1
|
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
|
2
|
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
|
3
|
Esposito MJ, Shapiro SH, Laufer H. Merkel Cell Tumor of the Penis. J Histotechnol 2013. [DOI: 10.1179/his.1994.17.4.361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
4
|
Eng TY, Boersma MG, Fuller CD, Goytia V, Jones WE, Joyner M, Nguyen DD. A comprehensive review of the treatment of Merkel cell carcinoma. Am J Clin Oncol 2008; 30:624-36. [PMID: 18091058 DOI: 10.1097/coc.0b013e318142c882] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Merkel cell carcinoma (MCC) is an uncommon but malignant cutaneous neuroendocrine carcinoma with a high incidence of local recurrence, regional lymph node metastases, and subsequent distant metastases. The etiology of MCC remains unknown. It usually occurs in sun-exposed areas in elderly people, many of whom have a history of other synchronous or metachronous sun-associated skin lesions. The outcome for most patients with MCC is generally poor. Surgery is the mainstay of treatment. The role of adjuvant therapy has been debated. However, data from recent development support a multimodality approach, including surgical excision of primary tumor with adequate margins and sentinel lymph node dissection followed by postoperative radiotherapy in most cases, as current choice of practice with better locoregional control and disease-free survival. Patients with regional nodal involvement or advanced disease should undergo nodal dissection followed by adjuvant radiotherapy and, perhaps, systemic platinum-based chemotherapy in most cases.
Collapse
Affiliation(s)
- Tony Y Eng
- Department of Radiation Oncology, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA.
| | | | | | | | | | | | | |
Collapse
|
5
|
Deichmann M, Kurzen H, Egner U, Altevogt P, Hartschuh W. Adhesion molecules CD171 (L1CAM) and CD24 are expressed by primary neuroendocrine carcinomas of the skin (Merkel cell carcinomas). J Cutan Pathol 2003; 30:363-8. [PMID: 12834484 DOI: 10.1034/j.1600-0560.2003.00073.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The neuroendocrine carcinoma of the skin is a rare malignant neuroendocrine tumor, which frequently metastasizes in regional lymph nodes or visceral organs. As adhesive interactions with endothelia, leukocytes, or thrombocytes enable malignant cells to penetrate the endothelium and to circulate in blood or lymphatic vessels, we here addressed the adhesion molecules CD171 (L1CAM) and CD24, which are known to be expressed by neurons, neuroblastomas, and other malignant tumors. METHODS Thirty-one neuroendocrine carcinomas of the skin (22 primary tumors, four recurrent tumors, and five metastases) were included in the study. Immunohistochemical staining of CD171 and CD24 was performed by the streptavidin-biotin-peroxidase-complex technique and a nickel-enhanced diaminobenzidine (DAB) reaction using the monoclonal antibodies UJ 127.11 and ML-5, respectively. RESULTS CD171 expression was detected in most neuroendocrine carcinomas of the skin, and staining was less frequent in metastases and recurrences in comparison with primary tumors which was statistically significant. The majority of neuroendocrine carcinomas of the skin was also positive for the mucin-like adhesion protein CD24. In contrast to tumor cells, cytokeratin 20-positive Merkel cells in 12 trichoblastomas and one fibroepithelioma of Pinkus were all negative for CD171 and CD24 staining. CONCLUSIONS Expression of CD171 and CD24 is found in most neuroendocrine carcinomas of the skin, which may be used diagnostically. Further studies will assess whether this feature may contribute to metastasis of neuroendocrine carcinomas of the skin by facilitating transendothelial migration or tumor cell dissemination as has been suggested for other malignancies.
Collapse
Affiliation(s)
- Martin Deichmann
- Department of Dermatology, Heidelberg University Clinics, Heidelberg, Germany.
| | | | | | | | | |
Collapse
|
6
|
Abstract
This article briefly reviews many immunohistochemical stains that have been in use for years, emphasizing their diagnostic use and potential pitfalls. Several newer immunostains are described in a more comprehensive fashion, including brief summaries from recently published studies.
