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Primary Merkel Cell Carcinoma: The Clinical Experience of Taipei Veterans General Hospital Revisited. Ann Plast Surg 2021; 84:S40-S47. [PMID: 31833886 DOI: 10.1097/sap.0000000000002177] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Merkel cell carcinoma (MCC) is rare among Asians. To evaluate the presence and characteristics of MCC in Taiwan, we described the characteristics, treatment, and prognostic findings of MCC in our institution. METHODS We revisited and carried out a retrospective chart review of 16 consecutive patients with MCC treated from 1995 to 2018. Patient demographic data, tumor size, location, previous treatment, and follow-up data about presence of locoregional recurrence and metastasis were evaluated. RESULTS There were 14 male and 2 female patients (mean age = 75.1 years; range = 26-91 years). Clinical follow-up revealed local recurrences in 5 patients 1 to 4 months after surgical excision. Lymph node metastasis was observed in 3 patients. We reviewed previously published articles and analyzed the clinical findings, pathologic examinations, and treatments. CONCLUSIONS Surgical wide excision of the primary tumor remains the mainstay of treatment for patients with local/regional MCC. Additional management strategies, such as lymphadenectomy, radiotherapy, chemotherapy, and targeted therapy, depend on the presence or absence of clinically detectable lymph node disease. The prognosis for MCC is variable. Our findings highlight the importance of maintaining a high clinical suspicion for this malignancy in the appropriate clinical context to avoid delays in diagnosis and management.
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High-grade Neuroendocrine Carcinomas of the Vulva: A Clinicopathologic Study of 16 Cases. Am J Surg Pathol 2021; 45:304-316. [PMID: 32826525 DOI: 10.1097/pas.0000000000001558] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Vulvar high-grade neuroendocrine carcinomas (HGNECs) are rare and primarily thought to represent Merkel cell carcinoma (MCC). We present the clinicopathologic features of 16 such cases, the largest series to date. Patients were most often White, postmenopausal, and symptomatic from a palpable vulvar mass/nodule. Tumors ranged from 0.7 to 6 cm and most commonly involved the labium majus. Majority of the cases were pure HGNECs (15/16) with small cell (SC) morphology (14/16); 2 were large cell neuroendocrine carcinomas, of which 1 was combined with moderately differentiated adenocarcinoma. All tumors expressed synaptophysin. Of the 14 HGNECs with SC morphology, 6 were CK20-positive MCCs with characteristic CAM5.2 and neurofilament (NF) expression. Five of these MCCs were positive for Merkel cell polyoma virus large T-antigen (MCPyVLTAg). In contrast, 6 HGNECs with SC morphology were negative for CK20, NF, and MCPyVLTAg and classified as SCNECs. High-risk human papilloma virus was positive in all SCNECs and negative in all MCCs. One case of HGNEC with SC morphology could not be entirely characterized due to lack of tissue for ancillary testing. Five of 12 (42%) cases had a discrepant diagnosis initially rendered. Most patients (10/15) presented with International Federation of Gynecology and Obstetrics stage III or IV disease. Usual sites of metastasis included inguinal lymph node, liver, bone, and lung. Twelve patients underwent surgery with adjuvant chemotherapy and/or radiation therapy, 1 received adjuvant immunotherapy, and 1 patient received neoadjuvant chemotherapy followed by surgery and adjuvant radiation therapy. Median overall survival was 24 months (range: 7 to 103 mo), and overall 5-year survival was 12% (95% confidence interval: 1% to 39%). In summary, vulvar HGNECs are rare, aggressive neoplasms that can be further subclassified into MCC, SCNEC, and large cell neuroendocrine carcinoma. CK20, CAM5.2, NF, TTF-1, MCPyVLTAg, and high-risk human papilloma virus facilitate the distinction of MCC from SCNEC. Proper identification of vulvar HGNECs is critical for patient management.
