1
|
Spontaneous regression of Markel cell carcinoma in anterior mediastinum without cutaneous involvement. JOURNAL OF RADIOTHERAPY IN PRACTICE 2020. [DOI: 10.1017/s1460396920000862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Background:
Merkel cell carcinoma (MCC) is a rare and highly aggressive neuroendocrine malignancy typically involving the skin. The majority of MCC involves the head/neck region and the extremities. Despite the aggressive nature of the disease, there have been several case studies that report spontaneous regression. We report a unique case of spontaneous regression of an MCC in a peculiar region in the anterior mediastinum with no cutaneous involvement.
Methods:
A 50-year-old man who presented with a mobile low anterior neck mass, proven by biopsy, to be MCC. Subsequent PET/CT confirmed an FDG (Flurodeoxyglucose)-avid upper mediastinal mass. The mass gradually regressed over the course of 1 month subsequent to biopsy and was no longer palpable on exam or visible on subsequent CT scans. The patient was treated with intensity modulated radiation therapy with a total dose of 6,160 cGy in 28 fractions to the site of previously visible primary disease. At-risk nodal basins were also treated. On subsequent follow-up, the patient continued to have no clinical or radiographic signs of disease.
Discussion:
Spontaneous regression of an MCC is rare but has been reported mostly in the head/neck region following biopsy. It is unknown why spontaneous regression occurs. There is a possibility that biopsy may stimulate T-lymphocytes resulting in spontaneous regression.
Conclusion:
This is the first case to our knowledge of spontaneous regression of an MCC in the anterior mediastinum with no cutaneous involvement. Most MCC are seen clinically due to skin changes with a majority of cases occurring in the head/neck region.
Collapse
|
2
|
Longo R, Balasanu O, Chastenet de Castaing M, Chatelain E, Yacoubi M, Campitiello M, Marcon N, Plastino F. A Spontaneous Regression of an Isolated Lymph Node Metastasis from a Primary Unknown Merkel Cell Carcinoma in a Patient with an Idiopathic Hyper-Eosinophilic Syndrome. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:1437-1440. [PMID: 30510152 PMCID: PMC6287448 DOI: 10.12659/ajcr.911840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Patient: Male, 69 Final Diagnosis: Spontaneous regression of a Lymph node metastasis Symptoms: Hypereosinophilia • inguinal mass Medication: — Clinical Procedure: — Specialty: Oncology
Collapse
Affiliation(s)
- Raffaele Longo
- Division of Medical Oncology, Centre Hospitalier Régional (CHR) Metz-Thionville, Ars-Laquenexy, France
| | - Oana Balasanu
- Division of Hematology, Centre Hospitalier Régional (CHR) Metz-Thionville, Ars-Laquenexy, France
| | | | - Eric Chatelain
- Division of Surgery, Centre Hospitalier Régional (CHR) Metz-Thionville, Ars-Laquenexy, France
| | - Mohammed Yacoubi
- Division of Radiotherapy, Centre Hospitalier Régional (CHR) Metz-Thionville, Ars-Laquenexy, France
| | - Marco Campitiello
- Division of Medical Oncology, Centre Hospitalier Régional (CHR) Metz-Thionville, Ars-Laquenexy, France
| | - Nathalie Marcon
- Division of Pathology, Centre Hospitalier Régional (CHR) Metz-Thionville, Ars-Laquenexy, France
| | - Francesca Plastino
- Division of Medical Oncology, Centre Hospitalier Régional (CHR) Metz-Thionville, Ars-Laquenexy, France
| |
Collapse
|
3
|
Nagase K, Inoue T, Koba S, Narisawa Y. Case of probable spontaneous regression of Merkel cell carcinoma combined with squamous cell carcinoma without surgical intervention. J Dermatol 2018; 45:858-861. [PMID: 29687461 DOI: 10.1111/1346-8138.14335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 03/23/2018] [Indexed: 11/29/2022]
Abstract
Merkel cell carcinoma (MCC) is a rare but more lethal cutaneous cancer than melanoma. However, spontaneous regression of a number of MCC has been reported, although the cause of this regression remains unclear. In most cases, MCC regresses after a surgical procedure, for example, biopsy. Herein, we report a case of Merkel cell polyomavirus-negative MCC coincident with squamous cell carcinoma (SCC) that underwent true spontaneous regression without biopsy. One month after the patient's first visit, clinical examination revealed that the tumor had not grown, but its surface showed changes in texture and color. Histopathologically, the excised specimen was indicative of MCC coincident with SCC and showed extensive necrosis in the upper portion of the tumor, numerous caspase-3-positive apoptotic cells, an accumulation of CD68-positive foam cells and vascular invasion. These findings suggested that the tumor had regressed. We hypothesize that extensive coagulative necrosis resulting from an insufficient local blood supply triggered the shedding of some products or components of MCC and SCC, which in turn induced antitumor immunity against both lesions.