Collapse
Affiliation(s)
- A R Hudson
- Division of Dermatopathology, University of Arkansas for Medical Sciences, Little Rock, USA
| | | |
Collapse
|
7
|
Affiliation(s)
- G Sozzi
- Division of Experimental Oncology A, Istituto Nazionale Tumori, Milan, Italy
| | | | | |
Collapse
|
8
|
Abstract
BACKGROUND Merkel cell carcinoma is an uncommon malignancy of the skin that often portends a poor prognosis. Since its first description by Toker in 1972, a plethora of case reports and articles regarding the etiopathogenesis and treatment have been published spanning multiple medical and surgical disciplines. Much confusion still exists regarding the diagnosis and treatment of this ominous tumor. OBJECT Through extensive review of the medical, surgical, and pathological literature, to collate the observations of multiple investigators and summarize these findings. METHODS Articles from journals of multiple subspecialties were carefully reviewed with particular emphasis placed on epidemiology, prognosis, histology, immunohistochemistry, electron microscopy, tumor origin, treatment, and work-up of Merkel cell carcinoma. RESULTS Merkel cell carcinoma is an aggressive malignant neoplasm. Local recurrence develops in 26-44% of patients despite therapy. Up to three-fourths of patients eventually develop regional nodal metastases with distant metastases occurring in one-third of all patients. Reported overall 5-year survival rates range from 30% to 64%. CONCLUSION Treatment recommendations unfortunately are based more on anecdotal than scientific data because of the rarity of the tumor and its recognized high risk. Most authors recommend wide local excision of the primary lesion and regional lymph node resection if lymph nodes are palpable followed by x-irradiation of both the postsurgical bed and lymph node basin. The role of elective lymph node resection in the absence of clinically positive nodes remains controversial.
Collapse
Affiliation(s)
- M L Haag
- Division of Dermatology and Cutaneous Surgery, University of South Florida College of Medicine, Tampa 33612, USA
| | | | | |
Collapse
|
9
|
Hamilton J, Levine MR, Lash R, Koenigsberg A. Merkel Cell Carcinoma of the Eyelid. Ophthalmic Surg Lasers Imaging Retina 1993. [DOI: 10.3928/1542-8877-19931101-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
10
|
Maiorano E, Renzulli G, Favia G, Ricco R. Expression of intermediate filaments in chordomas. An immunocytochemical study of five cases. Pathol Res Pract 1992; 188:901-7. [PMID: 1280357 DOI: 10.1016/s0344-0338(11)80251-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
An immunocytochemical investigation has been carried out on five cases of chordoma (2 of the sacrum, 2 in the spheno-occipital bone and 1 in the parapharyngeal area) to study the expression of the 5 classes of intermediate filaments (IF): cytokeratin (CK), desmin (DES), GFAP, neurofilaments (NF) and vimentin (VIM). Our results show that constant coexpression of CK, NF and VIM does occur in chordomas, whereas DES and GFAP are not demonstrable in tumor cells. The three detected IF are invariably present in all cell types but not in intracellular vacuoles or in the extracellular mucoid substance. The pattern of immunoreactivity of chordomas appears very unique as very few other neoplasms demonstrate the simultaneous occurrence of 3 distinct IF. Only choroid plexus tumors have been shown to manifest CK-NF-VIM immunoreactivity. The complex immunophenotype of chordomas may be related to their supposed origin from the notochord which normally undergoes conspicuous changes in location and morphology during embryonal development. Such changes might require the contemporary presence of multiple IF; IF expression, in fact, is known to be related to cell function and morphology. Notochordal cells and their neoplastic counterpart may consequently express an IF pattern which reflects unique architectural and morphological variations occurring during embryonal and tumor growth. Together with the speculative value of the detection of CK, NF and VIM in chordomas, the unusual immunocytochemical pattern of these tumors might provide useful diagnostic tool in differential diagnosis.
