1
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Esser E, Grünewald I, Mihailovic N. [Periocular Merkel Cell Carcinoma - an overview of clinical aspects and current therapeutic options]. Laryngorhinootologie 2024; 103:404-412. [PMID: 38128577 DOI: 10.1055/a-2214-5209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Merkel cell carcinoma (MCC) is a rare but highly aggressive and rapidly expanding malignant skin tumor. It affects the periocular region in approximately 10% of cases. The current treatment recommendation for resectable non-metastatic MCC comprises total surgical excision; however, lymph node or distant metastases are often already present by the time of the diagnosis. Since an immune checkpoint inhibitor therapy with avelumab was first approved for MCC in 2016, there has been considerable improvement in mean survival compared to cytostatic therapy; at the same time, there has been a reduction in serious treatment-associated adverse events. Other immune checkpoint inhibitors are currently still in clinical trials, with very promising initial results. Because of the complexity of the diagnosis, treatment, and prognosis, it is essential that MCC patients receive interdisciplinary care in a specialized center including consultation with a tumor review board.
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Affiliation(s)
- Eliane Esser
- Klinik für Augenheilkunde, Universitätsklinikum Münster, Munster, Germany
| | - Inga Grünewald
- Gerhard-Domagk-Institut für Pathologie, Universitätsklinikum Münster, Münster, Germany
| | - Natasa Mihailovic
- Klinik für Augenheilkunde, Universitätsklinikum Münster, Münster, Germany
- Klinik für Augenheilkunde, Klinikum Fulda gAG, Fulda, Germany
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2
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Siqueira SM, Campos-do-Carmo G, da Silva PRG, Small IÁ, De Melo AC. The prognostic role of PD-L1 expression and the presence of polyomavirus in Merkel cell carcinoma cases. Infect Agent Cancer 2024; 19:1. [PMID: 38178185 PMCID: PMC10768145 DOI: 10.1186/s13027-023-00564-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/20/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Merkel cell carcinoma (MCC) comprises a rare malignant primary skin tumor presenting neuroendocrine differentiation. Recently, agents blocking the programmed cell death protein 1 and programmed cell death protein ligand 1 pathway (PD-1/PD-L1) have demonstrated objective and durable tumor regressions in patients presenting advanced MCC. This study aimed to describe the sociodemographic, clinical, and histopathological characteristics of MCC patients, also assessing the prevalence of PD-L1 expression and Merkel cell Polyomavirus (MCPyV), as well as their prognostic roles. METHODS Data from patients diagnosed with MCC between 1996 and 2019 at a reference cancer center in Rio de Janeiro, southeastern Brazil, were evaluated in a retrospective study. Tumor samples were tested for MCPyV and PD-L1 employing immunohistochemistry. Survival analyses were carried out employing the Kaplan-Meier method and curves were compared using the log-rank test. A multiple semiparametric Cox model was used. Values p < 0.05 were considered significant. RESULTS A total of 65 patients were included in the study, with a mean age at diagnosis of 72 (standard deviation 13.9). A total of 56.9% (37/65) of the patients were male, 86.2% (56/65) were white, and 56.9% (37/64) were illiterate or with incomplete elementary school. MCPyV immunohistochemistry was positive in 29 cases (44.6%) and PD-L1 positivity was ≥ 1% in 42 cases (64.6%). Significant associations between MCPyV and PD-L1 expression ≥ 1% (p = 0.003) and PD-L1 expression ≥ 5% (p = 0.005) were noted. Concerning the multivariate analysis, only education level and advanced MCC stage indicated statistically significant worse progression-free survival. Regarding overall survival (OS), being male, education level and advanced stage comprised risk factors. The estimated OS at 60 months for stages I to III was of 48.9% and for stage IV, 8.9%. CONCLUSIONS This is the first large Brazilian cohort to assess the prevalence of MCPyV in MCC tumors, as well as PD-L1 expression and their associations. No correlations were noted between MCPyV infection or PD-L1 expression and survival rates.
