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Rosenthal A, Juhasz M, Zhang J, Ticknor I, Gharavi N, Man J. Survival outcomes of rare cutaneous malignancies within an insured cohort of patients, 1988-2018. J Am Acad Dermatol 2024; 90:328-338. [PMID: 37714218 DOI: 10.1016/j.jaad.2023.08.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 08/17/2023] [Accepted: 08/22/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND There are limited survival data on cutaneous angiosarcoma (CAS), dermatofibrosarcoma protuberans (DFSP), Merkel cell carcinoma (MCC), and sebaceous carcinoma (SC). OBJECTIVE To analyze survival trends in CAS, DFSP, MCC, and SC among a racially diverse, insured cohort of patients. METHODS Using data from the Kaiser Permanente Southern California Cancer Registry, we identified adults diagnosed with CAS, DFSP, MCC, or SC between January 1, 1988 and December 31 2018, followed through December 31, 2021. RESULTS Our cohort consisted of 83 diagnoses of CAS, 490 diagnoses of DFSP, 411 diagnoses of MCC, and 249 diagnoses of SC. Our analysis revealed no significant differences in overall or disease-specific 1000 person-years mortality rates among our populations of non-Hispanic Whites, Hispanics, African American/Blacks, and Asian American/Pacific Islanders diagnosed with CAS, DFSP, MCC, or SC. On multivariate analysis, controlling for patient and tumor characteristics, there was similarly no increased risk of overall mortality for minorities diagnosed with CAS, DFSP, MCC, or SC. LIMITATIONS Retrospective nature of the analysis and small sample size. CONCLUSION Contrary to existing literature, our results show a notable lack of racially driven survival disparities among insured individuals with CAS, DFSP, MCC, and SC, emphasizing the importance of health care coverage.
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Affiliation(s)
- Amanda Rosenthal
- Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California.
| | - Margit Juhasz
- Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California; Department of Dermatology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Jing Zhang
- Department of Research & Evaluation, Kaiser Permanente Southern California, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | - Iesha Ticknor
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | - Nima Gharavi
- Department of Dermatology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Jeremy Man
- Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
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Koumaki D, Manios G, Papadakis M, Doxastaki A, Zacharopoulos GV, Katoulis A, Manios A. Color Analysis of Merkel Cell Carcinoma: A Comparative Study with Cherry Angiomas, Hemangiomas, Basal Cell Carcinomas, and Squamous Cell Carcinomas. Diagnostics (Basel) 2024; 14:230. [PMID: 38275477 PMCID: PMC10814937 DOI: 10.3390/diagnostics14020230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 01/11/2024] [Accepted: 01/19/2024] [Indexed: 01/27/2024] Open
Abstract
Merkel cell carcinoma (MCC) is recognized as one of the most malignant skin tumors. Its rarity might explain the limited exploration of digital color studies in this area. The objective of this study was to delineate color alterations in MCCs compared to benign lesions resembling MCC, such as cherry angiomas and hemangiomas, along with other non-melanoma skin cancer lesions like basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), utilizing computer-aided digital color analysis. This was a retrospective study where clinical images of the color of the lesion and adjacent normal skin from 11 patients with primary MCC, 11 patients with cherry angiomas, 12 patients with hemangiomas, and 12 patients with BCC/SCC (totaling 46 patients) were analyzed using the RGB (red, green, and blue) and the CIE Lab color system. The Lab color system aided in estimating the Individual Typology Angle (ITA) change in the skin, and these results are documented in this study. It was demonstrated that the estimation of color components can assist in the differential diagnosis of these types of lesions because there were significant differences in color parameters between MCC and other categories of skin lesions such as hemangiomas, common skin carcinomas, and cherry hemangiomas. Significant differences in values were observed in the blue color of RGB (p = 0.003) and the b* parameter of Lab color (p < 0.0001) of MCC versus cherry angiomas. Similarly, the mean a* value of Merkel cell carcinoma (MCC) compared to basal cell carcinoma and squamous cell carcinoma showed a statistically significant difference (p < 0.0001). Larger prospective studies are warranted to further validate the clinical application of these findings.
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Affiliation(s)
- Dimitra Koumaki
- Dermatology Department, University Hospital of Heraklion, 71110 Heraklion, Greece;
| | - Georgios Manios
- Department of Computer Science and Biomedical Informatics, University of Thessaly, 35100 Lamia, Greece;
| | - Marios Papadakis
- Department of Surgery II, Witten/Herdecke University, Heusnerstrasse 40, 42283 Witten, Germany;
| | - Aikaterini Doxastaki
- Dermatology Department, University Hospital of Heraklion, 71110 Heraklion, Greece;
| | | | - Alexander Katoulis
- 2nd Department of Dermatology and Venereology, “Attikon” General University Hospital, Medical School, National and Kapodistrian University of Athens, Rimini 1, Haidari, 12462 Athens, Greece;
| | - Andreas Manios
- Plastic Surgery Unit, Surgical Oncology Department, University Hospital of Heraklion, 71110 Heraklion, Greece; (G.V.Z.); (A.M.)
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Incorvaia L, Dimino A, Algeri L, Brando C, Magrin L, De Luca I, Pedone E, Perez A, Sciacchitano R, Bonasera A, Bazan Russo TD, Li Pomi F, Peri M, Gristina V, Galvano A, Giuffrida D, Fazio I, Toia F, Cordova A, Florena AM, Giordano A, Bazan V, Russo A, Badalamenti G. Body mass index and baseline platelet count as predictive factors in Merkel cell carcinoma patients treated with avelumab. Front Oncol 2023; 13:1141500. [PMID: 37139149 PMCID: PMC10149939 DOI: 10.3389/fonc.2023.1141500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/23/2023] [Indexed: 05/05/2023] Open
Abstract
Background Merkel cell carcinoma (MCC) is a rare and aggressive skin cancer, associated with a worse prognosis. The Immune Checkpoint Inhibitors (ICIs) avelumab and pembrolizumab have been recently approved as first-line treatment in metastatic MCC (mMCC). The clinical observation of improved outcomes in obese patients following treatment with ICIs, known as the "obesity paradox", has been studied across many types of tumors. Probably due to the rarity of this tumor, data on mMMC patients are lacking. Patients and methods This is an observational, hospital-based, study to investigate the role of Body Mass Index (BMI) as predictive biomarker of ICI response in mMCC patients treated with avelumab as first-line treatment. The study population included the patients treated from February 2019 to October 2022 in an Italian referral center for rare tumors. Clinico-pathological characteristics, BMI, laboratory parameters (NLR and platelet count), and response to avelumab were analyzed from a MCC System database prospectively collected. Results Thirty-two (32) patients were included. Notably, the presence of pre-treatment BMI ≥ 30 was significantly associated with longer PFS [BMI < 30 Group: median PFS, 4 months (95% CI: 2.5-5.4); BMI ≥ 30 Group: median PFS, not reached; p<0.001)[. Additionally, the median PFS was significantly higher in patients with higher PLT (median PFS: 10 months in the "low PLT" Group (95% CI: 4.9, 16.1) vs 33 months (95% CI: 24.3, 43.2) in the "high PLT" Group (p=0.006). The multivariable Cox regression model confirmed these results. Conclusion To our knowledge, this is the first study that investigates the predictive role of BMI in MCC patients. Our data were consistent with the clinical observation of improved outcomes in obese patients across other tumor types. Thus, advanced age, a weakened immune system, and the obesity-associated "inflammaging", are key factors that could impact the cancer immune responses of mMCC patients.
