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Pokhrel A, Wu R, Wang JC. Review of Merkel cell carcinoma with solitary pancreatic metastases mimicking primary neuroendocrine tumor of the pancreas. Clin J Gastroenterol 2023; 16:641-662. [PMID: 37421584 DOI: 10.1007/s12328-023-01821-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 06/05/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVE/BACKGROUND Merkel cell carcinoma (MCC) but metastases to the pancreas are very rare. There are only a few cases of isolated metastases of MCC to the pancreas. Because of this rarity, it can be wrongly diagnosed as a neuroendocrine tumor of the pancreas(pNET), especially the poorly differentiated neuroendocrine carcinoma (PNEC) subtype, in which the treatment is vastly different than that of MCC with isolated metastases of the pancreas. METHODS An electronic search of the PubMed and google scholar databases was performed to obtain the literature on MCC with pancreatic metastases, using the following search terms: Merkel cell carcinoma, pancreas, and metastases. Results are limited to the following available article types: case reports and case series. We identified 45 cases of MCC with pancreatic metastases from the PubMed and Google Scholar database search and examined their potential relevance. Only 22 cases with isolated pancreatic metastases were taken for review including one case that we encountered. RESULTS The results from our review of cases of isolated pancreatic metastases of MCC were compared to the characteristics of the poorly differentiated pancreatic neuroendocrine tumor (PNEC). We found the following: (a) MCC with isolated pancreatic metastases occurred at an older age than PNEC and with male gender predominance (b) Most of the metastases occurred within 2 years of initial diagnosis of MCC (c) Resection of pancreatic mass was the first line treatment in case of resectable PNECs whereas resection of metastases was infrequently performed in MCC with pancreatic metastases.
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Affiliation(s)
- Akriti Pokhrel
- Department of Internal Medicine, Brookdale University Hospital Medical Center, Brooklyn, NY, USA
- Department of Hematology and Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY, USA
| | - Richard Wu
- Department of Pathology, Division of Hematology/Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY, USA
- Department of Hematology and Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY, USA
| | - Jen Chin Wang
- Department of Pathology, Division of Hematology/Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY, USA.
- Department of Hematology and Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY, USA.
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Banner L, Joffe D, Lee E, Porcu P, Nikbakht N. Incidence of cutaneous melanoma and Merkel cell carcinoma in patients with primary cutaneous B-cell lymphomas: A population study of the SEER registry. Front Med (Lausanne) 2023; 10:1110511. [PMID: 37089593 PMCID: PMC10117954 DOI: 10.3389/fmed.2023.1110511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/14/2023] [Indexed: 04/08/2023] Open
Abstract
IntroductionThe increased incidence of cutaneous melanoma (CM) and Merkel cell carcinoma (MCC) in patients with hematologic malignancies (HM) is well established. While the risk of CM has been assessed in some subtypes of HM including cutaneous T-cell lymphoma, the incidence in patients with primary cutaneous B-cell lymphoma (PCBCL) has not been interrogated.MethodsHere we evaluated the standardized incidence ratio (SIR) of CM and MCC in 5,179 PCBCL patients compared to approximately 1.5 billion individuals in the general population using the Surveillance, Epidemiology and End Results (SEER) database. Among patients with PCBCL, we identified subgroups that were at increased risk for CM or MCC as a second primary cancer.ResultsWe found 36 cases of CM in the PCBCL cohort (SIR, 1.35; 95% CI, 0.94–1.86), among which SIR was significantly elevated for non-Hispanic White patients compared to the general population (SIR, 1.48; 95% CI, 1.03–2.06). Males had a significantly increased risk of developing CM after a diagnosis of PCBCL (SIR, 1.60; 95% CI, 1.10–2.26). We found that males in the age group of 50–59 were at increased risk for CM development (SIR, 3.02; 95% CI, 1.11–6.58). Males were at increased risk of CM 1–5 years after PCBCL diagnosis (SIR, 2.06; 95% CI, 1.18–3.34). Patients were at greater risk of developing MCC within 1 year of diagnosis of PCBCL (SIR, 23.60; 95% CI, 2.86–85.27), particularly in patients who were over the age of 80 (SIR, 46.50; 95% CI, 5.63–167.96). Males aged 60–69 with PCBCL, subtype marginal zone, were also at increased risk for MCC (SIR, 42.71; 95% CI, 1.08–237.99).ConclusionThere is an increased incidence of CM in White, middle-aged males within 5 years of diagnosis of PCBCL and an increased risk of MCC in elderly patients within 1 year of PCBCL diagnosis. These data suggest that certain subgroups of patients with PCBCL may require more rigid surveillance for CM and MCC.