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Affiliation(s)
- Stella Meireles Siqueira
- Division of Clinical Research and Technological Development, Brazilian National Cancer Institute, Rio de Janeiro, Brazil.
| | | | | | - Isabele Ávila Small
- Division of Clinical Research and Technological Development, Brazilian National Cancer Institute, Rio de Janeiro, Brazil
| | - Andreia Cristina De Melo
- Division of Clinical Research and Technological Development, Brazilian National Cancer Institute, Rio de Janeiro, Brazil
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3
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Singh N, McClure EM, Akaike T, Park SY, Huynh ET, Goff PH, Nghiem P. The Evolving Treatment Landscape of Merkel Cell Carcinoma. Curr Treat Options Oncol 2023; 24:1231-1258. [PMID: 37403007 DOI: 10.1007/s11864-023-01118-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2023] [Indexed: 07/06/2023]
Abstract
OPINION STATEMENT Merkel cell carcinoma (MCC) has a high risk of recurrence and requires unique treatment relative to other skin cancers. The patient population is generally older, with comorbidities. Multidisciplinary and personalized care is therefore paramount, based on patient preferences regarding risks and benefits. Positron emission tomography and computed tomography (PET-CT) is the most sensitive staging modality and reveals clinically occult disease in ~ 16% of patients. Discovery of occult disease spread markedly alters management. Newly diagnosed, localized disease is often managed with sentinel lymph node biopsy (SLNB), local excision, primary wound closure, and post-operative radiation therapy (PORT). In contrast, metastatic disease is usually treated systemically with an immune checkpoint inhibitor (ICI). However, one or more of these approaches may not be indicated. Criteria for such exceptions and alternative approaches will be discussed. Because MCC recurs in 40% of patients and early detection/treatment of advanced disease is advantageous, close surveillance is recommended. Given that over 90% of initial recurrences arise within 3 years, surveillance frequency can be rapidly decreased after this high-risk period. Patient-specific assessment of risk is important because recurrence risk varies widely (15 to > 80%: Merkelcell.org/recur) depending on baseline patient characteristics and time since treatment. Blood-based surveillance tests are now available (Merkel cell polyomavirus (MCPyV) antibodies and circulating tumor DNA (ctDNA)) with excellent sensitivity that can spare patients from contrast dye, radioactivity, and travel to a cancer imaging facility. If recurrent disease is locoregional, management with surgery and/or RT is typically indicated. ICIs are now the first line for systemic/advanced MCC, with objective response rates (ORRs) exceeding 50%. Cytotoxic chemotherapy is sometimes used for debulking disease or in patients who cannot tolerate ICI. ICI-refractory disease is the major problem faced by this field. Fortunately, numerous promising therapies are on the horizon to address this clinical need.
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Affiliation(s)
- Neha Singh
- Department of Medicine, Division of Dermatology, University of Washington, 850 Republican Street, Box 358050, Seattle, WA, USA
- Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Erin M McClure
- Department of Medicine, Division of Dermatology, University of Washington, 850 Republican Street, Box 358050, Seattle, WA, USA
- University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - Tomoko Akaike
- Department of Medicine, Division of Dermatology, University of Washington, 850 Republican Street, Box 358050, Seattle, WA, USA
| | - Song Y Park
- Department of Medicine, Division of Dermatology, University of Washington, 850 Republican Street, Box 358050, Seattle, WA, USA
| | - Emily T Huynh
- Department of Medicine, Division of Dermatology, University of Washington, 850 Republican Street, Box 358050, Seattle, WA, USA
| | - Peter H Goff
- Department of Medicine, Division of Dermatology, University of Washington, 850 Republican Street, Box 358050, Seattle, WA, USA
- Department of Radiation Oncology, University of Washington, Seattle, WA, USA
| | - Paul Nghiem
- Department of Medicine, Division of Dermatology, University of Washington, 850 Republican Street, Box 358050, Seattle, WA, USA.