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Affiliation(s)
- Lorena Incorvaia
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | - Alessandra Dimino
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | - Laura Algeri
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | - Chiara Brando
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | - Luigi Magrin
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | - Ida De Luca
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | - Erika Pedone
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | - Alessandro Perez
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | - Roberta Sciacchitano
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | - Annalisa Bonasera
- Department of Oncology, Istituto Oncologico del Mediterraneo, Catania, Italy
| | - Tancredi Didier Bazan Russo
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | - Federica Li Pomi
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, Messina, Italy
| | - Marta Peri
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | - Valerio Gristina
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | - Antonio Galvano
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | - Dario Giuffrida
- Department of Oncology, Istituto Oncologico del Mediterraneo, Catania, Italy
| | - Ivan Fazio
- Radiotherapy Unit, Clinica Macchiarella, Palermo, Italy
| | - Francesca Toia
- Division of Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Adriana Cordova
- Division of Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Ada Maria Florena
- Pathologic Anatomy Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Antonio Giordano
- Sbarro Institute for Cancer Research and Molecular Medicine, Center for Biotechnology, College of Science and Technology, Temple University, Philadelphia, PA, United States
| | - Viviana Bazan
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bind.), Section of Medical Oncology, University of Palermo, Palermo, Italy
- Institute for Cancer Research and Molecular Medicine and Center of Biotechnology, Temple University, Philadelphia, PA, United States
| | - Antonio Russo
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy
- Institute for Cancer Research and Molecular Medicine and Center of Biotechnology, Temple University, Philadelphia, PA, United States
- *Correspondence: Antonio Russo,
| | - Giuseppe Badalamenti
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy
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Roberto M, Botticelli A, Caggiati A, Chiriatti A, Della Rocca C, Ferraresi V, Musicco F, Pellacani G, Marchetti P. A Regional Survey on Merkel Cell Carcinoma: A Plea for Uniform Patient Journey Modeling and Diagnostic-Therapeutic Pathway. Curr Oncol 2022; 29:7229-7244. [PMID: 36290847 PMCID: PMC9600681 DOI: 10.3390/curroncol29100570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/16/2022] [Accepted: 09/27/2022] [Indexed: 11/20/2022] Open
Abstract
Merkel cell carcinoma (MCC) is a rare and aggressive cutaneous neuroendocrine cancer that usually affects the elderly and immunosuppressed in sun-exposed areas. Due to its rarity, it is frequently unrecognized, and its management is not standardized across medical centers, despite the more recent availability of immunotherapy, with avelumab as first-line treatment improving the prognosis even in advanced stages of disease. We conducted a purpose-designed survey of a selected sample of physicians working in the Lazio region, in Italy, to assess their awareness and knowledge of MCC as well as their perspective on assisted diagnostic and therapeutic pathways. The Lazio region, and in particular Rome, is one of the most important academic and non- academic center in Italy dedicated to the diagnosis and treatment of skin cancer. A total of 368 doctors (including 100 general practitioners, 72 oncologists, 87 dermatologists, 59 surgeons, and 50 anatomopathologists) agreed to be part of this survey. Surgeons, oncologists, and dermatologists thought themselves significantly more updated on MCC than primary care physicians, but more than half of the interviewees are interested in CCM training courses and training with clearer and more standardized care pathways. Significant differences have been reported from survey participants in terms of multidisciplinary team set up for MCC management. The identification of specialized centers and the improvement of communication pathways among different specialties, as well as between patients and physicians, could be very beneficial in improving patients' journey modeling and starting a uniform diagnostic and therapeutic pathway for MCC patients in the new era of immunotherapies.
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Affiliation(s)
- Michela Roberto
- Medical Oncology Unit A, Umberto I University Hospital, Sapienza University, 00100 Rome, Italy
- Correspondence:
| | - Andrea Botticelli
- Department of Radiological, Oncological and Anatomopathological Science, Umberto I University Hospital, 00161 Rome, Italy
| | | | - Alberto Chiriatti
- Primary Care Physician Azienda Sanitaria Locale (ASL) Roma 3, 00125 Rome, Italy
| | - Carlo Della Rocca
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Pathology Service, Umberto I University Hospital, 00185 Rome, Italy
| | - Virginia Ferraresi
- Sarcomas and Rare Tumors Departmental Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Felice Musicco
- IRCCS IFO Regina Elena and San Gallicano Institute, 00144 Rome, Italy
| | - Giovanni Pellacani
- Dermatology Clinic, Department of Clinical, Internal, Anesthesiological and Cardiovascular Science, University of Rome, 00185 La Sapienza, Italy
| | - Paolo Marchetti
- Department of Radiological, Oncological and Anatomopathological Science, Umberto I University Hospital, 00161 Rome, Italy
- Istituto Dermopatico dell’Immacolata IRCCS, 00167 Rome, Italy
- Oncology Unit, Department of Clinical and Molecular Medicine, Sapienza University, Sant’Andrea Hospital, 00187 Rome, Italy
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Nakamura M, Magara T, Kano S, Matsubara A, Kato H, Morita A. Tertiary Lymphoid Structures and Chemokine Landscape in Virus-Positive and Virus-Negative Merkel Cell Carcinoma. Front Oncol 2022; 12:811586. [PMID: 35223493 PMCID: PMC8867579 DOI: 10.3389/fonc.2022.811586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/17/2022] [Indexed: 12/05/2022] Open
Abstract
Tertiary lymphoid structures (TLSs) are used as biomarkers in many cancers for predicting the prognosis and assessing the response to immunotherapy. In Merkel cell carcinoma (MCC), TLSs have only been examined in MCPyV-positive cases. Here, we examined the prognostic value of the presence or absence of TLSs in 61 patients with MCC, including MCPyV-positive and MCPyV-negative cases. TLS-positive samples had a significantly better prognosis than TLS-negative samples. MCPyV-positive samples had a good prognosis with or without TLSs, and MCPyV-negative/TLS-positive samples had a similarly good prognosis as MCPyV-positive samples. Only MCPyV-negative/TLS-negative samples had a significantly poor prognosis. All cases with spontaneous regression were MCPyV-positive/TLS-positive. We also performed a comprehensive analysis of the chemokines associated with TLS formation using next-generation sequencing (NGS). The RNA sequencing results revealed 5 chemokine genes, CCL5, CCR2, CCR7, CXCL9, and CXCL13, with significantly high expression in TLS-positive samples compared with TLS-negative samples in both MCPyV-positive and MCPyV-negative samples. Only 2 chemokine genes, CXCL10 and CX3CR1, had significantly different expression levels in the presence or absence of MCPyV infection in TLS-negative samples. Patients with high CXCL13 or CCL5 expression have a significantly better prognosis than those with low expression. In conclusion, the presence of TLSs can be a potential prognostic marker even in cohorts that include MCPyV-negative cases. Chemokine profiles may help us understand the tumor microenvironment in patients with MCPyV-positive or MCPyV-negative MCC and may be a useful prognostic marker in their own right.