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Affiliation(s)
- Lauren Banner
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Daniel Joffe
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Emily Lee
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Pierluigi Porcu
- Division of Hematologic Malignancies and Hematopoietic Stem Cell Transplantation, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Neda Nikbakht
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, PA, United States
- *Correspondence: Neda Nikbakht,
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Lingamaneni P, Laswi H, Krbanjevic A, Moturi K, Katiyar V, Gupta S. Merkel Cell Carcinoma With Isolated Pancreatic Metastasis. J Investig Med High Impact Case Rep 2021; 9:23247096211027413. [PMID: 34159821 PMCID: PMC8236778 DOI: 10.1177/23247096211027413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Merkel cell carcinoma (MCC) is a highly aggressive cutaneous neuroendocrine carcinoma, frequently associated with distant metastasis. However, recurrence of MCC manifesting with only pancreatic involvement is exceedingly rare. A 53-year-old man presented to our institution with abdominal discomfort 3 months after initial resection of chest wall MCC. Imaging revealed lesions in the pancreas and peripancreatic lymph nodes. Pathology obtained through endoscopic ultrasound confirmed recurrence of MCC. He underwent chemotherapy with cisplatin and etoposide, resulting in a complete resolution of the pancreatic lesions. Unfortunately, he passed away from sudden cardiac arrest while being in remission from MCC. Immunohistochemistry is crucial in differentiating MCC from primary pancreatic glandular and neuroendocrine tumors. While there are no definitive guidelines in the management of pancreatic lesions associated with MCC, checkpoint inhibitor immunotherapy is increasingly being used.
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Affiliation(s)
| | - Hisham Laswi
- John H. Stroger Hospital of Cook County, Chicago, IL, USA
| | | | - Krishna Moturi
- John H. Stroger Hospital of Cook County, Chicago, IL, USA
| | | | - Shweta Gupta
- John H. Stroger Hospital of Cook County, Chicago, IL, USA
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The Clinical Spectrum of Hepatic Manifestations in Chronic Lymphocytic Leukemia. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2017; 17:863-869. [DOI: 10.1016/j.clml.2017.07.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 07/19/2017] [Indexed: 12/18/2022]
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Li L, Molberg K, Cheedella N, Thibodeaux J, Hinson S, Lucas E. The diagnostic utility of Merkel cell polyomavirus immunohistochemistry in a fine needle aspirate of metastatic Merkel cell carcinoma of unknown primary to the pancreas. Diagn Cytopathol 2017; 46:67-71. [PMID: 28802095 DOI: 10.1002/dc.23794] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 07/17/2017] [Accepted: 07/25/2017] [Indexed: 12/22/2022]
Abstract
Merkel cell carcinoma (MCC) is an aggressive skin tumor with a high tendency for metastases. We report a case of MCC initially presenting as axillary and pancreatic metastases. A 33-year-old HIV-positive Hispanic male presented with a history of a rapidly growing axillary mass. A needle core biopsy demonstrated an epithelioid neoplasm composed of small to medium-sized cells with high nuclear-cytoplasmic ratio, nuclear molding, and frequent mitotic figures. A subsequent PET scan revealed a 1.5 cm FDG avid mass in the pancreas. Endoscopic ultrasound-guided FNA of the pancreatic mass showed neoplastic cells with similar morphology to those of the axillary mass. The tumor cells were positive with pancytokeratin AE1/AE3, CK20, CD56, synatophysin, chromogranin, and Merkel cell polyomavirus (MCPyV). This case of MCC most likely originated from a resolved primary skin lesion drained by the involved axillary lymph node with subsequent metastases to the pancreas and distant lymph nodes.