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4
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Moon IJ, Na H, Cho HS, Won CH, Chang SE, Lee MW, Lee WJ. Clinicopathological characteristics and prognosis of Merkel cell carcinoma: a single-center retrospective study in Korea. J Cancer Res Clin Oncol 2023; 149:10065-10074. [PMID: 37261524 DOI: 10.1007/s00432-023-04932-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 05/23/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Merkel cell carcinoma (MCC) is an aggressive neuroendocrine tumor of the skin with high mortality. However, its clinical characteristics in Asian patients remain uncertain owing to its low incidence. OBJECTIVE To analyze the clinicopathological features of MCC and identify factors associated with its prognosis. METHODS The medical records of 62 patients with MCC were retrospectively reviewed. Data on clinical features, survival outcomes, prognostic factors, histopathology and immunohistochemical profile of the patients were collected and analyzed. Merkel cell polyomavirus status was evaluated using immunohistochemistry. RESULTS The incidence of MCC significantly increased over time. The mean duration of follow-up was 51.2 months, with an overall 5-year survival of 80.6%. More female patients with MCC were identified than male patients (1.3:1). Approximately half of the patients had stage I disease at the time of initial presentation. The primary tumor was frequently located in the lower extremities (40.3%), followed by the head and neck (32.3%), upper extremities (22.6%), and the trunk (4.8%). Male sex was associated with poorer overall survival (p = 0.003). Post-resection adjuvant radiotherapy significantly improved the overall survival (p = 0.023). Sentinel lymph node biopsy during surgery ameliorated the progression-free survival (p = 0.036) in patients with stage I or II cancer. Lymphovascular and perineural invasion were associated with a poor prognosis. Old age, immunohistochemical profiles, and Merkel cell polyomavirus-positivity were not associated with prognosis. CONCLUSION Post-surgical adjuvant radiotherapy and sentinel lymph node biopsy significantly improve the course of MCC.
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Affiliation(s)
- Ik Jun Moon
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-Gil, Songpa-gu, Seoul, 05505, South Korea
| | - Hyungmin Na
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-Gil, Songpa-gu, Seoul, 05505, South Korea
| | - Hye Soo Cho
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-Gil, Songpa-gu, Seoul, 05505, South Korea
| | - Chong Hyun Won
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-Gil, Songpa-gu, Seoul, 05505, South Korea
| | - Sung Eun Chang
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-Gil, Songpa-gu, Seoul, 05505, South Korea
| | - Mi Woo Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-Gil, Songpa-gu, Seoul, 05505, South Korea
| | - Woo Jin Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-Gil, Songpa-gu, Seoul, 05505, South Korea.
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5
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Esser E, Grünewald I, Mihailovic N. Periocular Merkel Cell Carcinoma - An Overview of Clinical Aspects and Current Treatment Options. Klin Monbl Augenheilkd 2023; 240:24-32. [PMID: 36368663 DOI: 10.1055/a-1925-7703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Merkel cell carcinoma (MCC) is a rare but highly aggressive and rapidly expanding malignant skin tumor. It affects the periocular region in approximately 10% of cases. The current treatment recommendation for resectable non-metastatic MCC comprises total surgical excision; however, lymph node or distant metastases are often already present by the time of the diagnosis. Since an immune checkpoint inhibitor therapy with avelumab was first approved for MCC in 2016, there has been considerable improvement in mean survival compared to cytostatic therapy; at the same time, there has been a reduction in serious treatment-associated adverse events. Other immune checkpoint inhibitors are currently still in clinical trials, with very promising initial results. Because of the complexity of the diagnosis, treatment, and prognosis, it is essential that MCC patients receive interdisciplinary care in a specialized center including consultation with a tumor review board.
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Affiliation(s)
- Eliane Esser
- Klinik für Augenheilkunde, Universitätsklinikum Münster, Deutschland
| | - Inga Grünewald
- Gerhard-Domagk-Institut für Pathologie, Universitätsklinikum Münster, Deutschland
| | - Natasa Mihailovic
- Klinik für Augenheilkunde, Universitätsklinikum Münster, Deutschland.,Klinik für Augenheilkunde, Klinikum Fulda gAG, Deutschland
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6
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Nataren N, Yamada M, Prow T. Molecular Skin Cancer Diagnosis: Promise and Limitations. J Mol Diagn 2023; 25:17-35. [PMID: 36243291 DOI: 10.1016/j.jmoldx.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 09/13/2022] [Accepted: 09/20/2022] [Indexed: 11/22/2022] Open
Abstract
Skin cancer is a significant and increasing global health burden. Although the current diagnostic workflow is robust and able to provide clinically actionable results, it is subject to notable limitations. The training and expertise required for accurate diagnoses using conventional skin cancer diagnostics are significant, and patient access to this workflow can be limited by geographic location or unforeseen events, such as coronavirus disease 2019 (COVID-19). Molecular biomarkers have transformed diagnostics and treatment delivery in oncology. With rapid advancements in molecular biology techniques, understanding of the underlying molecular mechanism of cancer pathologies has deepened, yielding biomarkers that can be used to monitor the course of malignant diseases. Herein, commercially available, clinically validated, and emerging skin cancer molecular biomarkers are reviewed. The qualities of an ideal molecular biomarker are defined. The potential benefits and limitations of applying molecular biomarker testing over the course of skin cancer from susceptibility to treatment are explored, with a view to outlining a future model of molecular biomarker skin cancer diagnostics.