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Affiliation(s)
- Motoki Nakamura
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Tetsuya Magara
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shinji Kano
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Akihiro Matsubara
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hiroshi Kato
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Akimichi Morita
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Dudzisz-Sledz M, Sobczuk P, Kozak K, Switaj T, Kosela-Paterczyk H, Czarnecka AM, Falkowski S, Rogala P, Morysinski T, Spalek MJ, Zdzienicki M, Goryn T, Zietek M, Cybulska-Stopa B, Klek S, Kaminska-Winciorek G, Ziolkowska B, Szumera-Cieckiewicz A, Rutkowski P. Treatment of Locally Advanced Merkel Cell Carcinoma-A Multi-Center Study. Cancers (Basel) 2022; 14:422. [PMID: 35053584 PMCID: PMC8773590 DOI: 10.3390/cancers14020422] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/03/2022] [Accepted: 01/13/2022] [Indexed: 11/17/2022] Open
Abstract
Merkel cell carcinoma (MCC) is a rare, aggressive skin cancer with a high risk of recurrence and poor prognosis. The treatment of locally advanced disease involves surgery and radiotherapy. To analyze real-life treatment patterns and clinical outcomes, we conducted a retrospective analysis of data from 161 MCC patients treated with curative intent in four oncological centers in Poland. The median age at diagnosis was 72 years (30-94); 49.7% were male. Lymph node (LN) involvement at diagnosis was found in 26.9% of patients. Sentinel lymph node biopsy (SLNB) was performed in 36.5% of patients (positive in 10.5%), and 51.9% of patients received perioperative treatment. The relapse rate was 38.3%. With the median follow-up of 2.3 years, the median disease-free survival (DFS) was not reached, and the 1-year rate was 65%. The negative independent risk factors for DFS were male gender, metastases in LN at diagnosis, no SLNB in patients without clinical nodal metastases, and no perioperative radiotherapy. The estimated median overall survival (OS) was 6.9 years (95% CI 4.64-9.15). The negative independent risk factors for OS were male gender, age above 70, metastases in LN at diagnosis, and no SLNB in patients without clinical nodal metastases. Our results confirm that the MCC treatment should be conducted in an experienced multidisciplinary team; however, the outcomes are still unsatisfactory.
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Affiliation(s)
- Monika Dudzisz-Sledz
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (P.S.); (K.K.); (T.S.); (H.K.-P.); (A.M.C.); (S.F.); (P.R.); (T.M.); (M.J.S.); (M.Z.); (T.G.); (P.R.)
| | - Paweł Sobczuk
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (P.S.); (K.K.); (T.S.); (H.K.-P.); (A.M.C.); (S.F.); (P.R.); (T.M.); (M.J.S.); (M.Z.); (T.G.); (P.R.)
- Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Katarzyna Kozak
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (P.S.); (K.K.); (T.S.); (H.K.-P.); (A.M.C.); (S.F.); (P.R.); (T.M.); (M.J.S.); (M.Z.); (T.G.); (P.R.)
| | - Tomasz Switaj
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (P.S.); (K.K.); (T.S.); (H.K.-P.); (A.M.C.); (S.F.); (P.R.); (T.M.); (M.J.S.); (M.Z.); (T.G.); (P.R.)
| | - Hanna Kosela-Paterczyk
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (P.S.); (K.K.); (T.S.); (H.K.-P.); (A.M.C.); (S.F.); (P.R.); (T.M.); (M.J.S.); (M.Z.); (T.G.); (P.R.)
| | - Anna Malgorzata Czarnecka
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (P.S.); (K.K.); (T.S.); (H.K.-P.); (A.M.C.); (S.F.); (P.R.); (T.M.); (M.J.S.); (M.Z.); (T.G.); (P.R.)
- Department of Experimental Pharmacology, Mossakowski Medical Research Centre, Polish Academy of Sciences, 02-106 Warsaw, Poland
| | - Slawomir Falkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (P.S.); (K.K.); (T.S.); (H.K.-P.); (A.M.C.); (S.F.); (P.R.); (T.M.); (M.J.S.); (M.Z.); (T.G.); (P.R.)
| | - Paweł Rogala
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (P.S.); (K.K.); (T.S.); (H.K.-P.); (A.M.C.); (S.F.); (P.R.); (T.M.); (M.J.S.); (M.Z.); (T.G.); (P.R.)
| | - Tadeusz Morysinski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (P.S.); (K.K.); (T.S.); (H.K.-P.); (A.M.C.); (S.F.); (P.R.); (T.M.); (M.J.S.); (M.Z.); (T.G.); (P.R.)
| | - Mateusz Jacek Spalek
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (P.S.); (K.K.); (T.S.); (H.K.-P.); (A.M.C.); (S.F.); (P.R.); (T.M.); (M.J.S.); (M.Z.); (T.G.); (P.R.)
| | - Marcin Zdzienicki
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (P.S.); (K.K.); (T.S.); (H.K.-P.); (A.M.C.); (S.F.); (P.R.); (T.M.); (M.J.S.); (M.Z.); (T.G.); (P.R.)
| | - Tomasz Goryn
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (P.S.); (K.K.); (T.S.); (H.K.-P.); (A.M.C.); (S.F.); (P.R.); (T.M.); (M.J.S.); (M.Z.); (T.G.); (P.R.)
| | - Marcin Zietek
- Department of Oncology, Wrocław Medical University, 53-413 Wrocław, Poland;
- Department of Surgical Oncology, Wrocław Comprehensive Cancer Center, 53-413 Wrocław, Poland
| | - Bozena Cybulska-Stopa
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Cracow Branch, 31-115 Cracow, Poland;
| | - Stanisław Klek
- Department of Surgical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Cracow Branch, 31-115 Cracow, Poland;
| | - Grazyna Kaminska-Winciorek
- The Department of Bone Marrow Transplantation and Onco-Hematology, Skin Cancer and Melanoma Team, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland;
| | - Barbara Ziolkowska
- II Clinic of Radiotherapy & Chemotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland;
| | - Anna Szumera-Cieckiewicz
- Maria Sklodowska-Curie National Research Institute of Oncology, Department of Pathology and Laboratory Diagnostics, 02-781 Warsaw, Poland;
- Institute of Hematology and Transfusion Medicine, Diagnostic Hematology Department, 02-776 Warsaw, Poland
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (P.S.); (K.K.); (T.S.); (H.K.-P.); (A.M.C.); (S.F.); (P.R.); (T.M.); (M.J.S.); (M.Z.); (T.G.); (P.R.)