Collapse
Affiliation(s)
- 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
| | - Shinichi Koba
- 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
| |
Collapse
|
4
|
Petrov A, Kraleva S, Kubelka-Sabit K, Petrova D. Treatment of a Patient with Merkel Cell Skin Carcinoma Using Radiation Therapy - A Case Report. Open Access Maced J Med Sci 2018; 6:669-672. [PMID: 29731938 PMCID: PMC5927501 DOI: 10.3889/oamjms.2018.120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/30/2018] [Accepted: 04/04/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND: Merkel cell carcinoma (MCC) is a rare, very aggressive tumour. The pathogenesis remains unclear, but UV radiation, immunosuppression, and the presence of Merkel cell polyomavirus in the tumour genome appear to have a key role. Merkel cell carcinoma is a highly aggressive tumour that often has a lethal end. CAS REPORT: A patient at 93 years of age comes for an examination by a dermatologist due to a rapidly growing nodular tumour growth in the forehead area. A tumour was about 3 cm in size. It had no signs of basal-cell carcinoma, no arborising vascularisation, no pigmentations on dermoscopy. Clinically, an eventual Merkel cell carcinoma was considered for the patient, but other primary skin tumours had to be excluded, as well as the possibility that regarding the patient’s age, it may be a metastatic deposit. A skin biopsy was performed, as well as H-E examination and immunohistochemical analyses (positive CD56, positivity of neuroendocrine markers synaptophysin, chromogranin) which were in favour of Merkel cell carcinoma of the skin. After setting the diagnosis, our patient was treated with therapy which led to a complete withdrawal of a tumour. However, after 3 months the patient had repeated relapse of a tumour at the same site on the forehead and metastases in the retroauricular lymph nodes bilaterally. It shows that the radiotherapy as monotherapy has a great effect on the removal of the tumour formation, but unfortunately, it has no impact on lesion recurrence. It is also compatible with the literature data. CONCLUSION: In many adult patients, as our case suggests, radiotherapy could be a good palliative treatment opportunity that should be considered, as well as a combination of radiation therapy with other oncologic therapeutic options.
Collapse
Affiliation(s)
- Andrej Petrov
- Acibadem Sistina Hospital, Skopje, Republic of Macedonia.,Faculty of Medical Sciences, University Goce Delchev, Shtip, Republic of Macedonia
| | | | | | - Deva Petrova
- Acibadem Sistina Hospital, Skopje, Republic of Macedonia
| |
Collapse
|
5
|
Gaiser MR, Bongiorno M, Brownell I. PD-L1 inhibition with avelumab for metastatic Merkel cell carcinoma. Expert Rev Clin Pharmacol 2018; 11:345-359. [PMID: 29478343 DOI: 10.1080/17512433.2018.1445966] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Merkel cell carcinoma (MCC) is a rare and aggressive neuroendocrine skin cancer that lacks durable responses to traditional chemotherapy. Areas covered: After MCC was shown to be an immunogenic tumor, small trials revealed high objective response rates to PD-1/PD-L1 checkpoint inhibitors. The JAVELIN Merkel 200 (NCT02155647) trial tested the use of avelumab, a human IgG1 monoclonal antibody against PD-L1, in metastatic MCC. Avelumab recently became the first approved drug for metastatic MCC. Expert commentary: By conducting broad phase I studies assessing the safety of avelumab and a small phase II study demonstrating efficacy in this rare orphan tumor type, avelumab gained accelerated approval for the treatment of metastatic MCC. Additional studies are needed to determine how the antibody-dependent cellular cytotoxicity (ADCC) competent Fc region of avelumab contributes to disease control. Remaining questions: Longer follow-up will determine the durability of checkpoint blockade in controlling metastatic MCC. Additional studies will assess the utility and safety of adjuvant checkpoint blockade in patients with excised MCC. How to increase response rates by combining PD-1/PD-L1 blockade with other treatment approaches needs to be explored. In addition, treatment options for MCC patients who fail or do not respond to avelumab need to be identified.
Collapse
Affiliation(s)
- Maria Rita Gaiser
- a Skin Cancer Unit , German Cancer Research Center (DKFZ) , Heidelberg , Germany.,b Department of Dermatology, Venereology and Allergology , University Medical Center Mannheim, Ruprecht-Karl University of Heidelberg , Mannheim , Germany
| | | | - Isaac Brownell
- d Dermatology Branch , Center for Cancer Research, National Cancer Institute, National Institutes of Health , Bethesda , MD , USA
| |
Collapse
|
6
|
Update on Merkel Cell Carcinoma: Epidemiology, Etiopathogenesis, Clinical Features, Diagnosis, and Staging. ACTAS DERMO-SIFILIOGRAFICAS 2017. [DOI: 10.1016/j.adengl.2016.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
7
|
Llombart B, Requena C, Cruz J. Update on Merkel Cell Carcinoma: Epidemiology, Etiopathogenesis, Clinical Features, Diagnosis, and Staging. ACTAS DERMO-SIFILIOGRAFICAS 2016; 108:108-119. [PMID: 27770997 DOI: 10.1016/j.ad.2016.07.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Revised: 07/01/2016] [Accepted: 07/29/2016] [Indexed: 10/20/2022] Open
Abstract
Merkel cell carcinoma (MCC) is a rare, highly aggressive tumor, and local or regional disease recurrence is common, as is metastasis. MCC usually develops in sun-exposed skin in patients of advanced age. Its incidence has risen 4-fold in recent decades as the population has aged and immunohistochemical techniques have led to more diagnoses. The pathogenesis of MCC remains unclear but UV radiation, immunosuppression, and the presence of Merkel cell polyomavirus in the tumor genome seem to play key roles. This review seeks to update our understanding of the epidemiology, etiology, pathogenesis, and clinical features of MCC. We also review histologic and immunohistochemical features required for diagnosis. MCC staging is discussed, given its great importance in establishing a prognosis for these patients.
