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Kervarrec T, Appenzeller S, Tallet A, Jullie ML, Sohier P, Guillonneau F, Rütten A, Berthon P, Le Corre Y, Hainaut-Wierzbicka E, Blom A, Beneton N, Bens G, Nardin C, Aubin F, Dinulescu M, Visée S, Herfs M, Touzé A, Guyétant S, Samimi M, Houben R, Schrama D. Detection of wildtype Merkel cell polyomavirus genomic sequence and VP1 transcription in a subset of Merkel cell carcinoma. Histopathology 2024; 84:356-368. [PMID: 37830288 DOI: 10.1111/his.15068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/16/2023] [Accepted: 09/24/2023] [Indexed: 10/14/2023]
Abstract
AIMS Merkel cell carcinoma (MCC) is frequently caused by the Merkel cell polyomavirus (MCPyV). Characteristic for these virus-positive (VP) MCC is MCPyV integration into the host genome and truncation of the viral oncogene Large T antigen (LT), with full-length LT expression considered as incompatible with MCC growth. Genetic analysis of a VP-MCC/trichoblastoma combined tumour demonstrated that virus-driven MCC can arise from an epithelial cell. Here we describe two further cases of VP-MCC combined with an adnexal tumour, i.e. one trichoblastoma and one poroma. METHODS AND RESULTS Whole-genome sequencing of MCC/trichoblastoma again provided evidence of a trichoblastoma-derived MCC. Although an MCC-typical LT-truncating mutation was detected, we could not determine an integration site and we additionally detected a wildtype sequence encoding full-length LT. Similarly, Sanger sequencing of the combined MCC/poroma revealed coding sequences for both truncated and full-length LT. Moreover, in situ RNA hybridization demonstrated expression of a late region mRNA encoding the viral capsid protein VP1 in both combined as well as in a few cases of pure MCC. CONCLUSION The data presented here suggest the presence of wildtype MCPyV genomes and VP1 transcription in a subset of MCC.
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Affiliation(s)
- Thibault Kervarrec
- Department of Pathology, Université de Tours, Centre Hospitalier Universitaire de Tours, Tours, France
- "Biologie des Infections à Polyomavirus" Team, UMR INRAE ISP 1282, Université de Tours, Tours, France
| | - Silke Appenzeller
- Comprehensive Cancer Center Mainfranken, University Hospital of Würzburg, Würzburg, Germany
| | - Anne Tallet
- Platform of Somatic Tumor Molecular Genetics, Université de Tours, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Marie-Laure Jullie
- Department of Pathology, Hôpital Haut-Lévêque, CHU de Bordeaux, CARADERM Network, Pessac, France
| | - Pierre Sohier
- Faculté de Médecine, Université Paris Cité, Paris, France
- Department of Pathology, Hôpital Cochin, AP-HP.Centre-Université Paris Cité, Paris, France
| | - Francois Guillonneau
- 3P5 Proteomics, Hôpital Cochin, AP-HP, Centre-Université Paris Cité, Paris, France
| | | | - Patricia Berthon
- "Biologie des Infections à Polyomavirus" Team, UMR INRAE ISP 1282, Université de Tours, Tours, France
| | - Yannick Le Corre
- Dermatology Department, LUNAM Université, CHU Angers, Angers, France
| | | | - Astrid Blom
- Department of General and Oncologic Dermatology, CARADERM Network Ambroise-Paré hospital, APHP & Research Unit EA 4340, University of Versailles-Saint-Quentin-en-Yvelines, Paris-Saclay University, Boulogne-Billancourt, France
| | | | - Guido Bens
- Dermatology Department, CHR d'Orléans, Orléans, France
- Dermatology Department, CH de Blois, Blois, France
| | - Charline Nardin
- Dermatology Department, Inserm 1098, Université de Franche Comté, CHU Besançon, Besançon, France
| | - Francois Aubin
- Dermatology Department, Inserm 1098, Université de Franche Comté, CHU Besançon, Besançon, France
| | - Monica Dinulescu
- Dermatology Department, CHR Rennes, Rennes, France
- Institut Dermatologique du Grand Ouest (IDGO), Rennes, France
| | - Sebastien Visée
- Department of Pathology, Centre Hospitalier d'Angoulème, Angoulème, France
| | - Michael Herfs
- Laboratory of Experimental Pathology, GIGA-Cancer, University of Liège, Liège, Belgium
| | - Antoine Touzé
- "Biologie des Infections à Polyomavirus" Team, UMR INRAE ISP 1282, Université de Tours, Tours, France