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Sauerer T, Lischer C, Weich A, Berking C, Vera J, Dörrie J. Single-Molecule RNA Sequencing Reveals IFNγ-Induced Differential Expression of Immune Escape Genes in Merkel Cell Polyomavirus-Positive MCC Cell Lines. Front Microbiol 2021; 12:785662. [PMID: 35003017 PMCID: PMC8727593 DOI: 10.3389/fmicb.2021.785662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/18/2021] [Indexed: 12/15/2022] Open
Abstract
Merkel cell carcinoma (MCC) is a rare and highly aggressive cancer, which is mainly caused by genomic integration of the Merkel cell polyomavirus and subsequent expression of a truncated form of its large T antigen. The resulting primary tumor is known to be immunogenic and under constant pressure to escape immune surveillance. Because interferon gamma (IFNγ), a key player of immune response, is secreted by many immune effector cells and has been shown to exert both anti-tumoral and pro-tumoral effects, we studied the transcriptomic response of MCC cells to IFNγ. In particular, immune modulatory effects that may help the tumor evade immune surveillance were of high interest to our investigation. The effect of IFNγ treatment on the transcriptomic program of three MCC cell lines (WaGa, MKL-1, and MKL-2) was analyzed using single-molecule sequencing via the Oxford Nanopore platform. A significant differential expression of several genes was detected across all three cell lines. Subsequent pathway analysis and manual annotation showed a clear upregulation of genes involved in the immune escape of tumor due to IFNγ treatment. The analysis of selected genes on protein level underlined our sequencing results. These findings contribute to a better understanding of immune escape of MCC and may help in clinical treatment of MCC patients. Furthermore, we demonstrate that single-molecule sequencing can be used to assess characteristics of large eukaryotic transcriptomes and thus contribute to a broader access to sequencing data in the community due to its low cost of entry.
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Affiliation(s)
- Tatjana Sauerer
- RNA-based Immunotherapy, Hautklinik, Comprehensive Cancer Center Erlangen European Metropolitan Area of Nuremberg, Deutsches Zentrum Immuntherapie, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Christopher Lischer
- Systems Tumor Immunology, Hautklinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen European Metropolitan Area of Nuremberg, Deutsches Zentrum Immuntherapie, Erlangen, Germany
| | - Adrian Weich
- Systems Tumor Immunology, Hautklinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen European Metropolitan Area of Nuremberg, Deutsches Zentrum Immuntherapie, Erlangen, Germany
| | - Carola Berking
- Hautklinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen European Metropolitan Area of Nuremberg, Deutsches Zentrum Immuntherapie, Erlangen, Germany
| | - Julio Vera
- Systems Tumor Immunology, Hautklinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen European Metropolitan Area of Nuremberg, Deutsches Zentrum Immuntherapie, Erlangen, Germany
| | - Jan Dörrie
- RNA-based Immunotherapy, Hautklinik, Comprehensive Cancer Center Erlangen European Metropolitan Area of Nuremberg, Deutsches Zentrum Immuntherapie, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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Rotondo JC, Mazziotta C, Lanzillotti C, Tognon M, Martini F. Epigenetic Dysregulations in Merkel Cell Polyomavirus-Driven Merkel Cell Carcinoma. Int J Mol Sci 2021; 22:11464. [PMID: 34768895 DOI: 10.3390/ijms222111464] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/15/2021] [Accepted: 10/20/2021] [Indexed: 12/14/2022] Open
Abstract
Merkel cell polyomavirus (MCPyV) is a small DNA virus with oncogenic potential. MCPyV is the causative agent of Merkel Cell Carcinoma (MCC), a rare but aggressive tumor of the skin. The role of epigenetic mechanisms, such as histone posttranslational modifications (HPTMs), DNA methylation, and microRNA (miRNA) regulation on MCPyV-driven MCC has recently been highlighted. In this review, we aim to describe and discuss the latest insights into HPTMs, DNA methylation, and miRNA regulation, as well as their regulative factors in the context of MCPyV-driven MCC, to provide an overview of current findings on how MCPyV is involved in the dysregulation of these epigenetic processes. The current state of the art is also described as far as potentially using epigenetic dysregulations and related factors as diagnostic and prognostic tools is concerned, in addition to targets for MCPyV-driven MCC therapy. Growing evidence suggests that the dysregulation of HPTMs, DNA methylation, and miRNA pathways plays a role in MCPyV-driven MCC etiopathogenesis, which, therefore, may potentially be clinically significant for this deadly tumor. A deeper understanding of these mechanisms and related factors may improve diagnosis, prognosis, and therapy for MCPyV-driven MCC.
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Kim HJ, Lee KC, Kang CH, Ahn KS, Kim CH. Characteristic Imaging Features of Merkel Cell Carcinoma: A Case Report. Curr Med Imaging 2021; 17:562-566. [PMID: 33100207 DOI: 10.2174/1573405616666201023142724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/20/2020] [Accepted: 09/16/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Merkel cell carcinoma (MCC) is a rare primary cutaneous tumor. The standardized imaging guidelines for the diagnosis of MCC have not been established. We report the multimodality imaging features of MCC, including CT, MRI, and ultrasound with grayscale and color Doppler mode as well as the elastography and even a histopathologic confirmation. CASE REPORT We report the case of a 76-year old male patient with MCC on the elbow that was treated by excision. On MRI, prominent T2 low signal voiding was noted with branching or chaotic pattern and marked, branching, or chaotic vascularity was also seen on color doppler ultrasound. Those findings corresponded to histology that showed increased vascularity in stromal tissues of the tumor and in between the tumor cells. CONCLUSION A mass in the dermal and subcutaneous layer with marked and branching or chaotic vascularity may be the unique characteristic that may contribute to early diagnosis of MCC.