Collapse
Affiliation(s)
- E Maiorano
- Institute of Pathological Anatomy, University of Bari School of Medicine, Italy
| | | | | | | |
Collapse
|
11
|
Martin EM, Gould VE, Hoog A, Rosen ST, Radosevich JA, Deftos LJ. Parathyroid hormone-related protein, chromogranin A, and calcitonin gene products in the neuroendocrine skin carcinoma cell lines MKL1 and MKL2. BONE AND MINERAL 1991; 14:113-20. [PMID: 1717086 DOI: 10.1016/0169-6009(91)90088-h] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
We studied the production of parathyroid-hormone-related protein, chromogranin A, calcitonin and calcitonin-gene-related peptide in the neuroendocrine skin cell line, MKL1, and a subsequently derived cell line designated MKL2. Both cell lines had cytological, histological and electron-microscopic features typical of neuroendocrine differentiation. Immunohistology and radioimmunoassay studies demonstrated the presence of parathyroid-hormone-related protein, chromogranin A, calcitonin-gene-related peptide, and calcitonin in the MKL2 cell line and the last three substances in both cell lines. The secretion of each of the first three substances was regulated by phorbol in the MKL2 cells. Additional immunohistochemical studies demonstrated the variable expression of bombesin, substance P, and vasoactive intestinal polypeptide in MKL2 cells, and the expression of synaptophysin in both MKL1 and MKL2 cells. These studies demonstrate the neuroendocrine characteristics of the MKL cell lines and provide a novel model for studies of the production and interactions of several neuroendocrine proteins and peptides by human skin cells.
Collapse
Affiliation(s)
- E M Martin
- Department of Medicine, University of California, San Diego
| | | | | | | | | | | |
Collapse
|
12
|
Bayrou O, Avril MF, Charpentier P, Caillou B, Guillaume JC, Prade M. Primary neuroendocrine carcinoma of the skin. Clinicopathologic study of 18 cases. J Am Acad Dermatol 1991; 24:198-207. [PMID: 2007664 DOI: 10.1016/0190-9622(91)70027-y] [Citation(s) in RCA: 53] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The clinical and pathologic features of primary neuroendocrine carcinoma of the skin in 18 elderly patients are reported. The carcinomas arose in the dermis and subcutaneous tissues, particularly on the head and the upper extremities. One tumor occurred in an irradiated area. Using Gould's clinicopathologic classification, we have found four trabecular types, eleven intermediate cell types, and two small cell types. One tumor could not be classified. Other noteworthy pathologic features were association with invasive squamous cell carcinoma, lentiginous melanocytic hyperplasia, and presence of intratumoral melanocytes. Immunoreactivity for cytokeratins (56 kD), neurofilaments, neuron-specific enolase, and epithelial membrane antigen was observed. The paranuclear globular staining pattern of cytokeratins and neurofilaments was conspicuous. The ultrastructural features revealed paranuclear intermediate filament aggregates (fibrous bodies), neurosecretory granules, and cell junctions. In two metastatic tumors, high levels of catecholamines were found. The trabecular types were characterized by localized disease and a good prognosis. The patients with the small cell types died of distant metastases. Postoperative radiotherapy seemed to reduce the rate of local recurrences.