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Affiliation(s)
- Long Li
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, 75390
| | - Kyle Molberg
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, 75390
| | - Naga Cheedella
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, 75390
| | - Joel Thibodeaux
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, 75390
| | - Stacy Hinson
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, 75390
| | - Elena Lucas
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, 75390
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Quiroz-Sandoval OA, Cuellar-Hubbe M, Lino-Silva LS, Salcedo-Hernández RA, López-Basave HN, Padilla-Rosciano AE, León-Takahashi AM, Herrera-Gómez Á. Primary retroperitoneal Merkel cell carcinoma: Case report and literature review. Int J Surg Case Rep 2015; 19:21-4. [PMID: 26708276 PMCID: PMC4756087 DOI: 10.1016/j.ijscr.2015.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 12/03/2015] [Accepted: 12/04/2015] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Merkel cell carcinoma (MCC) is an aggressive cutaneous neuroendocrine carcinoma that affects elderly patients and typically arises in sun-exposed skin. The disease is very rare and only few cases present with no apparent skin lesion. In the retroperitoneum there are only two cases reported in the literature. CASE PRESENTATION We report a case of a 54-year-old Mexican male with MCC, which presented as a large retroperitoneal mass. Pathological and immunohistochemical analysis of the transabdominal CT-guided biopsy specimen revealed a MCC. The patient underwent preoperative chemotherapy followed by a laparotomy and the mass was successfully excised. DISCUSSION There are two possible explanations for what occurred in our patient. The most plausible theory is the retroperitoneal mass could be a massively enlarged lymph node where precursor cells became neoplastic. This would be consistent with a presumptive diagnosis of primary nodal disease. Moreover, metastasis to the retroperitoneal lymph nodes has been reported as relatively common when compared to other sites such as liver, bone, brain and skin. The less probable theory is the non-described "regression" phenomena of a cutaneous MCC, but we are not found a primary skin lesion. CONCLUSION Preoperative chemotherapy and excision of the primary tumor is the surgical treatment of choice for retroperitoneal MCC. We propose that further studies are needed to elucidate the true efficacy of chemotherapy in conventional and unconventional patients with MCC.
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Affiliation(s)
| | - Mario Cuellar-Hubbe
- Surgical Department of Bone and Soft Tissue Sarcomas, National Cancer Institute, Mexico City, Mexico
| | - Leonardo S Lino-Silva
- Anatomic Pathology Department of Gastrointestinal Tumors, National Cancer Institute, Mexico City, Mexico.
| | | | - Horacio N López-Basave
- Surgical Department of Gastrointestinal Tumors, National Cancer Institute, Mexico City, Mexico
| | | | | | - Ángel Herrera-Gómez
- Surgical Department of Gastrointestinal Tumors, National Cancer Institute, Mexico City, Mexico
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A case series and literature review of Merkel cell carcinoma metastasizing to pancreas. Dig Dis Sci 2015; 60:1805-12. [PMID: 25586085 DOI: 10.1007/s10620-014-3516-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 12/29/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Merkel cell carcinoma is a rare aggressive tumor arising from the mechanoreceptors of the epidermis with a relative higher mortality rate stage for stage than melanoma. Microscopically, the cells appear similar to small cell lung cancer, but they specifically stain positive for CK20 and are negative for TTF-1. It is rarely known to metastasize to the pancreas. AIMS To report four cases of Merkel cell carcinoma metastasizing to pancreas and compare them to previously reported patients. METHODS We performed a retrospective review of all patients who underwent endoscopic ultrasound with fine-needle aspiration (EUS-FNA) for a suspected pancreatic lesion between January 2004 and December 2012. We reviewed other reported cases with a literature search using PubMed, Embase, and Scopus. RESULTS Four male patients with mean age of 66 years were found to have metastatic disease in the pancreas on average 29 months after initial diagnosis of MCC. Two cases were diagnosed with EUS-FNA and two with PET-CT. Three patients had multifocal pancreatic involvement which has not been previously described. All four patients died within 3-9 months following tumor spread to the pancreas. Merkel cell carcinoma rarely metastasizes to the pancreas with only 10 cases being described in the medical literature. CONCLUSIONS EUS-FNA is an effective tool that can be utilized in diagnosing pancreatic masses. Differentiating metastatic pancreatic tumors, especially Merkel cell carcinoma from primary pancreatic tumor is useful as systemic therapy is an option in pancreatic adenocarcinoma, but is ineffective in metastatic Merkel cell carcinoma.