Collapse
Affiliation(s)
- B Llombart
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España.
| | - C Requena
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - J Cruz
- Servicio de Anatomía Patológica, Instituto Valenciano de Oncología, Valencia, España
| |
Collapse
|
8
|
Domínguez-Malagón HR, Michal M, Kazakov DV, Caro-Sánchez CH, Lino-Silva LS. Utility of CD99 Paranuclear Expression in the Differential Diagnosis of Merkel Cell Carcinoma. Int J Surg Pathol 2016; 24:293-296. [DOI: 10.1177/1066896915623361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Background. Recent reviews have referred to the paranuclear dot-like staining pattern of CD99 in several neoplasms, including solid pseudopapillary tumors in the pancreas, colonic adenocarcinomas, and colonic adenomas as well as in Merkel cell carcinoma (MCC). The aim of this work was to explore the utility of CD99 paranuclear staining in the differential diagnosis of MCC. Material and Methods. We explore paranuclear dot-like CD99 expression in several small, round blue cell neoplasms, including neuroendocrine neoplasms, Ewing sarcomas/primitive neuroectodermal tumors (EWS/PNET), melanomas, small cell lung carcinomas (SCC), lymphoblastic lymphoma/leukemia, and rhabdomyosarcomas, in comparison with 33 cases of MCC, to determine the specificity of the paranuclear dot-like CD99 expression in MCC. Results. Twenty MCC (60%) demonstrated focal expression of CD99 and of those, 14 (42.4%) showed the characteristic paranuclear dot-like expression. CD99 was also paranuclear positive in 4 of 11 (36%) SCC, in 3 of 7 (43%) EWS/PNET, in 1 of 6 (16%) lymphoblastic lymphoma/leukemia cases, in 3 of 3 (100%) rhabdomyosarcomas and all melanomas were negative for the CD99 reaction. Conclusion. CD99 paranuclear dot-like expression was not exclusive of the MCC compared with several neoplasms included in its differential diagnosis. This expression is not a great diagnostic aid.
Collapse
Affiliation(s)
| | - Michal Michal
- Charles University Hospital Pilsen, Pilsen, Czech Republic
| | | | | | | |
Collapse
|
9
|
Cirillo F. Spontaneous Regression of Primitive Merkel Cell Carcinoma. Rare Tumors 2015; 7:5961. [PMID: 26788270 PMCID: PMC4703916 DOI: 10.4081/rt.2015.5961] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 08/13/2015] [Accepted: 08/14/2015] [Indexed: 11/23/2022] Open
Abstract
Merkel cell carcinoma (MCC) is a rare, aggressive skin tumor that mainly occurs in the elderly with a generally poor prognosis. Like all skin cancers, its incidence is rising. Despite the poor prognosis, a few reports of spontaneous regression have been published. We describe the case of a 89-year-old male patient who presented two MCC lesions of the scalp. Following biopsy the lesions underwent complete regression with no clinical evidence of residual tumor up to 24 months. The current knowledge of MCC and the other cases of spontaneous regression described in the literature are reviewed.
Collapse
Affiliation(s)
- Fernando Cirillo
- Department of Surgery, General Surgery Unit, Rare Hormonal Tumors Group, AO Istituti Ospitalieri , Cremona, Italy
| |
Collapse
|
10
|
The role of Merkel cell polyomavirus and other human polyomaviruses in emerging hallmarks of cancer. Viruses 2015; 7:1871-901. [PMID: 25866902 PMCID: PMC4411681 DOI: 10.3390/v7041871] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 04/01/2015] [Accepted: 04/07/2015] [Indexed: 12/24/2022] Open
Abstract
Polyomaviruses are non-enveloped, dsDNA viruses that are common in mammals, including humans. All polyomaviruses encode the large T-antigen and small t-antigen proteins that share conserved functional domains, comprising binding motifs for the tumor suppressors pRb and p53, and for protein phosphatase 2A, respectively. At present, 13 different human polyomaviruses are known, and for some of them their large T-antigen and small t-antigen have been shown to possess oncogenic properties in cell culture and animal models, while similar functions are assumed for the large T- and small t-antigen of other human polyomaviruses. However, so far the Merkel cell polyomavirus seems to be the only human polyomavirus associated with cancer. The large T- and small t-antigen exert their tumorigenic effects through classical hallmarks of cancer: inhibiting tumor suppressors, activating tumor promoters, preventing apoptosis, inducing angiogenesis and stimulating metastasis. This review elaborates on the putative roles of human polyomaviruses in some of the emerging hallmarks of cancer. The reciprocal interactions between human polyomaviruses and the immune system response are discussed, a plausible role of polyomavirus-encoded and polyomavirus-induced microRNA in cancer is described, and the effect of polyomaviruses on energy homeostasis and exosomes is explored. Therapeutic strategies against these emerging hallmarks of cancer are also suggested.