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Affiliation(s)
- Hyun Jin Kim
- Departement of Radiology, Korea University Anam Hospital, Seoul, Korea
| | - Kyu-Chong Lee
- Department of Radiology, Armed Forces Daejeon Hospital; Daejeon, Korea
| | - Chang Ho Kang
- Departement of Radiology, Korea University Anam Hospital, Seoul, Korea
| | - Kyung-Sik Ahn
- Departement of Radiology, Korea University Anam Hospital, Seoul, Korea
| | - Chul Hwan Kim
- Department of Pathology, Korea University Anam Hospital, Seoul, Korea
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Yin X, She H, Martin Kasyanju Carrero L, Ma W, Zhou B. Nomogram prediction for the overall survival and cancer-specific survival of patients diagnosed with Merkel cell carcinoma. Ann Transl Med 2021; 9:286. [PMID: 33708913 PMCID: PMC7944317 DOI: 10.21037/atm-20-4578] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Merkel cell carcinoma (MCC) is a rare and aggressive neuroendocrine carcinoma of the skin, with a high recurrence rate and a high mortality rate worldwide. The purpose of this article is to construct a nomogram that incorporates significant clinical parameters and predicts the survival of individuals with MCC. Methods The Surveillance, Epidemiology, and End Results (SEER) database was employed to retrospectively analyze all confirmed MCC cases from 2004 to 2015. The data was collected from 3,688 patients, and was randomized as the training or validation group (1:1 ratio). The independent factors which predicted the cancer-specific survival (CSS) and overall survival (OS) for MCC cases were searched for nomogram construction respectively. Independent parameters that affected CSS were determined using the Fine and Gray competing risk regression model. In addition, the time-dependent receiver operating characteristic (ROC) curve was constructed. Then, the area under the curve (AUC) values, calibration curve, and the concordance index (C-index) were used to determine the nomogram performance. At last, decision curve analysis (DCA) was conducted to determine the net clinical benefit. Results The multivariate analysis results revealed that sex, age, race, marriage, American Joint Committee on Cancer (AJCC) stage, chemotherapy and radiotherapy were independent OS prognostic factors. Furthermore, competing risk analysis showed age, sex, AJCC stage, chemotherapy were the independent CSS prognostic factors. For validation, the C-index value of OS nomogram was 0.703 (95% CI: 0.686-0.721), while C-index value of CSS nomogram was 0.737 (95% CI: 0.710-0.764). Both C-index and AUC suggested that nomograms had superior performance to that of the AJCC stage system. In addition, according to the calibration curve, both nomograms were capable of accurate prediction of MCC prognosis. The DCA showed that the net benefits of the nomograms were superior among various threshold probabilities than these of AJCC stage system. Conclusions The present work established and verified the novel nomograms to predict the OS and CSS of MCC patients. If further confirmed in future studies, it may become another helpful tool for risk stratification and management of MCC patients.
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Affiliation(s)
- Xufeng Yin
- Department of Dermatology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Huihui She
- Department of Dermatology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | | | - Weiwei Ma
- Department of Dermatology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Bingrong Zhou
- Department of Dermatology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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11
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Sachpekidis C, Sidiropoulou P, Hassel JC, Drakoulis N, Dimitrakopoulou-Strauss A. Positron Emission Tomography in Merkel Cell Carcinoma. Cancers (Basel) 2020; 12:E2897. [PMID: 33050255 PMCID: PMC7601068 DOI: 10.3390/cancers12102897] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 12/23/2022] Open
Abstract
Merkel cell carcinoma (MCC) is a rare neuroendocrine skin malignancy usually arising as a nonspecific nodule on sun-exposed areas of the head and neck. Given the poor prognosis of this aggressive tumor, assessment of disease burden in pre- and post-treatment care may ensure an optimal management with significant implications for patient surveillance and prognosis. Although imaging has established its role in locally advanced or distant metastatic MCC, a standard imaging algorithm is yet to be determined and respective recommendations are mainly based on melanoma. Positron emission tomography/computed tomography (PET/CT) is increasingly evolving as a valuable imaging tool in metastatic or unresectable MCC, mostly utilizing the glucose analogue 18F-fluorodeoxyglucose (18F-FDG) as a radiotracer. Despite being inferior in detecting the disease in its early stages compared to the "gold standard" of sentinel lymph node biopsy, recent evidence suggests an important role for 18F-FDG PET/CT in the routine workup of localized MCC. Moreover, 68Ga-labeled somatostatin analogues have been employed as PET tracers in the field of MCC with promising, yet comparable to 18F-FDG, results. This article provides a structured literature review of the most important studies investigating the role of PET or PET/CT in the clinical practice of MCC.
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Affiliation(s)
- Christos Sachpekidis
- German Cancer Research Center, Clinical Cooperation Unit Nuclear Medicine, 69120 Heidelberg, Germany;
| | - Polytimi Sidiropoulou
- 1st Department of Dermatology-Venereology, Faculty of Medicine, National and Kapodistrian University of Athens, “A. Sygros” Hospital for Cutaneous & Venereal Diseases, GR-16121 Athens, Greece;
| | - Jessica C. Hassel
- Department of Dermatology and National Center for Tumor Diseases, University Hospital Heidelberg, 69120 Heidelberg, Germany;
| | - Nikolaos Drakoulis
- Research Group of Clinical Pharmacology and Pharmacogenomics, Faculty of Pharmacy, School of Health Sciences, National and Kapodistrian University of Athens, GR-15771 Athens, Greece;
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Guida M, D'Alò A, Mangia A, Di Pinto F, Sonnessa M, Albano A, Sciacovelli A, Asabella AN, Fucci L. Somatostatin Receptors in Merkel-Cell Carcinoma: A Therapeutic Opportunity Using Somatostatin Analog Alone or in Association With Checkpoint Inhibitors Immunotherapy. A Case Report. Front Oncol 2020; 10:1073. [PMID: 32733801 PMCID: PMC7358364 DOI: 10.3389/fonc.2020.01073] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 05/28/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Merkel-cell carcinoma (MCC) is a rare, highly aggressive skin cancer typically involving elderly people. Surgery is usually the first treatment for primary tumor. In adjuvant setting, radiotherapy is effective in reducing local recurrence and in improving overall survival. Regarding advanced disease, systemic chemotherapy ended up disappointing results whereas antiPD1/antiPD-L1 immunotherapy recently gave relevant clinical benefits. Interestingly, about the half of MCC patients expresses high somatostatin receptors (SRs) to possibly represent a target for the therapeutic use of somatostatin analogs (SSAs). Nevertheless, SSAs have been little studied in MCC and cases treated with SSAs in association with checkpoint inhibitor immunotherapy have not been published yet. Case Report: We report the case of a 73-year-old man affected by metastatic MCC of right arm previously treated with surgery and adjuvant radio and chemotherapy. Three years later the patient presented loco-regional relapse involving lateral-cervical, mediastinal, and submandibular lymph nodes with high value of chromogranin A and neuron specific enolase. Due to the high expression of SRs at octreoscan and immunoistochemistry, patient started octreotide 30 mg i.m. every 28 days with a good control of disease for about 2 years. A widespread progression of disease was reported afterwards. The patient started the antiPD-L1 avelumab immunotherapy, only recently available in Italy, while still taking SSA. The patient showed an impressive regression of the disease after only four cycles of avelumab until complete remission. Conclusions: SSA could be a valid therapeutic option in patients with MCC with high SR expression. When combined with PD-1/PD-L1 immune-checkpoint inhibition, SSA is likely to enhance antiproliferative activity. Our case report provides the rationale to conduct a prospective trial and translational research to verify the efficacy and safety of combined SSA and checkpoint inhibitors for advanced MCC.