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Merkel cell carcinoma in immunosuppressed patients. Cancers (Basel) 2014; 6:1328-50. [PMID: 24978436 PMCID: PMC4190543 DOI: 10.3390/cancers6031328] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 05/22/2014] [Accepted: 06/09/2014] [Indexed: 02/07/2023] Open
Abstract
Merkel cell carcinoma (MCC) is a rare and aggressive cutaneous malignancy. The infectivity of Merkel cell polyomavirus (MCPyV), an apparent agent in MCC development, may be exacerbated with impaired immune responses. This paper reviews relevant data regarding the role of immunosuppression in the development of MCC and describes modes of immunodeficient states. Because of the inherently low incidence rate of MCC, several case studies and series are also briefly mentioned to provide a more comprehensive summary of MCC in the setting of immunosuppression. We describe immunosuppressed patients who have experienced excessive UV radiation, organ transplantation, human immunodeficiency virus infection/AIDS, autoimmune diseases, and lymphoproliferative disorders. Iatrogenic forms of immunosuppression are also highlighted. Studies that quantify risks consistently report that individuals with a history of solid organ transplantation, autoimmune diseases, AIDS, and/or lymphoproliferative diseases have a significantly elevated risk of developing MCC. Overall, immunocompromised patients also appear to have an early onset and more aggressive course of MCC, with poorer outcomes. Recommendations for multidisciplinary approaches are proposed to effectively prevent and manage MCC in these patients.
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Vernadakis S, Moris D, Bankfalvi A, Makris N, Sotiropoulos GC. Metastatic Merkel cell carcinoma (MCC) of pancreas and breast: a unique case. World J Surg Oncol 2013; 11:261. [PMID: 24099413 PMCID: PMC3852773 DOI: 10.1186/1477-7819-11-261] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Accepted: 09/22/2013] [Indexed: 01/29/2023] Open
Abstract
Merkel cell carcinoma (MCC) is a rare potentially fatal skin tumor affecting older and immunosuppressed individuals. It is highly malignant with high rates of metastasis and poor survival. We present a case of a 67-year-old woman with a palpable mass in the upper abdomen. An abdominal CT revealed a mass in the tail of the pancreas. Two weeks before, lumpectomy of a 3.5 cm tumor of the left breast had been performed. Histology showed a primary neuroendocrine carcinoma of the mammary gland. The patient’s medical history was significant for a 0.7 × 0.9 cm MCC removed from her left forearm 2.5 years ago. There was no evidence of vascular involvement or peritoneal disease and by all criteria was resectable. A somatostatin receptor scintigraphy showed an enhanced uptake in the pancreatic tail region. The tumor was immunohistochemically strong staining for synaptophysin and CD56. The diagnosis of a metastatic-MCC in the tail of the pancreas was made. Further histological investigation of the prior removed neuroendocrine breast tumor and the MCC of the left forearm confirmed neuroendocrine origin and identical histology to the previously resected MCC of the left forearm. In this article, we aim to highlight that MCC has the potential to spread even in unusual organs, such as pancreas or breast, and therefore a diligent follow-up should be applied in patients with MCC.
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Affiliation(s)
- Spiridon Vernadakis
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Hufelandstr, 55, Esse 45122, Germany.
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11
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Tadmor T, Aviv A, Polliack A. Merkel cell carcinoma, chronic lymphocytic leukemia and other lymphoproliferative disorders: an old bond with possible new viral ties. Ann Oncol 2011; 22:250-256. [DOI: 10.1093/annonc/mdq308] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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12
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Abstract
Cutaneous lesions occur in up to 25% of patients with chronic lymphocytic leukemia (CLL). These can be caused by either cutaneous seeding by leukemic cells (leukemia cutis, LC) and other malignant diseases or nonmalignant disorders. Skin infiltration with B-lymphocyte CLL manifests as solitary, grouped, or generalized papules, plaques, nodules, or large tumors. Prognosis in CLL patients with LC is rather good and many authors claim that it does not significantly affect patients' survival. However, prognosis is poor in patients in whom LC shows blastic transformation (Richter's syndrome) and when leukemic infiltrations in the skin appear after the diagnosis of CLL. Secondary cutaneous malignancies are also frequent complications in patients with CLL. A higher risk was seen in skin cancer, for which eightfold higher occurrence has been stated. There are some suggestions that alkylating agents and purine analogs may be associated with an increased incidence of secondary malignancies in CLL. Nonspecific, secondary cutaneous lesions are frequently observed in CLL patients. The most common secondary cutaneous changes seen in CLL are those of infectious or hemorrhagic origin. Other secondary lesions present as vasculitis, purpura, generalized pruritus, exfoliative erythroderma, and paraneoplastic pemphigus. An exaggerated reaction to an insect bite and insect bite-like reactions have been also observed.