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Affiliation(s)
- Nathalie Nataren
- Future Industries Institute, University of South Australia, Adelaide, South Australia, Australia
| | - Miko Yamada
- Future Industries Institute, University of South Australia, Adelaide, South Australia, Australia
| | - Tarl Prow
- Future Industries Institute, University of South Australia, Adelaide, South Australia, Australia; Skin Research Centre, York Biomedical Research Institute, Hull York Medical School, University of York, York, United Kingdom.
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7
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Silk AW, Barker CA, Bhatia S, Bollin KB, Chandra S, Eroglu Z, Gastman BR, Kendra KL, Kluger H, Lipson EJ, Madden K, Miller DM, Nghiem P, Pavlick AC, Puzanov I, Rabinowits G, Ruiz ES, Sondak VK, Tavss EA, Tetzlaff MT, Brownell I. Society for Immunotherapy of Cancer (SITC) clinical practice guideline on immunotherapy for the treatment of nonmelanoma skin cancer. J Immunother Cancer 2022; 10:jitc-2021-004434. [PMID: 35902131 PMCID: PMC9341183 DOI: 10.1136/jitc-2021-004434] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2022] [Indexed: 12/21/2022] Open
Abstract
Nonmelanoma skin cancers (NMSCs) are some of the most commonly diagnosed malignancies. In general, early-stage NMSCs have favorable outcomes; however, a small subset of patients develop resistant, advanced, or metastatic disease, or aggressive subtypes that are more challenging to treat successfully. Recently, immune checkpoint inhibitors (ICIs) have been approved by the US Food and Drug Administration (FDA) for the treatment of Merkel cell carcinoma (MCC), cutaneous squamous cell carcinoma (CSCC), and basal cell carcinoma (BCC). Although ICIs have demonstrated activity against NMSCs, the routine clinical use of these agents may be more challenging due to a number of factors including the lack of predictive biomarkers, the need to consider special patient populations, the management of toxicity, and the assessment of atypical responses. With the goal of improving patient care by providing expert guidance to the oncology community, the Society for Immunotherapy of Cancer (SITC) convened a multidisciplinary panel of experts to develop a clinical practice guideline (CPG). The expert panel drew on the published literature as well as their own clinical experience to develop recommendations for healthcare professionals on important aspects of immunotherapeutic treatment for NMSCs, including staging, biomarker testing, patient selection, therapy selection, post-treatment response evaluation and surveillance, and patient quality of life (QOL) considerations, among others. The evidence- and consensus-based recommendations in this CPG are intended to provide guidance to cancer care professionals treating patients with NMSCs.
