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Bob A, Nielen F, Krediet J, Schmitter J, Freundt D, Terhorst D, Röwert-Huber J, Kanitakis J, Stockfleth E, Ulrich C, Weichenthal M, Egberts F, Lange-Asschenfeldt B. Tumor vascularization and clinicopathologic parameters as prognostic factors in merkel cell carcinoma. J Cancer Res Clin Oncol 2017. [PMID: 28639083 DOI: 10.1007/s00432-017-2455-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE Merkel cell carcinoma (MCC) is a rare but aggressive neuroendocrine tumor of the skin with an increasing incidence. The clinical course is variable and reliable prognostic factors are scarce. Tumor angiogenesis has been shown to have prognostic impact in different types of cancer. The aim of our study was to determine potential prognostic factors, including tumor vascularization, for clinical outcome of MCC. METHODS The medical records of 46 patients with MCC diagnosed between 1997 and 2010 were analyzed retrospectively. Tissue samples were immune-stained for the lymphatic endothelial vessel marker podoplanin/D2-40 and the panvascular marker CD31. These immunostained sections were analyzed using computer-assisted morphometric image analyses. Aside from the parameters of tumor vascularization, clinicopathologic features were investigated, and progression-free survival (PFS) and tumor-specific survival (TSS) were assessed. Univariate and multivariate analyses were performed to determine prognostic factors. RESULTS Male sex of the MCC patients and a high cross-sectional whole vessel area (WVA) in relation to the entire tumor area as determined on CD31-stained tumor sections were found to be negative prognostic factors for PFS in a univariate and multivariate regression analysis. Ulceration of the primary tumor was significantly associated with both impaired PFS and TSS. CONCLUSIONS Our results indicate a high prognostic impact of tumor vascularization on the clinical outcome of MCC patients. Male sex and ulceration of the primary MCC were identified as independent unfavorable prognostic markers for the clinical outcome. As an outlook, MCC patients with increased angiogenesis might be identified and subjected to a targeted anti-angiogenic treatment.
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Affiliation(s)
- A Bob
- Department of Dermatology, Venerology and Allergology, Charité University Medicine Berlin, Berlin, Germany
| | - F Nielen
- Department of Dermatology, Schleswig-Holstein University Hospital, Campus Kiel, Kiel, Germany
| | - J Krediet
- Department of Dermatology, Venerology and Allergology, Charité University Medicine Berlin, Berlin, Germany
| | - J Schmitter
- Department of Dermatology, Venerology and Allergology, Charité University Medicine Berlin, Berlin, Germany.,Department of Dermatology, Schleswig-Holstein University Hospital, Campus Kiel, Kiel, Germany
| | - D Freundt
- Department of Dermatology, Venerology and Allergology, Charité University Medicine Berlin, Berlin, Germany
| | - D Terhorst
- Department of Dermatology, Venerology and Allergology, Charité University Medicine Berlin, Berlin, Germany
| | - J Röwert-Huber
- Department of Dermatology, Venerology and Allergology, Charité University Medicine Berlin, Berlin, Germany
| | - J Kanitakis
- Department of Dermatology and Pathology, Edouard Herriot Hospital Group, Hospices Civils de Lyon, Lyon, France
| | - E Stockfleth
- Department of Dermatology, Venerology and Allergology, Charité University Medicine Berlin, Berlin, Germany
| | - Ch Ulrich
- Department of Dermatology, Venerology and Allergology, Charité University Medicine Berlin, Berlin, Germany
| | - M Weichenthal
- Department of Dermatology, Schleswig-Holstein University Hospital, Campus Kiel, Kiel, Germany
| | - F Egberts
- Department of Dermatology, Schleswig-Holstein University Hospital, Campus Kiel, Kiel, Germany.
| | - B Lange-Asschenfeldt
- Department of Dermatology, Venerology and Allergology, Charité University Medicine Berlin, Berlin, Germany. .,Department of Dermatology, State Hospital Klagenfurt, Klagenfurt Am Wörthersee, Austria.
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Zinser ME, Salzer HJF, Stein A, von Petersdorff M, Koops A, Holzhüter J. [A 73-year-old female patient after liver and kidney transplantation with dull pain in the epigastrium and recurrent epistaxis]. Internist (Berl) 2015; 56:566-72. [PMID: 25874738 DOI: 10.1007/s00108-015-3700-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A 73-year-old female patient who had received a liver and kidney transplantation presented with symptomatic pancytopenia and right-sided upper abdominal pain. The histological investigation of a bone marrow biopsy showed the extremely rare manifestation of a disseminated Merkel cell carcinoma with infiltration of the bone marrow and suppression of hematopoiesis. Also a Coombs test positive hemolytic anemia did not show a significant response to high-dose steroid therapy. Palliative chemotherapy with carboplatin and etoposide at reduced dosage had to be terminated due to deterioration of the patient's general condition. The patient died 2 days after initiation of chemotherapy.
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Affiliation(s)
- M E Zinser
- I. Medizinische Klinik, Zentrum für Innere Medizin, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland,
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