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Affiliation(s)
- Michele Guida
- Department of Medical Oncology, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Alessandro D'Alò
- Department of Medical Oncology, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Anita Mangia
- Functional Biomorphology Laboratory, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Federica Di Pinto
- Department of Pathology, Research Hospital, National Institute of Gastroenterology "S. De Bellis", Castellana Grotte, Italy
| | - Margherita Sonnessa
- Department of Pathology, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Anna Albano
- Department of Medical Oncology, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Angela Sciacovelli
- Department of Medical Oncology, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Artor Niccoli Asabella
- Nuclear Medicine Unit, Department of Interdisciplinary Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Livia Fucci
- Department of Pathology, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
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Zhu JW, Doerwald-Munoz L, Lee JWY. Medically inoperable Merkel cell carcinoma of the head and neck treated with stereotactic body radiation therapy: a case report. Ann Palliat Med 2020; 10:2354-2358. [PMID: 32527130 DOI: 10.21037/apm-20-258] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 04/07/2020] [Indexed: 11/06/2022]
Abstract
Merkel cell carcinoma (MCC) is a rare but aggressive neuroendocrine tumour of the skin. MCC is the second most common cause of death from non-melanoma skin cancer and the most aggressive cutaneous malignancy. An 88-year-old male presented with a large, bleeding skin tumour located on the right temple and pre-auricular region. A biopsy confirmed MCC; immunohistochemistry (IHC) was positive for synaptophysin and CK20. The patient was assessed by a head and neck surgical oncologist and not deemed to have operable disease due to medical co-morbidities and extent of disease. The patient underwent a single fraction of electron treatment, followed by stereotactic body radiation therapy (SBRT) to a total dose of 40 Gy in 5 fractions over 2 weeks. Bleeding stopped and the patient tolerated treatment well with no reported side effects other than fatigue. There was symptomatic improvement within 2 weeks and a complete clinical response within 4 weeks of treatment. There are limited data on the use of radiotherapy in unresected/ inoperable MCC. For elderly, medically frail patients who cannot undergo surgery, SBRT may be an option to alleviate symptoms and control the tumour in a relatively short number of treatments; further study is warranted.
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Affiliation(s)
- Jie Wei Zhu
- Michael G. DeGroote School of Medicine, McMaster University, Ontario, Canada
| | | | - Justin Wann-Yee Lee
- Department of Oncology, Juravinski Cancer Centre, McMaster University, Ontario, Canada.
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Caldarelli C, Autorino U, Iaquinta C, De Marchi A. Merkel cell carcinoma of the forehead area: a literature review and case report. Oral Maxillofac Surg 2019; 23:365-373. [PMID: 31342210 DOI: 10.1007/s10006-019-00793-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 07/10/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Merkel cell carcinoma (MCC) is an uncommon, aggressive malignancy of the skin, mostly affecting head and neck area in elderly white patients. Between head/neck sites, face accounts for 61% and forehead accounts for 17% of all face MCCs. PURPOSE We here present a literature review MCC cases arising in the forehead area, published in the English literature in the period 1987-2018, and report a personal observation with a late diagnosis and a treatment out of the current recommendations. The aims of this paper are to provide an up-to-date on MCC arising in the forehead area and to raise awareness about misdiagnosis of this type of lesion mimicking arteriovenous malformations (AVM). MATERIAL AND METHOD Literature review was performed on PubMed and Medline database and "Merkel cell carcinoma (MCC)," "forehead" and "MCC forehead location" were the terms the authors searched for. Patients' data have been drawn from descriptions of single cases and of short case series reports. For each case, data were collected about clinical characteristics, treatment modalities and outcomes. The study has been limited to the clinical features of the disease, excluding etiologic/pathogenic aspects. RESULTS Twenty-five patients with forehead MCC have been identified, coming from 20 sources. Nineteen presented a locoregional disease and 6 had an advanced pathology. TNM classification was reported in only two cases lacking for the other available data. Patients presented at mean age of 66 years with solitary or multiple nodules or dome-shaped/hemispherical mass, rarely ulcerated. Mean size of tumors was 1.13 cm of max diameter. Previous or concurrent malignancies or immune-hematologic disorders (AIDS) were often associated. At first investigation, lesion was often mistaken for other malignant or benign processes and, then, diagnosis was generally late. Some type of preoperative biopsy was performed in 3 patients, while the others had only a postoperative microscopic study of specimen. Initial treatment consisted in 6 cases (24%) in a not further specified about extent and width of margins local excision of the primary lesion, while a wide resection was reported in only 3 cases (12%). Surgical treatment of involved lymph-nodes was performed in 3 cases (12%). Six patients underwent radiotherapy for locoregional or distant recurrences. Mortality and overall survival rate at five years were 28% and 24%, respectively. Spontaneous regression was observed in 3 patients (12%). CASE REPORT Personal observation concerned an 82-year-old woman presenting with a forehead periorbital 5 × 5 cm red-bluish mass. The erythematous lesion was erroneously diagnosed as hemangioma on the base of color, the absence of any signs of malignancy, an angio CT indicating a hypervascular tissue and a FNA cytology (FNAC) lacking of malignant cells. The mass was excised as a benign lesion with about 1 cm margins extent without searching larger edges. Postoperative radiotherapy was offered to the patient after histology report, but she refused. After 4 months from surgery, she had a parotid metastasis and died from the illness in spite of platinum-based chemotherapy. CONCLUSIONS This study confirms the aggressiveness of forehead MCC, comparable with that of other face similar tumors. Personal case suggests that the deceitful benign feature of lesion may mimic an AVM and that FNAC may be misleading and diagnostic failure worsen prognosis. Our experience suggests that in the face smaller than 2-3 cm margins resection may increase the risk of locoregional recurrence. Therefore, postoperative wide-field irradiation should be ever delivered, after forehead MCC surgery, not only when clear margins are unattainable or involved with tumor, but also when negative microscopic edges are documented and residual cancer is thought not persist in the tumor bed. Orbit irradiation seems to be not dangerous for the eye.
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Affiliation(s)
- Claudio Caldarelli
- Department of Otorhinolaryngology and MaxilloFacial Surgery, S. Giovanni Bosco Hospital, Piazza del donatore di sangue, Turin, 10154, Italy.
| | - Umberto Autorino
- Division of Maxillofacial Surgery, Surgical Science Dpt., Città della Salute e delle Scienze Hospital, University of Turin, Turin, 10124, Italy
| | - Caterina Iaquinta
- Department of Otorhinolaryngology and MaxilloFacial Surgery, S. Giovanni Bosco Hospital, Piazza del donatore di sangue, Turin, 10154, Italy
| | - Andrea De Marchi
- Department of Pathology Unit, S. Giovanni Bosco Hospital, Piazza del donatore di sangue, 3, Turin, 10154, Italy
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Abstract
Introduction Merkel cell carcinoma (MCC) is a rare cutaneous malignancy that normally occurs in sun-exposed areas of the skin. Risk factors are immundeficency and Merkel cell polyomavirus. Treatment options are surgery, radiotherapy, chemotherapy and immunotherapy in clinical trials. Case report We describe a case of an 80-year-old woman with ovarian metastasis of MCC six years after excision of a cutaneous MCC on the cheek. Discussion To our knowledge only three cases with ovarian metastasis of MCC have been described so far. Our case is the second with distant metastasis to the ovary spreading from a primary tumor in the skin of the head, in the other two cases the primary tumor was in the inguinal skin. Conculsion MCC is a highly aggressive cutaneous and mucosal malignancy with frequent recurrence, lymph node and distant metastases. There is no clear consensus how to treat metastatic disease. MCC is a rare malignancy. Recurrence and metastases are frequent. There is little knowledge of treatments for metastatic MCC.