Collapse
|
11
|
Fujimoto N, Nakanishi G, Kabuto M, Nakano T, Eto H, Nakajima H, Sano S, Tanaka T. Merkel cell carcinoma showing regression after biopsy: Evaluation of programmed cell death 1-positive cells. J Dermatol 2015; 42:496-9. [DOI: 10.1111/1346-8138.12805] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 01/03/2015] [Indexed: 01/08/2023]
Affiliation(s)
- Noriki Fujimoto
- Department of Dermatology; Shiga University of Medical Science; Shiga Japan
| | - Gen Nakanishi
- Department of Dermatology; Shiga University of Medical Science; Shiga Japan
| | - Miho Kabuto
- Department of Dermatology; Shiga University of Medical Science; Shiga Japan
| | | | - Hikaru Eto
- Department of Dermatology; St Lukes Hospital; Tokyo Japan
| | - Hideki Nakajima
- Department of Dermatology; Kochi Medical School Kochi University; Kochi Japan
| | - Shigetoshi Sano
- Department of Dermatology; Kochi Medical School Kochi University; Kochi Japan
| | - Toshihiro Tanaka
- Department of Dermatology; Shiga University of Medical Science; Shiga Japan
| |
Collapse
|
12
|
Systemic Therapy for Merkel Cell Carcinoma: What's on the Horizon? Cancers (Basel) 2014; 6:1180-94. [PMID: 24840048 PMCID: PMC4074823 DOI: 10.3390/cancers6021180] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 05/08/2014] [Accepted: 05/09/2014] [Indexed: 12/23/2022] Open
Abstract
Merkel cell carcinoma is an aggressive neuroendocrine skin cancer that usually affects elderly patients. Despite being uncommon, incidence has been steadily increasing over the last two decades, likely due to increased awareness, better diagnostic methods and aging of the population. It is currently one of the most lethal cutaneous malignancies, with a five-year overall survival of approximately 50%. With the better understanding of the molecular pathways that lead to the development of Merkel cell carcinoma, there has been an increasing excitement and optimism surrounding novel targeted therapies, in particular to immunotherapy. Some of the concepts surrounding the novel targeted therapies and currently ongoing clinical trials are reviewed here.
Collapse
|
13
|
Merkel Cell Carcinoma (Primary Neuroendocrine Carcinoma of Skin) Mimicking Basal Cell Carcinoma With Review of Different Histopathologic Features. Am J Dermatopathol 2014; 36:160-6. [DOI: 10.1097/dad.0b013e3182a67f6f] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
14
|
Chen KT, Papavasiliou P, Edwards K, Zhu F, Perlis C, Wu H, Turaka A, Berger A, Farma JM. A better prognosis for Merkel cell carcinoma of unknown primary origin. Am J Surg 2013; 206:752-7. [PMID: 23835211 DOI: 10.1016/j.amjsurg.2013.02.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2012] [Revised: 12/03/2012] [Accepted: 02/28/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND There is limited evidence that Merkel cell carcinoma (MCC) arising from a nodal basin without evidence of a primary cutaneous (PC) site has better prognosis. We present our experience at 2 tertiary care referral centers with stage III MCC with and without a PC site. METHODS Fifty stage III MCC patients were identified between 1996 and 2011. Clinical data were analyzed, with primary endpoints being disease-free survival and overall survival. RESULTS Of stage III patients, 34 patients presented with a PC site and 16 patients with an unknown primary (UP) site. Treatment strategies varied; of patients with UP vs. PC sites, 25% vs. 44% underwent combined regional lymphadenectomy and radiation, with an additional 25% vs. 15% receiving chemotherapy. The median disease-free survival for a UP site was not reached vs. 15 months for a PC site (hazards ratio = .48, P = .18). The median overall survival for a UP site was not reached vs 21 months for a PC site (hazards ratio = .34, P = .03). Multivariate analysis showed that UP status was a significant factor in overall survival (P = .002). CONCLUSIONS Stage III MCC with a UP site portends a better prognosis than MCC with a PC site.
Collapse
Affiliation(s)
- Kathryn T Chen
- Department of Surgical Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
15
|
A practical update of surgical management of merkel cell carcinoma of the skin. ISRN SURGERY 2013; 2013:850797. [PMID: 23431473 PMCID: PMC3570924 DOI: 10.1155/2013/850797] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 10/30/2012] [Indexed: 01/08/2023]
Abstract
The role of surgeons in the treatment of Merkel cell carcinoma (MCC) of the skin is reviewed, with respect to diagnosis and treatment. Most of the data in the literature are case reports. Surgery is the mainstay of treatment. A wide local excision, with sentinel node (SLN) biopsy, is the recommended treatment of choice. If SLN is involved, nodal dissection should be performed; unless patient is unfit, then regional radiotherapy can be given. Surgeons should always refer patients for assessment of the need for adjuvant treatments. Adjuvant radiotherapy is well tolerated and effective to minimize recurrence. Adjuvant chemotherapy may be considered for selected node-positive patients, as per National Comprehensive Cancer Network guideline. Data are insufficient to assess whether adjuvant chemotherapy improves survival. Recurrent disease should be treated by complete surgical resection if possible, followed by radiotherapy and possibly chemotherapy. Generally results of multimodality treatment for recurrent disease are better than lesser treatments. Future research should focus on newer chemotherapy and molecular targeted agents in the adjuvant setting and for gross disease.