| | - Serge Guyétant
- Department of Pathology, Université de Tours, Centre Hospitalier Universitaire de Tours, Tours, France
- "Biologie des Infections à Polyomavirus" Team, UMR INRAE ISP 1282, Université de Tours, Tours, France
| | - Mahtab Samimi
- "Biologie des Infections à Polyomavirus" Team, UMR INRAE ISP 1282, Université de Tours, Tours, France
- Departement of Dermatology, Université de Tours, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Roland Houben
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - David Schrama
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
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Abstract
Merkel cell carcinoma (MCC) is a rare and highly aggressive neuroendocrine carcinoma of unknown origin. We performed a retrospective histologic review of primary cutaneous MCCs diagnosed from 1997 to 2018 in several clinical institutions and literature review to determine the frequency of various unusual morphologic appearances of MCC. Of the 136 primary MCCs identified, intraepidermal carcinoma or epidermotropism was noted in 11/136 (8%) cases. An association with pilar cyst in 1/136 (0.7%) case, with actinic keratosis in 2/136 (1.5%) cases, with either invasive or in situ squamous cell carcinoma (SCC) in 14/136 (10%) cases, with poroma in 1/136 (0.7%), and with basal cell carcinoma in 1/136 (0.7%) case was noted. Trabecular pattern and rosettes were noted in 7/136 (5%) and 3/136 (2%) cases, respectively. There was one case of metastatic MCC in a lymph node with chronic lymphocytic leukemia and one rare case of metastatic MCC and SCC in a lymph node. Although uncommon, differentiation toward other cell lineage can be observed in both primary and metastatic MCCs. The tumor can assume a variety of histologic appearances including association with SCC, basal cell carcinoma, melanocytic neoplasm, and follicular cyst; as well as exhibit glandular, sarcomatous, and mesenchymal differentiation. This diversity of morphologic appearance of MCC reflects the complexity of its underlying pathogenesis.
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Abstract
Neuroendocrine differentiation is characterized by endocrine and neuronal features with prominent dense secretory granules and neuropeptides. Neuroendocrine differentiation of skin tumors is of unknown clinical significance. Nonetheless, the acknowledgment of this line of differentiation is important to prevent diagnostic pitfalls and subsequent inappropriate management. This review aims at summarizing the skin neoplasms that can express neuroendocrine markers.
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Kervarrec T, Aljundi M, Appenzeller S, Samimi M, Maubec E, Cribier B, Deschamps L, Sarma B, Sarosi EM, Berthon P, Levy A, Bousquet G, Tallet A, Touzé A, Guyétant S, Schrama D, Houben R. Polyomavirus-Positive Merkel Cell Carcinoma Derived from a Trichoblastoma Suggests an Epithelial Origin of this Merkel Cell Carcinoma. J Invest Dermatol 2019; 140:976-985. [PMID: 31759946 DOI: 10.1016/j.jid.2019.09.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 08/22/2019] [Accepted: 09/19/2019] [Indexed: 12/20/2022]
Abstract
Merkel cell carcinoma (MCC), an aggressive neuroendocrine carcinoma of the skin, is to date the only human cancer known to be frequently caused by a polyomavirus. However, it is a matter of debate which cells are targeted by the Merkel cell polyomavirus (MCPyV) to give rise to the phenotypically multifaceted MCC cells. To assess the lineage of origin of MCPyV-positive MCC, genetic analysis of a very rare tumor combining benign trichoblastoma and MCPyV-positive MCC was conducted by massive parallel sequencing. Although MCPyV was found to be integrated only in the MCC part, six somatic mutations were shared by both tumor components. The mutational overlap between the trichoblastoma and MCPyV-positive MCC parts of the combined tumor implies that MCPyV integration occurred in an epithelial tumor cell before MCC development. Therefore, our report demonstrates that MCPyV-positive MCC can derive from the epithelial lineage.