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Kervarrec T, Samimi M, Gaboriaud P, Gheit T, Beby-Defaux A, Houben R, Schrama D, Fromont G, Tommasino M, Le Corre Y, Hainaut-Wierzbicka E, Aubin F, Bens G, Maillard H, Furudoï A, Michenet P, Touzé A, Guyétant S. Detection of the Merkel cell polyomavirus in the neuroendocrine component of combined Merkel cell carcinoma. Virchows Arch 2018; 472:825-837. [PMID: 29594354 DOI: 10.1007/s00428-018-2342-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 02/15/2018] [Accepted: 03/19/2018] [Indexed: 12/31/2022]
Abstract
Merkel cell carcinoma (MCC) is an aggressive neuroendocrine carcinoma of the skin. The main etiological agent is Merkel cell polyomavirus (MCPyV), detected in 80% of cases. About 5% of cases, called combined MCC, feature an admixture of neuroendocrine and non-neuroendocrine tumor cells. Reports of the presence or absence of MCPyV in combined MCC are conflicting, most favoring the absence, which suggests that combined MCC might have independent etiological factors and pathogenesis. These discrepancies might occur with the use of different virus identification assays, with different sensitivities. In this study, we aimed to determine the viral status of combined MCC by a multimodal approach. We histologically reviewed 128 cases of MCC and sub-classified them as "combined" or "conventional." Both groups were compared by clinical data (age, sex, site, American Joint Committee on Cancer [AJCC] stage, immunosuppression, risk of recurrence, and death during follow-up) and immunochemical features (cytokeratin 20 and 7, thyroid transcription factor 1 [TTF1], p53, large T antigen [CM2B4], CD8 infiltrates). After a first calibration step with 12 conventional MCCs and 12 cutaneous squamous cell carcinomas as controls, all eight cases of combined MCC were investigated for MCPyV viral status by combining two independent molecular procedures. Furthermore, on multiplex genotyping assay, the samples were examined for the presence of other polyoma- and papillomaviruses. Combined MCC differed from conventional MCC in earlier AJCC stage, increased risk of recurrence and death, decreased CD8 infiltrates, more frequent TTF1 positivity (5/8), abnormal p53 expression (8/8), and frequent lack of large T antigen expression (7/8). With the molecular procedure, half of the combined MCC cases were positive for MCPyV in the neuroendocrine component. Beta papillomaviruses were detected in 5/8 combined MCC cases and 9/12 conventional MCC cases. In conclusion, the detection of MCPyV DNA in half of the combined MCC cases suggests similar routes of carcinogenesis for combined and conventional MCC.
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Affiliation(s)
- Thibault Kervarrec
- Department of Pathology, Université de Tours, Centre Hospitalier Universitaire de Tours, 37044, Tours Cedex 09, France.
- Biologie des infections à polyomavirus team, UMR INRA ISP 1282, Université de Tours, 31, Avenue Monge, 37200, Tours, France.
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Josef-Schneider-Straße 2, 97080, Würzburg, Germany.
| | - Mahtab Samimi
- Biologie des infections à polyomavirus team, UMR INRA ISP 1282, Université de Tours, 31, Avenue Monge, 37200, Tours, France
- Department of Dermatology, Université François Rabelais, Centre Hospitalier Universitaire de Tours, 37044, Tours Cedex 09, France
| | - Pauline Gaboriaud
- Biologie des infections à polyomavirus team, UMR INRA ISP 1282, Université de Tours, 31, Avenue Monge, 37200, Tours, France
| | - Tarik Gheit
- Infections and Cancer Biology Group, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69008, Lyon, France
| | - Agnès Beby-Defaux
- Université de Poitiers, 2RCT "Récepteurs et régulation des cellules tumorales" team, 1 rue Georges Bonnet, 86073, Poitiers, France
- Department of Virology, Université de Poitiers, Centre Hospitalier Universitaire de Poitiers, 2 rue de la Milétrie, 86021, Poitiers, France
| | - Roland Houben
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Josef-Schneider-Straße 2, 97080, Würzburg, Germany
| | - David Schrama
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Josef-Schneider-Straße 2, 97080, Würzburg, Germany
| | - Gaëlle Fromont
- Department of Pathology, Université de Tours, Centre Hospitalier Universitaire de Tours, 37044, Tours Cedex 09, France
| | - Massimo Tommasino
- Department of Dermatology, Université François Rabelais, Centre Hospitalier Universitaire de Tours, 37044, Tours Cedex 09, France
| | - Yannick Le Corre
- Department of Dermatology, LUNAM Université, Centre Hospitalier Universitaire d'Angers, 4 rue Larrey, 49933, Angers, France
| | - Eva Hainaut-Wierzbicka
- Department of Dermatology, Université de Poitiers, Centre Hospitalier Universitaire de Poitiers, 2 rue de la Milétrie, 86021, Poitiers, France
| | - Francois Aubin
- Department of Dermatology, Université de Franche Comté, Centre Hospitalier Universitaire de Besançon, EA3181, IFR133, 2 boulevard Fleming, 25030, Besançon, France
| | - Guido Bens
- Department of Dermatology, Centre Hospitalier Régional d'Orléans, 14 avenue de l'Hôpital, CS 86709, 45067, Orléans cedex 2, France
| | - Hervé Maillard
- Department of Dermatology, Centre Hospitalier Régional du Mans, 194 avenue Rubillard, 72037, Le Mans, France
| | - Adeline Furudoï
- Department of Pathology, Université de Bordeaux, Centre Hospitalier Universitaire de Bordeaux, Avenue de Magellan, 33604, Pessac, France
| | - Patrick Michenet
- Department of Pathology, Centre Hospitalier Régional d'Orléans, 14 avenue de l'Hôpital, CS 86709, 45067, Orléans cedex 2, France
| | - Antoine Touzé
- Biologie des infections à polyomavirus team, UMR INRA ISP 1282, Université de Tours, 31, Avenue Monge, 37200, Tours, France
| | - Serge Guyétant
- Department of Pathology, Université de Tours, Centre Hospitalier Universitaire de Tours, 37044, Tours Cedex 09, France
- Biologie des infections à polyomavirus team, UMR INRA ISP 1282, Université de Tours, 31, Avenue Monge, 37200, Tours, France
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