Collapse
|
16
|
Ciudad C, Avilés JA, Alfageme F, Lecona M, Suárez R, Lázaro P. Spontaneous Regression in Merkel Cell Carcinoma. Dermatol Surg 2010; 36:687-93. [DOI: 10.1111/j.1524-4725.2010.01531.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
17
|
Vazmitel M, Michal M, Kempf W, Mukensnabl P, Kazakov DV. Merkel Cell Carcinoma With a Follicular Lymphocytic Infiltrate: Report of 2 Cases. Am J Dermatopathol 2008; 30:389-91. [DOI: 10.1097/dad.0b013e318178336c] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
18
|
Total Spontaneous Regression of Advanced Merkel Cell Carcinoma after Biopsy. Dermatol Surg 2008. [DOI: 10.1097/00042728-200806000-00018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
19
|
Richetta AG, Mancini M, Torroni A, Lorè B, Iannetti G, Sardella B, Calvieri S. Total spontaneous regression of advanced merkel cell carcinoma after biopsy: review and a new case. Dermatol Surg 2008; 34:815-22. [PMID: 18363731 DOI: 10.1111/j.1524-4725.2008.34153.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
20
|
Vesely MJJ, Murray DJ, Neligan PC, Novak CB, Gullane PJ, Ghazarian D. Complete spontaneous regression in Merkel cell carcinoma. J Plast Reconstr Aesthet Surg 2008; 61:165-71. [PMID: 17382612 DOI: 10.1016/j.bjps.2006.10.020] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2006] [Accepted: 10/15/2006] [Indexed: 11/29/2022]
Abstract
Merkel cell carcinoma is a rare, aggressive, cutaneous malignancy of the elderly with a generally poor prognosis. Like all skin cancers, its incidence is rising. A few reports of spontaneous regression have been published. The case of a 67-year-old female patient who presented with a cheek Merkel cell carcinoma is described. Following biopsy it underwent complete regression with no evidence of residual tumour in the excision specimen taken seven weeks later. The current knowledge of Merkel cell carcinoma and the other cases of spontaneous regression described in the literature are reviewed.
Collapse
Affiliation(s)
- Martin J J Vesely
- Division of Plastic Surgery, University of Toronto, University Health Network, Wharton Head & Neck Centre, Toronto, Ontario, Canada
| | | | | | | | | | | |
Collapse
|
21
|
Pozo L, Sanchez-Carrillo JJ, Martinez A, Blanes A, Diaz-Cano SJ. Differential kinetic features by tumour topography in cutaneous small-cell neuroendocrine (Merkel cell) carcinomas. J Eur Acad Dermatol Venereol 2008; 21:1220-8. [PMID: 17894709 DOI: 10.1111/j.1468-3083.2007.02236.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND/OBJECTIVES Merkel cell carcinomas (MCC) reveal epithelial and neuroendocrine differentiation, but its topographic cell kinetics remains unknown. This study analyses proliferation, apoptosis, and DNA ploidy by topography, features that can help planning therapeutic protocols. This study topographically analyses proliferation, apoptosis, and DNA ploidy. METHODS We selected 27 small-cell MCCs (expressing one epithelial and two neural markers, with consistent ultrastructural findings) to evaluate mitotic figure counting, Ki-67 index, apoptosis index based on the in situ end labelling of fragmented DNA (using Escherichia coli DNA polymerase I, Klenow fragment), DNA ploidy, and BCL2 and TP53 immuno-expression. At least 50 high-power fields were screened per topographic compartment (superficial or papillary dermis, and deep or reticular dermis), recording average and standard deviation for each variable. Variables were statistically compared in each tumour compartment using analysis of variance and Student's t-test (significant if P < 0.05). RESULTS MCCs revealed superficial aneuploid DNA content, and no topographic differences for proliferation markers. Apoptosis showed significantly lower values in the deep compartment (average, P = 0.0050, and standard deviation, P = 0.0074), correlating with increased BCL2 and TP53 immuno-expressions. CONCLUSIONS High homogeneously distributed proliferation and superficial aneuploid DNA content defines MCCs. Apoptosis follows proliferation in superficial compartments, being less variable and proliferation independent in deep compartments, where it is inversely correlated with BCL2/TP53 expression.
Collapse
Affiliation(s)
- L Pozo
- Department of Dermatology, Homerton University Hospital, London, UK
| | | | | | | | | |
Collapse
|
22
|
KUBO H, MATSUSHITA S, FUKUSHIGE T, KANZAKI T, KANEKURA T. Spontaneous regression of recurrent and metastatic Merkel cell carcinoma. J Dermatol 2007; 34:773-7. [DOI: 10.1111/j.1346-8138.2007.00382.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
23
|
Torroni A, Loré B, Iannetti G. The Importance of the Head and Neck Region in Regression of Advanced MCC. J Craniofac Surg 2007; 18:1173-6. [PMID: 17912107 DOI: 10.1097/scs.0b013e31812f76c0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This paper presents the case of a 76-year-old woman who experienced a total regression of a Merkel cell carcinoma (MCC). The primary site of the tumor was on her right eyebrow. After this lesion was excised, the patient presented a massive locoregional metastasis on the right parotid gland and the laterocervical lymph nodes. No distant metastases were detected. An incisional biopsy into the right parotid gland confirmed the diagnosis of MCC metastasis. No surgical treatment was prescribed because of the advanced stage of the disease. Spontaneous total regression on the parotid and the neck mass was observed within 3 months. This is the 15th case of spontaneous regression in total and the 14th case with a site of origin in the head and neck region.
Collapse
Affiliation(s)
- Andrea Torroni
- Division of Maxillofacial Surgery, University of Rome La Sapienza Rome, Italy.