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Affiliation(s)
- Thibault Kervarrec
- Department of Pathology, Université de Tours, Centre Hospitalier Universitaire de Tours, Tours Cedex, France; Biologie des infections à polyomavirus team, UMR INRA ISP 1282, Université de Tours, Tours, France; Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany.
| | - Mohanad Aljundi
- Department of Dermatology, Avicenne University Hospital, Bobigny, France
| | - Silke Appenzeller
- Core Unit Bioinformatics, Comprehensive Cancer Center Mainfranken, University Hospital of Würzburg, Würzburg, Germany
| | - Mahtab Samimi
- Biologie des infections à polyomavirus team, UMR INRA ISP 1282, Université de Tours, Tours, France; Department of Dermatology, Université de Tours, Centre Hospitalier Universitaire de Tours, Tours Cedex, France
| | - Eve Maubec
- Department of Dermatology, Avicenne University Hospital, Bobigny, France
| | - Bernard Cribier
- Dermatology Clinic, Hôpitaux Universitaires & Université de Strasbourg, Hôpital Civil, Strasbourg, France
| | | | - Bhavishya Sarma
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Eva-Maria Sarosi
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Patricia Berthon
- Biologie des infections à polyomavirus team, UMR INRA ISP 1282, Université de Tours, Tours, France
| | - Annie Levy
- Department of Pathology, Avicenne University Hospital, Bobigny, France
| | - Guilhem Bousquet
- Department of Medical Oncology, Avicenne University Hospital, Bobigny, France
| | - Anne Tallet
- Platform of Somatic Tumor Molecular Genetics, Université de Tours, Centre Hospitalier Universitaire de Tours, Tours Cedex, France
| | - Antoine Touzé
- Biologie des infections à polyomavirus team, UMR INRA ISP 1282, Université de Tours, Tours, France
| | - Serge Guyétant
- Department of Pathology, Université de Tours, Centre Hospitalier Universitaire de Tours, Tours Cedex, France; Biologie des infections à polyomavirus team, UMR INRA ISP 1282, Université de Tours, Tours, France
| | - David Schrama
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Roland Houben
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
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Kervarrec T, Samimi M, Guyétant S, Sarma B, Chéret J, Blanchard E, Berthon P, Schrama D, Houben R, Touzé A. Histogenesis of Merkel Cell Carcinoma: A Comprehensive Review. Front Oncol 2019; 9:451. [PMID: 31245285 PMCID: PMC6579919 DOI: 10.3389/fonc.2019.00451] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 05/13/2019] [Indexed: 12/11/2022] Open
Abstract
Merkel cell carcinoma (MCC) is a primary neuroendocrine carcinoma of the skin. This neoplasia features aggressive behavior, resulting in a 5-year overall survival rate of 40%. In 2008, Feng et al. identified Merkel cell polyomavirus (MCPyV) integration into the host genome as the main event leading to MCC oncogenesis. However, despite identification of this crucial viral oncogenic trigger, the nature of the cell in which MCC oncogenesis occurs is actually unknown. In fact, several hypotheses have been proposed. Despite the large similarity in phenotype features between MCC tumor cells and physiological Merkel cells (MCs), a specialized subpopulation of the epidermis acting as mechanoreceptor of the skin, several points argue against the hypothesis that MCC derives directly from MCs. Alternatively, MCPyV integration could occur in another cell type and induce acquisition of an MC-like phenotype. Accordingly, an epithelial as well as a fibroblastic or B-cell origin of MCC has been proposed mainly based on phenotype similarities shared by MCC and these potential ancestries. The aim of this present review is to provide a comprehensive review of the current knowledge of the histogenesis of MCC.