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Affiliation(s)
- Ann W Silk
- Merkel Cell Carcinoma Center of Excellence, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Christopher A Barker
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Shailender Bhatia
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Kathryn B Bollin
- Hematology and Medical Oncology, Scripps MD Anderson Cancer Center, San Diego, California, USA
| | - Sunandana Chandra
- Hematology Oncology Division, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Zeynep Eroglu
- Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Brian R Gastman
- Melanoma and High-Risk Skin Cancer Program, Cleveland Clinic Cancer Center, Cleveland, Ohio, USA
| | - Kari L Kendra
- Division Of Medical Oncology, The Ohio State University, Columbus, Ohio, USA
| | - Harriet Kluger
- Yale Cancer Center, Yale University, New Haven, Connecticut, USA
| | - Evan J Lipson
- Bloomberg Kimmel Institute for Cancer Immunotherapy, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Kathleen Madden
- Melanoma/Cutaneous Oncology Program, New York University Langone Perlmutter Cancer Center, New York, New York, USA
| | - David M Miller
- Department of Medicine and Department of Dermatology, Massachusetts General Cancer Center, Boston, Massachusetts, USA
| | - Paul Nghiem
- Division of Dermatology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Anna C Pavlick
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, New York, USA
| | - Igor Puzanov
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Guilherme Rabinowits
- Department of Hematology/Oncology, Miami Cancer Institute/Baptist Health South Florida, Miami, Florida, USA
| | - Emily S Ruiz
- Mohs and Dermatologic Surgery Center, Dana-Farber/Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Vernon K Sondak
- Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | | | - Michael T Tetzlaff
- Dermopathology Division, University of California San Francisco, San Francisco, California, USA
| | - Isaac Brownell
- Dermatology Branch, National Institutes of Health, Bethesda, Maryland, USA
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8
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García-Mesa Y, Feito J, Cuendias P, García-Piqueras J, Germanà A, García-Suárez O, Martín-Biedma B, Vega JA. The acquisition of mechanoreceptive competence by human digital Merkel cells and sensory corpuscles during development: an immunohistochemical study of PIEZO2. Ann Anat 2022; 243:151953. [PMID: 35523396 DOI: 10.1016/j.aanat.2022.151953] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/05/2022] [Accepted: 04/20/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND PIEZO2 is a transmembrane protein forming part of an ion channel required for mechanotransduction. In humans, PIEZO2 is present in axon terminals of adult Meissner and Pacinian corpuscles, as well as Merkel cells in Merkel cell-neurite complexes. METHODS To study the acquisition of functional capability for mechanotransduction of developing type I slowly adapting low-threshold mechanoreceptors, i.e., Merkel cell-neurite complexes, a battery of immunohistochemical and immunofluorescence techniques was performed on human skin specimens covering the whole development and growth, from 11 weeks of estimated gestational age to 20 years of life. In addition, developmental expression of PIEZO2 type I (Meissner's corpuscles) and type II (Pacinian corpuscles) rapidly adapting mechanoreceptors was studied in parallel. RESULTS The first evidence of Merkel cells showing the typical morphology and placement was at 13 weeks of estimated gestation age, and at this time positive immunoreactivity for PIEZO2 was achieved. PIEZO2 expression in axons terminals started at 23 WEGA in Pacinian corpuscles and at 36 WEGA in the case of Meissner corpuscles. The occurrence of PIEZO2 in Merkel cells, Meissner and Pacinian corpuscles was maintained for all the time investigated. Interestingly PIEZO2 was absent in most Aβ type I slowly adapting low-threshold mechanoreceptors that innervate MC while it was regularly present in most Aβ type I and type II rapidly adapting low-threshold mechanoreceptors that supplies Meissner and Pacinian corpuscles. CONCLUSION The present results provide evidence that human cutaneous mechanoreceptors could perform mechanotransduction already during embryonic development.
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Affiliation(s)
- Yolanda García-Mesa
- Departamento de Morfología y Biología Celular, Grupo SINPOS, Universidad de Oviedo, Oviedo, Spain
| | - Jorge Feito
- Departamento de Morfología y Biología Celular, Grupo SINPOS, Universidad de Oviedo, Oviedo, Spain; Servicio de Anatomía Patológica, Complejo Hospitalario Universitario de Salamanca, Salamanca, Spain
| | - Patricia Cuendias
- Departamento de Morfología y Biología Celular, Grupo SINPOS, Universidad de Oviedo, Oviedo, Spain
| | - Jorge García-Piqueras
- Departamento de Morfología y Biología Celular, Grupo SINPOS, Universidad de Oviedo, Oviedo, Spain
| | - Antonino Germanà
- Zebrafish Neuromorphology Lab, Department of Veterinary Sciences, University of Messina, Messina, Italy
| | - Olivia García-Suárez
- Departamento de Morfología y Biología Celular, Grupo SINPOS, Universidad de Oviedo, Oviedo, Spain
| | - Benjamín Martín-Biedma
- Departamento de Cirugía y Especialidades Médico-Quirúrgicas, Universidad de Santiago de Compostela, Spain
| | - José A Vega
- Departamento de Morfología y Biología Celular, Grupo SINPOS, Universidad de Oviedo, Oviedo, Spain; Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Santiago, Chile.