| | | | | |
Collapse
|
24
|
Strobel ES, Feyer P, Steingräber M, Schmitt-Gräff A, Kohl PK. An unusual case of Merkel cell carcinoma. J Cancer Res Clin Oncol 2007; 134:119-23. [PMID: 17653576 DOI: 10.1007/s00432-007-0257-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2007] [Accepted: 06/05/2007] [Indexed: 11/26/2022]
Abstract
PURPOSE Merkel cell carcinoma (MCC) is a rare aggressive neuroendocrine tumor of the skin mainly found in elderly white patients. Due to its poor prognosis with distant metastases in up to 33% and local recurrence in 25-33% and a 5 year disease-specific survival of 64% (1-2) its early diagnosis and appropriate treatment is mandatory. METHODS The study is an exceptional clinical case of a patient with a large inoperable MCC unable to be treated according to treatment guidelines due to her old age. We review the literature addressing treatment options. RESULTS The patient was treated with palliative definitive radiotherapy to her large MCC of the left lower leg. She showed a rapid clinical response to four palliative radiation doses of 7 Gy each, necrosis of tumor mass and persistent clearing at a follow-up of 32 weeks. Our patient was very unusual in terms of her extensive MCC and her rapid and complete response to palliative radiotherapy lasting for 6 months at present. CONCLUSIONS As MCC is an aggressive tumor, best survival is achieved with early diagnosis in a localized stage and prompt adequate surgery and further stage-adjusted treatment. Thus, the differential diagnosis of MCC should not be dismissed in a reddish nodule on the leg, and every excision should be submitted to pathology. In accordance with the literature we demonstrate here that definitive radiotherapy is an effective treatment option for inoperable MCC, which in this individual patient produced necrosis of the extensive tumor mass after only four palliative doses.
Collapse
Affiliation(s)
- Eva-Susanne Strobel
- Department of Medical Oncology, St Georg Vorsorge- und Rehabilitationskliniken, Kurhausplatz 1, 79862 Höchenschwand, Germany.
| | | | | | | | | |
Collapse
|
25
|
Tucci MG, Lucarini G, Giangiacomi M, Zizzi A, Criante P, Ricotti G, Biagini G. Immunohistochemical study of apoptosis markers and involvement of chemokine CXCR4 in skin Merkel cell carcinoma. J Eur Acad Dermatol Venereol 2006; 20:1220-5. [PMID: 17062035 DOI: 10.1111/j.1468-3083.2006.01764.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Merkel cell carcinoma (MCC) is a rare, aggressive cancer of the skin that mainly affects elderly patients. Because of its rarity, there is no established treatment or proven markers to guide therapy or prognosis. Immunohistochemical expression of apoptosis proteins is considered a useful marker of both malignancy and tumour progression. Apoptosis plays a fundamental role in skin homeostasis, and apoptotic cells have been detected in normal and diseased skin. Chemokines possess a wide range of biological activities and CXCR4 is expressed in some cancer cells, where it plays an efficient role in metastasis formation. OBJECTIVE To identify immunohistochemical parameters that can help clinicians select the most suitable therapy for skin MCC. DESIGN Antibodies against ki67, bcl-2, p53, survivin, p16 and CXCR4 were tested to assess the usefulness of these antigens as indices of proliferation potential and predictors of prognosis. METHODS Immunohistochemical detection of apoptosis inhibitors and CXCR4 was performed on tissue from 12 patients with primary MCC. After excision of the primary lesion, five survived and had no metastases, and seven experienced local recurrence or lymph node metastases. RESULTS Expression of ki67 and survivin was increased in patients with local recurrence or metastasis (retrospectively classified as 'poor prognosis') compared with those with a 'good prognosis', and bcl-2 expression was significantly greater (P=0.003). P53 and p16 immunostaining was moderate in both groups. A positive correlation was observed between survivin and mutant p53 in the poor prognosis group (r=0.593, P=0.033; regression coefficient). High values of p53 were measured in patients with high levels of survivin and vice versa. CXCR4 was not detected at all. CONCLUSIONS Our results show strong MCC cell apoptosis inhibition and a high cell proliferation capacity. The positive correlation between survivin and p53 may be a predictor of MCC spread via the lymphatic network. Absent CXCR4 expression may reflect a less aggressive form, with less efficient development of distant and non-organ-selective metastasis formation.
Collapse
Affiliation(s)
- M G Tucci
- U.O. Dermatologia, INRCA-IRCCS, Ancona, Italy
| | | | | | | | | | | | | |
Collapse
|
26
|
Junquera L, Torre A, Vicente JC, García-Consuegra L, Fresno MF. Complete spontaneous regression of Merkel cell carcinoma. Ann Otol Rhinol Laryngol 2005; 114:376-80. [PMID: 15966524 DOI: 10.1177/000348940511400507] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Merkel cell carcinoma (MCC) is a very aggressive primary cutaneous neoplasm most often occurring on the head and neck of the elderly. Spontaneous regression of MCC was first described in 1986. A 79-year-old woman with MCC on the right cheek underwent spontaneous regression of the malignancy, documented by photographic follow-up, computed tomography, and histologic studies. A review of the literature is presented. Complete clinical and histologic regression of MCC was observed in the present case. Although the literature documents 11 similar cases, only 6 can be regarded as complete spontaneous regressions following exclusive performance of a biopsy (primary complete spontaneous regression). Primary complete spontaneous regression of MCC is infrequent, and most case reports describe this phenomenon in women with MCC on the cheek. The reasons underlying regression are unknown.