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MESH Headings
- Diagnosis, Differential
- Female
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemic Infiltration
- Male
- Neoplasms, Second Primary/diagnosis
- Neoplasms, Second Primary/pathology
- Pemphigoid, Bullous/diagnosis
- Pemphigus/diagnosis
- Prognosis
- Skin/pathology
- Skin Diseases/diagnosis
- Skin Diseases/metabolism
- Skin Diseases/microbiology
- Skin Neoplasms/complications
- Skin Neoplasms/diagnosis
- Skin Neoplasms/secondary
- Syndrome
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Affiliation(s)
- Ewa Robak
- Department of Dermatology and Venereology, Medical University of Lodz, Poland
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Craig PJ, Calonje JE, Harries M, Stefanato CM. Incidental chronic lymphocytic leukaemia in a biopsy of Merkel cell carcinoma. J Cutan Pathol 2009; 36:706-10. [DOI: 10.1111/j.1600-0560.2008.01115.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Turk T, Orlic ZC, Smoljan I, Nacinovic A, Bekafigo IS, Radic J, Zamolo G. Spontaneous regression of Merkel cell carcinoma in a patient with chronic lymphocytic leukemia: a case report. J Med Case Rep 2009; 3:7270. [PMID: 19830161 PMCID: PMC2726515 DOI: 10.1186/1752-1947-3-7270] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2008] [Accepted: 01/22/2009] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Merkel cell carcinoma is a rare and aggressive primary cutaneous neuroendocrine malignant tumor. The tumor has a high rate of local recurrence after surgical removal. Spontaneous regression appears to be relatively common in this rare type of tumor. CASE PRESENTATION We describe the clinical course, cytological and histological findings of a Merkel cell carcinoma in a 70-year-old Caucasian woman, simultaneously diagnosed with chronic lymphatic leukemia. The tumor showed clinical regression after fine needle aspiration. At primary presentation, the tumor had no apparent leukocyte infiltration, but was completely cleared by T-cell mediated immunity within 3 weeks after fine needle aspiration. CONCLUSION Fine needle aspiration may have acted as a mechanical trigger involved in the activation of cell-mediated immunity, leading to the clinical and histological regression of the tumor. To the best of our knowledge, this is the first case report of spontaneous regression of Merkel cell carcinoma in a patient with a co-malignancy, that is to say, chronic lymphocytic leukemia.
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Liu YT. A technological update of molecular diagnostics for infectious diseases. Infect Disord Drug Targets 2008; 8:183-8. [PMID: 18782035 DOI: 10.2174/1871526510808030183] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Identification of a causative pathogen is essential for the choice of treatment for most infectious diseases. Many FDA approved molecular assays; usually more sensitive and specific compared to traditional tests, have been developed in the last decade. A new trend of high throughput and multiplexing assays are emerging thanks to technological developments for the human genome sequencing project. The applications of microarray and ultra high throughput sequencing technologies for diagnostic microbiology are reviewed. The race for the $1000 genome technology by 2014 will have a profound impact in diagnosis and treatment of infectious diseases in the near future.
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Affiliation(s)
- Yu-Tsueng Liu
- Moores Cancer Center, University of California, San Diego, 3855 Health Sciences Drive, 0815, La Jolla, CA 92093, USA.
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Abstract
The spectrum of skin diseases that occurs in the oncology patient differs somewhat from that seen in other immunosuppressed populations. We review the cutaneous manifestations of invasive mold infections in the leukemia/lymphoma population. Aspergillus mold infections are now the leading infectious cause of death in this population. We also review the pustular eruption caused by a new class of chemotherapy for solid malignancies. An update on cutaneous graft-versus-host disease appears elsewhere in this journal. Cutaneous squamous cell carcinomas and basal cell carcinomas occur more frequently in the chronic lymphocytic leukemia and non-Hodgkin's lymphoma population; this is discussed, as is the more aggressive clinical course of these tumors.
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Affiliation(s)
- Steven R Mays
- Department of Dermatology, MD Anderson Cancer Center, Houston, TX 77030, USA.