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9
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Subacute sensory neuronopathy associated with Merkel cell carcinoma with unknown primary: a case report with literature review. J Neurol 2022; 269:4080-4088. [DOI: 10.1007/s00415-022-11116-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 11/26/2022]
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10
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Rastrelli M, Del Fiore P, Russo I, Tartaglia J, Dal Monico A, Cappellesso R, Nicolè L, Piccin L, Fabozzi A, Biffoli B, Di Prata C, Ferrazzi B, Dall'Olmo L, Vecchiato A, Spina R, Russano F, Bezzon E, Cingarlini S, Mazzarotto R, Parisi A, Scarzello G, Pigozzo J, Brambullo T, Tropea S, Vindigni V, Bassetto F, Bertin D, Gregianin M, Dei Tos AP, Cavallin F, Alaibac M, Chiarion-Sileni V, Mocellin S. Merkel Cell Carcinoma: Evaluation of the Clinico-Pathological Characteristics, Treatment Strategies and Prognostic Factors in a Monocentric Retrospective Series (n=143). Front Oncol 2022; 11:737842. [PMID: 34976795 PMCID: PMC8718393 DOI: 10.3389/fonc.2021.737842] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 12/02/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Merkel cell carcinoma (MCC) is a rare neuroendocrine tumor of the skin. The incidence of the disease has undergone a significant increase in recent years, which is caused by an increase in the average age of the population and in the use of immunosuppressive therapies. MCC is an aggressive pathology, which metastasizes early to the lymph nodes. These characteristics impose an accurate diagnostic analysis of the regional lymph node district with radiography, clinical examination and sentinel node biopsy. In recent years, there has been a breakthrough in the treatment of the advanced pathology thanks to the introduction of monoclonal antibodies acting on the PD-1/PD-L1 axis. This study aimed to describe the clinico-pathological characteristics, treatment strategies and prognostic factors of MCC. METHODS A retrospective cohort study was conducted involving 143 consecutive patients who were diagnosed and/or treated for MCC. These patients were referred to the Veneto Institute of Oncology IOV-IRCCS and to the University Hospital of Padua (a third-level center) in the period between December 1991 and January 2020. In the majority of cases, diagnosis took place at the IOV. However, some patients were diagnosed elsewhere and subsequently referred to the IOV for a review of the diagnosis or to begin specific therapeutic regimens. RESULTS 143 patients, with an average age of 71 years, were affected mainly with autoimmune and neoplastic comorbidities. Our analysis has shown that age, autoimmune comorbidities and the use of therapy with immunomodulating drugs (which include corticosteroids, statins and beta-blockers) are associated with a negative prognosis. In this sense, male sex is also a negative prognostic factor. CONCLUSIONS Autoimmune and neoplastic comorbidities were frequent in the studied population. The use of drugs with immunomodulatory effects was also found to be a common feature of the population under examination. The use of this type of medication is considered a negative prognostic factor. The relevance of a multidisciplinary approach to the patient with MCC is confirmed, with the aim of assessing the risks and benefits related to the use of immunomodulating therapy in the individual patient.
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Affiliation(s)
- Marco Rastrelli
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology (IOV)-IRCCS, Padua, Italy.,Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padua, Padua, Italy
| | - Paolo Del Fiore
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology (IOV)-IRCCS, Padua, Italy
| | - Irene Russo
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology (IOV)-IRCCS, Padua, Italy.,Division of Dermatology, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Jacopo Tartaglia
- Division of Dermatology, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Alessandro Dal Monico
- Division of Dermatology, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Rocco Cappellesso
- Pathological Anatomy Unit, University Hospital of Padua, Padua, Italy
| | - Lorenzo Nicolè
- Department of Medicine, University of Padua School of Medicine and Surgery, Padua, Italy.,Unit of Surgical Pathology & Cytopathology, Ospedale dell'Angelo, Mestre, Italy
| | - Luisa Piccin
- Melanoma Oncology Unit, Veneto Institute of Oncology (IOV)-IRCCS, Padua, Italy
| | - Alessio Fabozzi
- Oncology Unit 3, Veneto Institute of Oncology (IOV)-IRCCS, Padua, Italy