Collapse
Affiliation(s)
- Luis Junquera
- Department of Oral and Maxillofacial Surgery, University of Oviedo, Central Hospital of Asturias, Oviedo, Spain
| | | | | | | | | |
Collapse
|
27
|
Agelli M, Clegg LX. Epidemiology of primary Merkel cell carcinoma in the United States. J Am Acad Dermatol 2004; 49:832-41. [PMID: 14576661 DOI: 10.1016/s0190-9622(03)02108-x] [Citation(s) in RCA: 377] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Merkel cell carcinoma (MCC) is a rare, aggressive skin cancer. OBJECTIVE We sought to describe primary MCC incidence trends, epidemiology, and predictors of survival. METHODS The population covered by the Surveillance, Epidemiology, and End Results Program was analyzed as a prospective cohort. We measured age-adjusted incidence rates (per 100,000 person-years) and effect of age, anatomic site, and stage on survival. RESULTS Incidence was higher in males (0.34) than in females (0.17). Cases (n = 1034) occurred mostly in whites (94%), in people older than 65 years (76%), and at the head (48%). The 5-year relative survival was 75%, 59%, and 25% for localized, regional, and distant MCC, respectively. Female sex, limb presentation, localized disease, and younger age were positive predictors of survival. CONCLUSION The highest incidence of MCC was observed in whites, males, and in people older than 65 years. Only 49% of cases were reported as localized. Better survival was associated with limb localization, early-stage disease, younger age, and female sex.
Collapse
|
28
|
Sais G, Admella C, Soler T. Spontaneous regression in primary cutaneous neuroendocrine (Merkel cell) carcinoma: a rare immune phenomenon? J Eur Acad Dermatol Venereol 2002; 16:82-3. [PMID: 11952300 DOI: 10.1046/j.1468-3083.2002.374_2.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
29
|
Chiu PM, Ngan YS, Khoo US, Cheung AN. Apoptotic activity in gestational trophoblastic disease correlates with clinical outcome: assessment by the caspase-related M30 CytoDeath antibody. Histopathology 2001; 38:243-9. [PMID: 11260306 DOI: 10.1046/j.1365-2559.2001.01065.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
AIMS The objective of this study was to assess apoptotic activity in gestational trophoblastic disease (GTD) and its prognostic value in hydatidiform mole (HM). METHODS AND RESULTS Expression of the specific caspase cleavage site within cytokeratin 18 was assessed immunohistochemically using the monoclonal antibody M30 CytoDeath in 12 spontaneous abortions, 22 partial and 57 complete HM, eight choriocarcinoma (CCA) and 28 normal placentas. The M30 immunoreactivity occurred predominantly in the syncytiotrophoblasts. A significantly higher M30 index in HM and CCA was found when compared with normal placentas and spontaneous abortions (P < 0.001). The M30 index of those HM which spontaneously regressed was significantly higher than those HM which developed persistent disease requiring chemotherapy (P < 0.001). The M30 index correlated with another apoptotic index previously detected by TdT-mediated dUTP nick-end labelling (TUNEL) (P = 0.007) and the proliferation index assessed by the Ki67 antigen (P = 0.034). CONCLUSIONS We conclude that apoptosis is important in the pathogenesis of GTD. Assessment of apoptotic activity in HM by the M30 index may be considered as an alternative prognostic indicator for predicting the clinical behaviour.
Collapse
Affiliation(s)
- P M Chiu
- Department of Pathology, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong
| | | | | | | |
Collapse
|
30
|
Mori Y, Hashimoto K, Tanaka K, Cui CY, Mehregan DR, Stiff MA. A study of apoptosis in Merkel cell carcinoma: an immunohistochemical, ultrastructural, DNA ladder, and TUNEL labeling study. Am J Dermatopathol 2001; 23:16-23. [PMID: 11176047 DOI: 10.1097/00000372-200102000-00003] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We performed immunohistochemical, ultrastructural, terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick-end labeling (TUNEL), and DNA ladder studies of apoptosis in nine cases of Merkel cell carcinoma (MCC). None of the cases showed spontaneous regression as has been reported in several MCCs. Neuron-specific enolase was demonstrated by immunohistochemistry (8/8 MCCs), and staining for cytokeratin 20 was positive (2/8 MCCs). Ultrastructural examination revealed many cytoplasmic dense-cored granules, desmosome-like structures, and intermediate filaments. The granules were seen along the plasma membrane or around perinuclear centrioles. We found various stages of development of apoptotic bodies. Apoptosis resulted in vacuolization and fragmentation of nuclei and phagocytosed bodies in tumor cells. Apoptotic cells were also detected by TUNEL, DNA ladder, and immunostaining using the antibody against Fas (Apo- 1/CD95) antigen. It seems that a high apoptotic rate is a common finding in MCC, although spontaneous regression is an exceedingly rare event. It is thus unlikely that apoptosis alone would explain spontaneous regression.
Collapse
Affiliation(s)
- Y Mori
- Department of Dermatology, Iwate Medical University, Morioka, Japan
| | | | | | | | | | | |
Collapse
|
31
|
Inoue T, Yoneda K, Manabe M, Demitsu T. Spontaneous regression of merkel cell carcinoma: a comparative study of TUNEL index and tumor-infiltrating lymphocytes between spontaneous regression and non-regression group. J Dermatol Sci 2000; 24:203-11. [PMID: 11084302 DOI: 10.1016/s0923-1811(00)00103-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Some Merkel cell carcinomas (MCC) have been reported to regress spontaneously. To clarify the mechanisms of spontaneous regression (SR) of MCC, we analyzed the TUNEL index, the labeling index of proliferating cell nuclear antigen (PCNA), the labeling index of bcl-2 protein, and the expression of p53 of the tumor cells. We also evaluated the number of infiltrating lymphocytes surrounding the tumor in the tissue specimens. Among seven patients with MCC (SR: n=4; non-regression (NR): n=3), the TUNEL index in the SR group was significantly higher than that in NR group (5.2 and 2.0%, respectively). In addition, the number of lymphocytes around the tumor nests was also significantly increased in the SR group compared to NR group (1576 and 663 cells/mm(2), respectively). Most of the infiltrating lymphocytes were UCHL-1 positive T-cells. There were no significant differences of the PCNA labeling index, the bcl-2 protein labeling index, and the expression p53 between SR and NR group. These results indicate that apoptosis and local T-cell mediated immune response might be involved in spontaneous regression of MCC.