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Affiliation(s)
- Thibault Kervarrec
- Department of Pathology, Centre Hospitalier Universitaire de Tours, Tours, France.,ISP "Biologie des infections à polyomavirus" team, UMR INRA 1282, University of Tours, Tours, France.,Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Mahtab Samimi
- ISP "Biologie des infections à polyomavirus" team, UMR INRA 1282, University of Tours, Tours, France.,Departement of Dermatology, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Serge Guyétant
- Department of Pathology, Centre Hospitalier Universitaire de Tours, Tours, France.,ISP "Biologie des infections à polyomavirus" team, UMR INRA 1282, University of Tours, Tours, France
| | - Bhavishya Sarma
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Jérémy Chéret
- Monasterium Laboratory, Skin and Hair Research Solutions GmbH, Münster, Germany
| | - Emmanuelle Blanchard
- Department of Pathology, Centre Hospitalier Universitaire de Tours, Tours, France.,Plateforme IBiSA de Microscopie Electronique, INSERM 1259, Université de Tours, Tours, France
| | - Patricia Berthon
- ISP "Biologie des infections à polyomavirus" team, UMR INRA 1282, University of Tours, Tours, France
| | - David Schrama
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Roland Houben
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Antoine Touzé
- ISP "Biologie des infections à polyomavirus" team, UMR INRA 1282, University of Tours, Tours, France
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Concurrent Metastatic Merkel Cell Carcinoma and Cutaneous Squamous Cell Carcinoma in the Same Lymph Node. Am J Dermatopathol 2018; 41:e61-e63. [PMID: 30461423 DOI: 10.1097/dad.0000000000001318] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The coexistence of Merkel cell carcinoma (MCC) and squamous cell carcinoma (SCC) in the same cutaneous lesion is well known. The pathogenesis is believed to be distinct from conventional polyomavirus-related MCC, and it has a more aggressive course. Metastasis of MCC and SCC to the same lymph node is exceedingly rare with only one previously reported case in the English literature. To the best of our knowledge, this is the second case of MCC and SCC with metastasis to the same lymph node. Our case demonstrates the aggressive nature of the combined MCC and SCC in the setting of immunosuppression.
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Narisawa Y, Inoue T, Nagase K. Evidence of proliferative activity in human Merkel cells: implications in the histogenesis of Merkel cell carcinoma. Arch Dermatol Res 2018; 311:37-43. [PMID: 30460510 DOI: 10.1007/s00403-018-1877-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 10/25/2018] [Accepted: 11/11/2018] [Indexed: 10/27/2022]
Abstract
The cellular origin of Merkel cell carcinoma (MCC) is controversial. We previously hypothesized that MCC originates from hair follicle stem cells or Merkel cell (MC) progenitors residing within the hair follicle bulge. Examination of three cases of combined MCC led to the unexpected discovery that numerous keratin 20 (CK20)-positive MCs within the squamous cell carcinoma (SCC) component of combined MCC appeared morphologically normal with dendritic and oval shapes. Moreover, one extremely rare case of combined SCC and MCC showed both intra-epidermal and dermal MCCs. These three cases represent the first documentation of MC hyperplasia in MCC, besides various benign follicular neoplasms associated with MC hyperplasia. Therefore, to elucidate the proliferating potential of MCs and their histogenetic relationship with MCCs, we further investigated these cases based on pathological observations. We identified numerous cells co-expressing CK20 and the proliferation marker Ki-67, identical to the morphological and immunohistochemical features of normal MCs. This finding indicated that MCs can no longer be considered as pure post-mitotic cells. Instead, they have proliferative potential under specific conditions in the diseased or wounded skin, or adjacent to various skin tumors, including MCC. Intimate co-existence of two malignant cell components composed of intradermal and intra-epidermal MCCs, with the proliferation of normal-appearing MCs in the same lesion, lends support to the hypothesis that MCs and MCC cells are derived from MC progenitors residing within the hair follicle bulge. Specifically, MCCs are derived from transformed MC progenitors with potential for dual-directional differentiation towards neuroendocrine and epithelial lineages.