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Affiliation(s)
- Nicole Keller
- Gynecology and Obstetrics, Hospital Grabs, Spitalstrasse 44, CH-9472 Grabs, Switzerland
| | - Beatrix Haemmerle
- Gynecology and Obstetrics, Hospital Grabs, Spitalstrasse 44, CH-9472 Grabs, Switzerland
| | - Seraina Schmid
- Gynecology and Obstetrics, Hospital Grabs, Spitalstrasse 44, CH-9472 Grabs, Switzerland
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Abstract
There are many different types of skin tumors in the World Health Organization (WHO) classification. The natural course and treatment varies according to the histological type. This review summarizes clinical experience for treatment decision. Contemporary radiotherapy and systemic therapy are improving. Landmark studies for basal cell and Merkel cell carcinomas (MCC) trigger further research and impetus for improving treatment outcome. Avelumab, nivolumab, pembrolizumab, ipilimumab appear to be promising for treatment of advanced MCCs and adjuvant trials are underway.
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Affiliation(s)
- Patricia Tai
- Allan Blair Cancer Center, University of Saskatchewan, Saskatoon, Canada
| | - Joseph Au
- Adventist Hospital, University of Hong Kong, Hong Kong, China
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18
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Paulson KG, Lewis CW, Redman MW, Simonson WT, Lisberg A, Ritter D, Morishima C, Hutchinson K, Yelistratova L, Blom A, Iyer J, Moshiri AS, Shantha E, Carter JJ, Bhatia S, Kawasumi M, Galloway DA, Wener MH, Nghiem P. Viral oncoprotein antibodies as a marker for recurrence of Merkel cell carcinoma: A prospective validation study. Cancer 2017; 123:1464-1474. [PMID: 27925665 PMCID: PMC5384867 DOI: 10.1002/cncr.30475] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 10/27/2016] [Accepted: 10/31/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND Merkel cell carcinoma (MCC) is an aggressive skin cancer with a recurrence rate of >40%. Of the 2000 MCC cases per year in the United States, most are caused by the Merkel cell polyomavirus (MCPyV). Antibodies to MCPyV oncoprotein (T-antigens) have been correlated with MCC tumor burden. The present study assesses the clinical utility of MCPyV-oncoprotein antibody titers for MCC prognostication and surveillance. METHODS MCPyV-oncoprotein antibody detection was optimized in a clinical laboratory. A cohort of 219 patients with newly diagnosed MCC were followed prospectively (median follow-up, 1.9 years). Among the seropositive patients, antibody titer and disease status were serially tracked. RESULTS Antibodies to MCPyV oncoproteins were rare among healthy individuals (1%) but were present in most patients with MCC (114 of 219 patients [52%]; P < .01). Seropositivity at diagnosis independently predicted decreased recurrence risk (hazard ratio, 0.58; P = .04) in multivariate analyses adjusted for age, sex, stage, and immunosuppression. After initial treatment, seropositive patients whose disease did not recur had rapidly falling titers that became negative by a median of 8.4 months. Among seropositive patients who underwent serial evaluation (71 patients; 282 time points), an increasing oncoprotein titer had a positive predictive value of 66% for clinically evident recurrence, whereas a decreasing titer had a negative predictive value of 97%. CONCLUSIONS Determination of oncoprotein antibody titer assists in the clinical management of patients with newly diagnosed MCC by stratifying them into a higher risk seronegative cohort, in which radiologic imaging may play a more prominent role, and into a lower risk seropositive cohort, in which disease status can be tracked in part by oncoprotein antibody titer. Cancer 2017;123:1464-1474. © 2016 American Cancer Society.
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Affiliation(s)
- Kelly G. Paulson
- Division of Dermatology, Department of Medicine, University of Washington, Seattle WA
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle WA
- Seattle Cancer Care Alliance, Seattle WA
| | - Christopher W. Lewis
- Division of Dermatology, Department of Medicine, University of Washington, Seattle WA
| | - Mary W. Redman
- Clinical Statistics, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle WA
| | | | - Aaron Lisberg
- Division of Dermatology, Department of Medicine, University of Washington, Seattle WA
| | - Deborah Ritter
- Department of Laboratory Medicine, University of Washington, Seattle WA
| | - Chihiro Morishima
- Department of Laboratory Medicine, University of Washington, Seattle WA
| | - Kathy Hutchinson
- Department of Laboratory Medicine, University of Washington, Seattle WA
| | - Lola Yelistratova
- Division of Dermatology, Department of Medicine, University of Washington, Seattle WA
| | - Astrid Blom
- Division of Dermatology, Department of Medicine, University of Washington, Seattle WA
| | - Jayasri Iyer
- Division of Dermatology, Department of Medicine, University of Washington, Seattle WA
| | - Ata S. Moshiri
- Division of Dermatology, Department of Medicine, University of Washington, Seattle WA
| | - Erica Shantha
- Division of Dermatology, Department of Medicine, University of Washington, Seattle WA
| | - Joseph J. Carter
- Division of Human Biology, Fred Hutchinson Cancer Research Center, Seattle WA
| | - Shailender Bhatia
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle WA
- Seattle Cancer Care Alliance, Seattle WA
| | - Masaoki Kawasumi
- Division of Dermatology, Department of Medicine, University of Washington, Seattle WA
| | - Denise A. Galloway
- Division of Human Biology, Fred Hutchinson Cancer Research Center, Seattle WA
| | - Mark H. Wener
- Department of Laboratory Medicine, University of Washington, Seattle WA
| | - Paul Nghiem
- Division of Dermatology, Department of Medicine, University of Washington, Seattle WA
- Seattle Cancer Care Alliance, Seattle WA
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19
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Yaramada P, Lim BS, Flannery CM, Koh SS, Yaghsezian H. Merkel cell carcinoma of unknown primary with lymph node and mesenteric metastasis involving the pancreas and duodenum. J Gastrointest Oncol 2016; 7:S66-70. [PMID: 27034815 DOI: 10.3978/j.issn.2078-6891.2015.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Merkel cell carcinoma (MCC) of skin is a rare, aggressive cutaneous malignancy of neuroendocrine origin. MCC predominantly affects elderly Caucasians and has high predilection for sun exposed areas. Histologic exam and immunohistochemical profile is required to establish the diagnosis. It has high propensity for local recurrence and metastasis, and carries poor prognosis. However, metastasis to mesentery involving the duodenum is very uncommon and rarely reported in literature. We hereby describe a patient with lymph node and mesenteric metastasis invading duodenum and pancreas with unknown primary origin of MCC.