Collapse
Affiliation(s)
- T Inoue
- Department of Dermatology, Akita University School of Medicine, 1-1-1 Hondo, 010-8543, Akita, Japan.
| | | | | | | |
Collapse
|
32
|
Tai PT, Yu E, Tonita J, Gilchrist J. Merkel cell carcinoma of the skin. J Cutan Med Surg 2000; 4:186-95. [PMID: 11231196 DOI: 10.1177/120347540000400403] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2000] [Accepted: 03/20/2000] [Indexed: 11/17/2022]
Abstract
BACKGROUND Neuroendocrine/Merkel cell carcinoma (MCC) of the skin is an uncommon tumour. Currently, there are only limited data available on the natural history, prognostic factors, and patient management of MCC. OBJECTIVES To review our experience and build the largest database from the literature. METHODS Twenty-eight cases from the London Regional Cancer Center were combined with 633 cases obtained from the literature searched in English, French, German, and Chinese for the years 1966 to 1998. The database included age, sex, initial disease status at presentation to the clinic, site of primary, any coexisting disease, any previous irradiation, sizes of primary/nodal/distant metastases, management details, and final disease status. A new modified staging system was used: stage Ia (primary disease only, size > 2 cm), stage Ib (primary disease only, size > 2 cm); stage II (regional nodal disease), and stage III (beyond regional nodes and/or distant disease). RESULTS Age > 65 years, male sex, size of primary > 2 cm, truncal site, nodal/distant disease at presentation, and duration of disease before presentation (< or =3 months) were poor prognostic factors. Surgery was the initial treatment of choice and it significantly improved overall survival (p =.004). CONCLUSIONS We identified poor prognostic factors that may necessitate more aggressive treatment. The suggested staging system, incorporating primary tumour size, accurately predicted outcomes.
Collapse
Affiliation(s)
- P T Tai
- London Regional Cancer Center, London, Ontario, Canada
| | | | | | | |
Collapse
|
33
|
Ríos-Martín JJ, Solorzano-Amoreti A, González-Cámpora R, Galera-Davidson H. Neuroendocrine carcinoma of the skin with a lymphoepithelioma-like histological pattern. Br J Dermatol 2000; 143:460-2. [PMID: 10951173 DOI: 10.1046/j.1365-2133.2000.03690.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
34
|
Maruo K, Kayashima KI, Ono T. Regressing Merkel cell carcinoma-a case showing replacement of tumour cells by foamy cells. Br J Dermatol 2000; 142:1184-9. [PMID: 10848744 DOI: 10.1046/j.1365-2133.2000.03546.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Merkel cell carcinoma (MCC) is a malignant neuroendocrine tumour with a high rate of recurrence and metastasis. However, some cases of spontaneous regression have recently been reported. We describe the clinical course of an 80-year-old Japanese woman with regressing MCC. We also report histological findings of the regressing tumour for the first time. After the patient's first visit to our hospital, the lesion was a rapidly progressive tumour, but suddenly began decreasing in size, and rapidly regressed. The surface of the tumour flattened, the colour changed from red to dark red, and finally the lesion appeared as a small yellowish plaque. Histopathological analysis of the completely regressed tumour revealed that the tumour cells were completely replaced by numerous foamy cells. This is the first report demonstrating the histopathological features of regressing MCC.
Collapse
Affiliation(s)
- K Maruo
- Department of Dermatology, Kumamoto University School of Medicine, Kumamoto 860-0811, Japan.
| | | | | |
Collapse
|
35
|
Rosso R, Paulli M, Carnevali L. Neuroendocrine carcinoma of the skin with lymphoepithelioma-like features. Am J Dermatopathol 1998; 20:483-6. [PMID: 9790110 DOI: 10.1097/00000372-199810000-00010] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report a case of primary neuroendocrine carcinoma of the skin (PNECS) mimicking a lymphoepithelioma-like carcinoma of the skin (LELCS) with respect to both cytomorphology and the presence of a dense lymphoplasmacytic stroma. The tumor occurred in the left forearm of a 86-year-old woman, and its history was marked by aggressive behavior, with metastases to lymph nodes and to visceral sites within 1.5 years of diagnosis. The neoplastic epithelial cells had an immunophenotypic profile typical of PNECS, reacting for cytokeratin 20 and other low-molecular weight cytokeratins, neuron-specific enolase, neurofilament protein, synaptophysin, and chromogranin A. In addition, they were immunoreactive for epithelial membrane antigen, carcinoembryonic antigen, and S-100 protein, as observed in LELCS of supposed adnexal differentiation. The tumor-infiltrating lymphocytes were mostly of T-lineage, with a predominance of CD8+ cells. We believe the case is a morphologic variant of PNECS, retaining its aggressive behavior and high metastatic potential, and should not be confused with true LELCS, which has a more favorable outcome. Immunohistochemistry is paramount in establishing the diagnosis. Lymphoid infiltration, even if prominent, does not seem to be of favorable prognostic significance in such a context.
Collapse
Affiliation(s)
- R Rosso
- Department of Pathology, University of Pavia and I.R.C.C.S. S. Matteo Hospital, Italy
| | | | | |
Collapse
|