-100]; P = .03). Emerging data reveal divergent biological pathways in Merkel cell carcinoma, each with a characteristic immunohistochemical profile. Virus-positive tumors (all pure) exhibit high retinoblastoma protein and low p53 expression, whereas virus-negative cases (few pure and all combined) show high p53 and relatively high c-kit expression. The potential biological implications of this dichotomy call for consistent stratification of these tumors in future studies.
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Affiliation(s)
- Jonathan H Lai
- Department of Pathology, Queen Elizabeth II Health Sciences Center, Capital District Health Authority, Halifax, NS, B3H 1V8, Canada
| | - Kirsten E Fleming
- Department of Pathology, Queen Elizabeth II Health Sciences Center, Capital District Health Authority, Halifax, NS, B3H 1V8, Canada; Dalhousie University, Halifax, NS, B3H 1V8, Canada
| | - Thai Yen Ly
- Department of Pathology, Queen Elizabeth II Health Sciences Center, Capital District Health Authority, Halifax, NS, B3H 1V8, Canada; Dalhousie University, Halifax, NS, B3H 1V8, Canada
| | - Sylvia Pasternak
- Department of Pathology, Queen Elizabeth II Health Sciences Center, Capital District Health Authority, Halifax, NS, B3H 1V8, Canada; Dalhousie University, Halifax, NS, B3H 1V8, Canada
| | - Marek Godlewski
- Dalhousie University, Halifax, NS, B3H 1V8, Canada; Department of Pathology, Saint John Regional Hospital, Horizon Health Network, Saint John, NB, E2L 4L4, Canada
| | - Steve Doucette
- Dalhousie University, Halifax, NS, B3H 1V8, Canada; Research Methods Unit, Capital District Health Authority, Halifax, NS, B3H 1V7, Canada
| | - Noreen M Walsh
- Department of Pathology, Queen Elizabeth II Health Sciences Center, Capital District Health Authority, Halifax, NS, B3H 1V8, Canada; Dalhousie University, Halifax, NS, B3H 1V8, Canada.
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Iwasaki T, Matsushita M, Nonaka D, Kato M, Nagata K, Murakami I, Hayashi K. Phosphohistone-H3 (PHH3) is prognostic relevant in Merkel cell carcinomas but Merkel cell polyomavirus is a more powerful prognostic factor than AJCC clinical stage, PHH3, Ki-67 or mitotic indices. Pathol Int 2015; 65:404-9. [PMID: 25982855 DOI: 10.1111/pin.12305] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Accepted: 04/10/2015] [Indexed: 01/11/2023]
Abstract
Merkel cell carcinomas (MCCs) associated with Merkel cell polyomavirus (MCPyV) have better prognosis than those without MCPyV. The relationship between mitotic index (MI) and MCC outcome has remained elusive because of the difficulty in differentiating mitotic cells from apoptotic ones. We evaluated the role of phosphohistone-H3 (PHH3) (Ser10), a new mitotic count biomarker, in MCPyV-positive or -negative MCC patients, and assessed its prognostic value in comparison to Ki-67 labeling index or MI using hematoxylin and eosin (HE) staining. We compared the prognostic value of PHH3 mitotic index with that of MI by HE in 19 MCPyV-positive and 9 MCPyV-negative MCC patients. PHH3-positive immunoreactivity was mostly observed in mitotic figures. Multivariate analysis significantly showed that MCPyV status (HR, 0.004; 95% CI 0.0003-0.058) and the American Joint Committee of Cancer (AJCC) stage (HR, 5.02; 95% CI 1.23-20.51) were observed as significantly independent prognostic factors for OS. PHH3-positive cell counts/10 HPF was a slightly significant independent prognostic factor for OS (HR, 4.96; 95% CI 0.93-26.55). PHH3-positive MI and MCPyV status in MCC patients are useful in prognostication, although MCPyV-infection is a more powerful prognostic factor in MCCs than the AJCC scheme on proliferation or mitotic indices.
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Affiliation(s)
- Takeshi Iwasaki
- Division of Molecular Pathology, Department of Pathology, Tottori University Faculty of Medicine, Yonago, Japan
| | - Michiko Matsushita
- Division of Molecular Pathology, Department of Pathology, Tottori University Faculty of Medicine, Yonago, Japan.,Department of Pathobiological Science and Technology, School of Health Science, Tottori University Faculty of Medicine, Yonago, Japan
| | - Daisuke Nonaka
- Department of Histopathology, The Christie NHS Foundation Trust, Manchester, UK
| | - Masako Kato
- Division of Molecular Pathology, Department of Pathology, Tottori University Faculty of Medicine, Yonago, Japan
| | - Keiko Nagata
- Division of Molecular Pathology, Department of Pathology, Tottori University Faculty of Medicine, Yonago, Japan
| | - Ichiro Murakami
- Division of Molecular Pathology, Department of Pathology, Tottori University Faculty of Medicine, Yonago, Japan
| | - Kazuhiko Hayashi
- Division of Molecular Pathology, Department of Pathology, Tottori University Faculty of Medicine, Yonago, Japan
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Abstract
CONTEXT Immunohistochemistry is not a diagnostic test but a highly valuable tool that requires interpretation within a context. OBJECTIVE To review the current status and limitations of immunohistochemistry in dermatopathology. DATA SOURCES English-language literature published between 1980 and 2014. CONCLUSIONS Although immunohistochemistry is rarely completely specific or sensitive, it is an important adjunctive technique in dermatopathology and can be helpful in a series of diagnostic dilemmas.
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Affiliation(s)
- Tammie Ferringer
- From the Departments of Dermatology and Laboratory Medicine, Geisinger Medical Center, Danville, Pennsylvania
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Henderson SA, Tetzlaff MT, Pattanaprichakul P, Fox P, Torres-Cabala CA, Bassett RL, Prieto VG, Richards HW, Curry JL. Detection of mitotic figures and G2+ tumor nuclei with histone markers correlates with worse overall survival in patients with Merkel cell carcinoma. J Cutan Pathol 2014; 41:846-52. [PMID: 25263506 DOI: 10.1111/cup.12383] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 08/12/2014] [Accepted: 09/01/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND High mitotic figure count (MFC) correlates with low survival rate in Merkel cell carcinoma (MCC). However, the prognostic impact of histone biomarkers as surrogates of MFC in MCC is unknown. We evaluated the prognostic significance of the immunodetection of mitotic figures and of G2+ tumor nuclei with histone-associated mitotic markers H3K79me3T80ph (H3KT) and phosphohistone H3 (PHH3) in MCC. METHODS Immunohistochemical analyses of H3KT and PHH3 and proliferative marker Ki-67 were performed in a series of 21 cases of MCC. The significance of the pathologic data and immunoreactivity with these markers was evaluated with Pearson correlation and paired Student t-test. Univariate Cox proportional hazards regression models were performed to assess the relationships between these markers and survival. RESULTS H3KT detected a higher number of mitotic figure (p<0.0001) and G2+ tumor nuclei (p<0.0052) than did PHH3. Furthermore, the MFC combined with G2+ tumor nuclei detected with H3KT compared to PHH3 and manual MFC was a significant predictor of impaired survival in patients with MCC (p=0.035; HR=1.0172), corresponding to a 1.72% increased risk of death for each unit increase in H3KT. CONCLUSIONS Biomarker analysis of proliferative rates with histone markers may have relevance in stratifying risk in patients with MCC.
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