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17
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Adsay NV, Andea A, Basturk O, Kilinc N, Nassar H, Cheng JD. Secondary tumors of the pancreas: an analysis of a surgical and autopsy database and review of the literature. Virchows Arch 2004; 444:527-35. [PMID: 15057558 DOI: 10.1007/s00428-004-0987-3] [Citation(s) in RCA: 226] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2003] [Accepted: 02/03/2004] [Indexed: 12/13/2022]
Abstract
The vast majority of pancreatic carcinomas are primary, and, among these, more than 90% are of ductal origin. However, a variety of extrapancreatic tumors may involve the pancreas secondarily and may manifest different clinicopathological characteristics and outcomes. In this study, pathology material from 973 surgical specimens and 4955 adult autopsy cases was reviewed to identify the tumors metastatic to or secondarily involving the pancreas. Biliary and periampullary neoplasms and tumors confined to peripancreatic soft tissue were excluded. In the autopsy series, the pancreas was involved by tumor in 190 cases, and 81 of these were secondary tumors. These were predominantly of epithelial origin, most commonly from lung (34), followed by GI tract (20), kidney (4), breast (3), liver (2), ovary (1), and urinary bladder (1). In addition, there were six tumors of hematopoietic origin, two melanomas, two sarcomas, and two mesotheliomas. Among the 973 surgical specimens, 38 cases contained metastatic tumors to the pancreas. Of these, 11 were lymphomas, and the others were carcinomas of stomach (7), kidney (6), lung (2), liver, prostate, ovary, uterus (1 case of each), and a Merkel cell carcinoma. In addition, there were three malignant gastrointestinal stromal tumors and one retroperitoneal leiomyosarcoma. In conclusion, lung cancer is the most common source of metastasis to pancreas, followed by gastrointestinal carcinomas and lymphomas. These tumors are usually seen in patients with disseminated disease and are detected mainly in autopsies. Secondary tumors constitute about 4% of pancreatic specimens in the authors' surgical database. Approximately one-third of them are clinically mistaken as primary tumors of the pancreas. These are predominantly hematopoietic malignancies or carcinomas of renal or gastric origin. Secondary tumors should be entertained in both the clinical and pathological differential diagnosis of pancreatic neoplasia.
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Affiliation(s)
- N Volkan Adsay
- Department of Pathology, The Karmanos Cancer Institute and Wayne State University, Harper Hospital, 3990 John R. Street, Detroit, MI 48201, USA.
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Vlad R, Woodlock TJ. Merkel cell carcinoma after chronic lymphocytic leukemia: case report and literature review. Am J Clin Oncol 2004; 26:531-4. [PMID: 14663367 DOI: 10.1097/01.coc.0000037108.86294.5e] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Increasing evidence supports an association of Merkel cell carcinoma (MCC) with immunodeficiency and neoplasia, and the management and outcome of these patients requires study. This report describes a 72-year-old man with newly diagnosed chronic lymphocytic leukemia (CLL) who developed MCC of his right upper extremity and died of bone marrow metastases at 8 months. In the five previously reported cases of MCC after CLL, a shorter time interval between the diagnosis of CLL and the onset of MCC was associated with a better prognosis. In contrast, in this case the near simultaneous onset of CLL and MCC was followed by a rapid, lethal outcome.
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Affiliation(s)
- Roxana Vlad
- Department of Medicine, Unity Health System, Rochester, New York 14611, USA
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Sinclair N, Mireskandari K, Forbes J, Crow J. Merkel cell carcinoma of the eyelid in association with chronic lymphocytic leukaemia. Br J Ophthalmol 2003; 87:240. [PMID: 12543759 PMCID: PMC1771510 DOI: 10.1136/bjo.87.2.240] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- N Sinclair
- Department of Ophthalmology, Royal Free Hampstead NHS Trust, London, UK.
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Affiliation(s)
- Wolfram Goessling
- Department of Adult Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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Abstract
Merkel cell carcinoma has been found to have an increased incidence among immunosuppressed patients, specifically organ transplant recipients receiving immunosuppressive therapy. HIV similarly depresses the immune response of infected persons. We report a case of Merkel cell carcinoma (MCC) in an HIV-infected patient who died from liver metastases 2 years after his tumor was diagnosed. The purpose of this report is to describe the possible relationship between HIV and MCC and to emphasize the importance of early diagnosis and aggressive management of MCC.
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Affiliation(s)
- K P An
- Department of Dermatology, College of Physicians and Surgeons of Columbia University, New York, NY, USA
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