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Affiliation(s)
- Priyanka Yaramada
- 1 Department of Internal Medicine, University of California, Riverside, School of Medicine, Riverside, California, USA ; 2 Department of Gastroenterology, Kaiser Permanente Riverside Medical Center, Riverside, California, USA ; 3 Department of Adult Gastroenterology, Loma Linda University Medical Center, Loma Linda, California, USA ; 4 Department of Pathology, Kaiser Permanente Riverside Medical Center, Riverside, California, USA
| | - Brian S Lim
- 1 Department of Internal Medicine, University of California, Riverside, School of Medicine, Riverside, California, USA ; 2 Department of Gastroenterology, Kaiser Permanente Riverside Medical Center, Riverside, California, USA ; 3 Department of Adult Gastroenterology, Loma Linda University Medical Center, Loma Linda, California, USA ; 4 Department of Pathology, Kaiser Permanente Riverside Medical Center, Riverside, California, USA
| | - Christopher M Flannery
- 1 Department of Internal Medicine, University of California, Riverside, School of Medicine, Riverside, California, USA ; 2 Department of Gastroenterology, Kaiser Permanente Riverside Medical Center, Riverside, California, USA ; 3 Department of Adult Gastroenterology, Loma Linda University Medical Center, Loma Linda, California, USA ; 4 Department of Pathology, Kaiser Permanente Riverside Medical Center, Riverside, California, USA
| | - Stephen S Koh
- 1 Department of Internal Medicine, University of California, Riverside, School of Medicine, Riverside, California, USA ; 2 Department of Gastroenterology, Kaiser Permanente Riverside Medical Center, Riverside, California, USA ; 3 Department of Adult Gastroenterology, Loma Linda University Medical Center, Loma Linda, California, USA ; 4 Department of Pathology, Kaiser Permanente Riverside Medical Center, Riverside, California, USA
| | - Harout Yaghsezian
- 1 Department of Internal Medicine, University of California, Riverside, School of Medicine, Riverside, California, USA ; 2 Department of Gastroenterology, Kaiser Permanente Riverside Medical Center, Riverside, California, USA ; 3 Department of Adult Gastroenterology, Loma Linda University Medical Center, Loma Linda, California, USA ; 4 Department of Pathology, Kaiser Permanente Riverside Medical Center, Riverside, California, USA
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20
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Parikh MP, Samo S, Ganipisetti V, Krishnan S, Dhandha M, Yungbluth M, Glaws WR. Gastric metastasis of Merkel cell carcinoma, a rare cause of gastrointestinal bleeding: case report and review of the literature. J Gastrointest Oncol 2014; 5:E68-72. [PMID: 25083309 DOI: 10.3978/j.issn.2078-6891.2014.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 05/12/2014] [Indexed: 01/09/2023] Open
Abstract
Merkel cell carcinoma (MCC) is a highly aggressive cutaneous tumor of neuroendocrine origin. It is usually seen in elderly Caucasian males and occurs in sun exposed areas of the body. Diagnosis of MCC can be challenging and requires confirmation by immunohistochemical studies. It has an aggressive biological behavior with early local and distant metastasis and carries a dismal prognosis. However, metastasis of MCC to the stomach is very uncommon and rarely reported in the literature. We hereby describe a patient with gastric metastasis of MCC, who presented with upper gastrointestinal (GI) bleeding.
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Affiliation(s)
- Malav P Parikh
- 1 Department of Internal Medicine, Division of Gastroenterology, 2 Department of Pathology, Presence Saint Francis Hospital, University of Illinois at Chicago, Evanston, IL-60202, USA
| | - Salih Samo
- 1 Department of Internal Medicine, Division of Gastroenterology, 2 Department of Pathology, Presence Saint Francis Hospital, University of Illinois at Chicago, Evanston, IL-60202, USA
| | - Venu Ganipisetti
- 1 Department of Internal Medicine, Division of Gastroenterology, 2 Department of Pathology, Presence Saint Francis Hospital, University of Illinois at Chicago, Evanston, IL-60202, USA
| | - Sathish Krishnan
- 1 Department of Internal Medicine, Division of Gastroenterology, 2 Department of Pathology, Presence Saint Francis Hospital, University of Illinois at Chicago, Evanston, IL-60202, USA
| | - Maulik Dhandha
- 1 Department of Internal Medicine, Division of Gastroenterology, 2 Department of Pathology, Presence Saint Francis Hospital, University of Illinois at Chicago, Evanston, IL-60202, USA
| | - Margaret Yungbluth
- 1 Department of Internal Medicine, Division of Gastroenterology, 2 Department of Pathology, Presence Saint Francis Hospital, University of Illinois at Chicago, Evanston, IL-60202, USA
| | - Walter R Glaws
- 1 Department of Internal Medicine, Division of Gastroenterology, 2 Department of Pathology, Presence Saint Francis Hospital, University of Illinois at Chicago, Evanston, IL-60202, USA
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21
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Schmidt MC, Uhrhan K, Markiefka B, Hasselbring L, Schlaak M, Cremer B, Kunze S, Baum RP, Dietlein M. (68)Ga-DotaTATE PET-CT followed by Peptide Receptor Radiotherapy in combination with capecitabine in two patients with Merkel Cell Carcinoma. Int J Clin Exp Med 2012; 5:363-366. [PMID: 23293710 PMCID: PMC3526339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 08/25/2012] [Indexed: 06/01/2023]
Abstract
Herein, we report about two Caucasian patients with the histopathological diagnosis of Merkel cell carcinoma suffering from extensive lymph node metastases. The extent of the disease was diagnosed by Ga-68-DotaTATE-PET-CT. Both patients had rapid disease progression, one of them despite a three months course of sunitinibe followed by four chemotherapy cycles of cisplatin and etoposide. Both patients were sent for peptide receptor radiotherapy with 90Y-DotaTATE or 177Lu-DotaTATE in combination with capecitabine. Additional external beam radiotherapy of the cervical and inguinal lymph nodes was given to the patient with progressive disease despite chemotherapy. Temporary partial response in both patients was achieved. Despite extensive therapeutic efforts, fatal outcome could not be prevented 10 and 14 months after first clinical symptoms.
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Affiliation(s)
| | - Klara Uhrhan
- Department of Nuclear Medicine, University Hospital of CologneGermany
| | | | - Laura Hasselbring
- Ear, Nose and Throat Department, University Hospital of CologneGermany
| | - Max Schlaak
- Department of Dermatology, University Hospital of CologneGermany
| | - Birgit Cremer
- Department I for Internal Medicine, University Hospital of CologneGermany
| | - Sabine Kunze
- Department of Radiation Oncology, University Hospital of CologneGermany
| | - Richard P Baum
- Department of Nuclear Medicine / Center for PETBad Berka, Germany
| | - Markus Dietlein
- Department of Nuclear Medicine, University Hospital of CologneGermany
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