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Affiliation(s)
- Yutaka Narisawa
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, 849-8501, Japan.
| | - Takuya Inoue
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, 849-8501, Japan
| | - Kotaro Nagase
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, 849-8501, Japan
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9
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Basal-Cell Carcinoma Occurring in Cutaneous Infundibular Cysts: Report of 2 Cases and Review of the Literature. Am J Dermatopathol 2016; 37:635-8. [PMID: 25079202 DOI: 10.1097/dad.0000000000000196] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cysts lined by stratified squamous epithelium indistinguishable from the epidermis, referred to as epidermoid cysts, epidermal inclusion cysts, and infundibular cysts, are the most common type of cyst occurring in the skin. They are invariably benign, and malignant neoplasms arising within the wall of such cysts are distinctly uncommon. Even basal-cell carcinoma, which is the most common cutaneous malignant neoplasm of the skin, has rarely been reported to occur in association with epidermoid cysts. The authors report their experience studying 2 patients with basal-cell carcinoma arising in association with an epidermoid cyst. These cases highlight the need to examine, histopathologically, tissue from this common and usually benign lesion. The authors also review the medical literature.
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Molina-Ruiz AM, Bernárdez C, Requena L, Rütten A. Merkel cell carcinoma arising within a poroma: report of two cases. J Cutan Pathol 2015; 42:353-60. [DOI: 10.1111/cup.12468] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 02/15/2015] [Accepted: 02/15/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Ana M. Molina-Ruiz
- Department of Dermatology, Fundación Jiménez Díaz; Universidad Autónoma; Madrid Spain
| | - Claudia Bernárdez
- Department of Dermatology, Fundación Jiménez Díaz; Universidad Autónoma; Madrid Spain
| | - Luis Requena
- Department of Dermatology, Fundación Jiménez Díaz; Universidad Autónoma; Madrid Spain
| | - Arno Rütten
- Dermatopathologisches Gemeinschaftslabor; Friedrichshafen Germany
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Bajoghli A, Agarwal S, Goldberg L, Mirzabeigi M. Melanoma arising from an epidermal inclusion cyst. J Am Acad Dermatol 2013; 68:e6-7. [PMID: 23244388 DOI: 10.1016/j.jaad.2012.04.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Revised: 04/04/2012] [Accepted: 04/11/2012] [Indexed: 10/27/2022]
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12
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Detection of Merkel Cell Polyomavirus and Human Papillomaviruses in Merkel Cell Carcinoma Combined With Squamous Cell Carcinoma in Immunocompetent European Patients. Am J Dermatopathol 2012; 34:506-10. [DOI: 10.1097/dad.0b013e31823b9b4e] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Primary Cutaneous Neuroendocrine Carcinoma Within a Cystic Trichoblastoma: A Nonfortuitous Association? Am J Dermatopathol 2011; 33:383-7. [DOI: 10.1097/dad.0b013e3181e3ceb9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Abstract
Merkel cell carcinoma (MCC) is synonymous with primary cutaneous neuroendocrine carcinoma. It tends to affects elderly whites, but there is also an increased incidence among immunosuppressed patients. The recent identification of a novel polyomavirus associated with the tumor has stimulated renewed interest in its pathogenesis. MCC tends to show classic histologic features of a neuroendocrine carcinoma and is often positive for CK20, but nonclassic cytologic findings and unusual immunophenotypes may be observed and can lead to a diagnostic confusion. MCC needs to be distinguished from other primary cutaneous tumors with a small cell appearance and metastatic tumors. Surgical excision is the treatment of choice, but radiation therapy has also found to be effective. Sentinel lymph node biopsy has become an integral part of the staging of patients with MCC.
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