Collapse
Affiliation(s)
- O Bayrou
- Institut Gustave-Roussy, Villejuif, France
| | | | | | | | | | | |
Collapse
|
13
|
Kivelä T, Tarkkanen A. The Merkel cell and associated neoplasms in the eyelids and periocular region. Surv Ophthalmol 1990; 35:171-87. [PMID: 2274847 DOI: 10.1016/0039-6257(90)90087-c] [Citation(s) in RCA: 97] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Merkel cells are clear oval cells in the epidermis and outer root sheaths of hair follicles, which are probably of epithelial origin, share ultrastructural features with neuroendocrine cells, and are found in association with touch receptors. In the eyelid, they occur singly in the epidermis and external root sheaths of hairs and eyelashes, and in specialized touch spots alternating with eyelashes. Their typical electron microscopical and antigenic features include dense-core granules, intranuclear rodlets, spinous processes, and a positive reaction for specific cytokeratins, epithelial membrane antigen, neuron-specific enolase, chromogranin and synaptophysin. Merkel cell carcinoma probably develops from precursor cells which give rise to keratinocytes and Merkel cells, and nearly one out of ten Merkel cell carcinomas occur in the eyelid and periocular region. They tend to be bulging lesions near the lid margin of elderly patients, reddish in color, and erythematous with telangiectatic vessels. The diagnosis is based on the frequent presence of neurofilaments and paranuclear aggregates of intermediate filaments in addition to features typical of normal Merkel cells. The tumor often mimics lymphoma or undifferentiated carcinoma and frequently invades lymphatic vessels. One third of Merkel cell carcinomas recur, almost two thirds give rise to regional node metastases, and up to one half metastasize widely and result in death. Initial treatment should be prompt and aggressive, with wide resection and routine postoperative irradiation. Although metastatic lesions often respond to radiation therapy and cytostatic drugs, these treatments are mainly of palliative value.
Collapse
Affiliation(s)
- T Kivelä
- Department of Ophthalmology, Helsinki University Central Hospital, Finland
| | | |
Collapse
|
14
|
Zhou XJ, Zhang TH, Yu YQ, Wang FA. Human pituitary somatotroph adenoma and prolactinoma: an ultrastructural and immunoelectron microscopical study. JOURNAL OF TONGJI MEDICAL UNIVERSITY = TONG JI YI KE DA XUE XUE BAO 1990; 10:83-7. [PMID: 2213957 DOI: 10.1007/bf02887866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
17 cases of pituitary somatotroph adenoma and 38 cases of prolactinoma were studied with electron microscopy and immunoelectron microscopy using protein A-gold complex. 4 adenomas were shown by immunoelectron microscopy to contain simultaneously growth hormone (GH)-producing and prolactin (PRL)-producing cells. 6 cases were classified as densely granulated GH adenomas and 11 as sparsely granulated variant, whereas only 3 adenomas out of 38 prolactinomas were identified as densely granulated adenomas. The present study showed that not all cells with fibrous bodies possessed secretory granules positive for GH, and in some cells with fibrous bodies PRL-producing granules were also detected. Misplaced exocytosis was found frequently in the sparsely granulated prolactinomas. From these findings it may be suggested that fibrous bodies are not a morphological feature characteristic of pituitary somatotroph adenomas.
Collapse
Affiliation(s)
- X J Zhou
- Department of Ultrastructural Pathology, Jinling Hospital, Nanjing
| | | | | | | |
Collapse
|
15
|
Argenyi ZB, Bergfeld WF, McMahon JT, Goeken JA, Garewal GS. Primitive neuroectodermal tumor in the skin with features of neuroblastoma in an adult patient. J Cutan Pathol 1986; 13:420-30. [PMID: 3819148 DOI: 10.1111/j.1600-0560.1986.tb01085.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
A case of primitive neuroectodermal tumor of an 81-year-old man is presented, which was located in the cutis. The occurrence in this age and this superficial location is unusual and raises wide differential diagnostic possibilities. The tumor demonstrated Homer Wright rosettes, was positive for neuron-specific enolase and ultrastructurally revealed neurosecretory granules. These features support the diagnosis of a peripheral neuroblastoma. We discuss the controversy about the terminology of peripheral neuroblastoma vs. neuroepithelioma, as well as the differential diagnosis of these tumors.
Collapse
|
16
|
Rubinstein LJ. Inaugural Dorothy S. Russell memorial lecture. Immunohistochemical signposts--not markers--in neural tumour differentiation. Neuropathol Appl Neurobiol 1986; 12:523-37. [PMID: 3561689 DOI: 10.1111/j.1365-2990.1986.tb00157.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|