| | - Bernardo Biffoli
- Clinic of Plastic Surgery, Department of Neuroscience, Padua University Hospital, University of Padua, Padua, Italy
| | - Claudia Di Prata
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology (IOV)-IRCCS, Padua, Italy
| | - Beatrice Ferrazzi
- Postgraduate School of Occupational Medicine, University of Verona, Verona, Italy
| | - Luigi Dall'Olmo
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology (IOV)-IRCCS, Padua, Italy.,Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padua, Padua, Italy
| | - Antonella Vecchiato
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology (IOV)-IRCCS, Padua, Italy
| | - Romina Spina
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology (IOV)-IRCCS, Padua, Italy
| | - Francesco Russano
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology (IOV)-IRCCS, Padua, Italy
| | - Elisabetta Bezzon
- Radiology Unit, Department of Imaging and Medical Physics, Istituto Oncologico Veneto (IOV) IRCSS, Padua, Italy
| | - Sara Cingarlini
- Oncology Section, Department of Oncology, Verona University and Hospital Trust, Verona, Italy
| | - Renzo Mazzarotto
- Department of Radiotherapy, Ospedale Civile Maggiore, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Alessandro Parisi
- Radiotherapy Unit, Veneto Institute of Oncology, Istituto Oncologico Veneto (IOV)-IRCCS, Padua, Italy
| | - Giovanni Scarzello
- Radiotherapy Unit, Veneto Institute of Oncology, Istituto Oncologico Veneto (IOV)-IRCCS, Padua, Italy
| | - Jacopo Pigozzo
- Melanoma Oncology Unit, Veneto Institute of Oncology (IOV)-IRCCS, Padua, Italy
| | - Tito Brambullo
- Clinic of Plastic Surgery, Department of Neuroscience, Padua University Hospital, University of Padua, Padua, Italy
| | - Saveria Tropea
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology (IOV)-IRCCS, Padua, Italy
| | - Vincenzo Vindigni
- Clinic of Plastic Surgery, Department of Neuroscience, Padua University Hospital, University of Padua, Padua, Italy
| | - Franco Bassetto
- Clinic of Plastic Surgery, Department of Neuroscience, Padua University Hospital, University of Padua, Padua, Italy
| | - Daniele Bertin
- Radiotherapy and Nuclear Medicine Unit, Oncological Institute of Veneto IOV-IRCCS, Padua, Italy
| | - Michele Gregianin
- Radiotherapy and Nuclear Medicine Unit, Oncological Institute of Veneto IOV-IRCCS, Padua, Italy
| | - Angelo Paolo Dei Tos
- Pathological Anatomy Unit, University Hospital of Padua, Padua, Italy.,Department of Medicine (DIMED), Surgical Pathology Unit, University of Padua, Padua, Italy
| | | | - Mauro Alaibac
- Division of Dermatology, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | | | - Simone Mocellin
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology (IOV)-IRCCS, Padua, Italy.,Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padua, Padua, Italy
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11
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Ahmed MM, Cushman CH, DeCaprio JA. Merkel Cell Polyomavirus: Oncogenesis in a Stable Genome. Viruses 2021; 14:v14010058. [PMID: 35062263 PMCID: PMC8781562 DOI: 10.3390/v14010058] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 12/28/2021] [Accepted: 12/29/2021] [Indexed: 12/14/2022] Open
Abstract
Merkel cell polyomavirus (MCV) is the causative agent for the majority of Merkel cell carcinoma (MCC) cases. Polyomavirus-associated MCC (MCCP) is characterized by the integration of MCV DNA into the tumor genome and a low tumor mutational burden. In contrast, nonviral MCC (MCCN) is characterized by a high tumor mutational burden induced by UV damage. Since the discovery of MCV, much work in the field has focused on understanding the molecular mechanisms of oncogenesis driven by the MCV tumor (T) antigens. Here, we review our current understanding of how the activities of large T (LT) and small T (ST) promote MCC oncogenesis in the absence of genomic instability. We highlight how both LT and ST inhibit tumor suppressors to evade growth suppression, an important cancer hallmark. We discuss ST interactions with cellular proteins, with an emphasis on those that contribute to sustaining proliferative signaling. Finally, we examine active areas of research into open questions in the field, including the origin of MCC and mechanisms of viral integration.
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Affiliation(s)
- Mona M. Ahmed
- Program in Virology, Graduate School of Arts and Sciences, Harvard University, Cambridge, MA 02138, USA; (M.M.A.); (C.H.C.)
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Camille H. Cushman
- Program in Virology, Graduate School of Arts and Sciences, Harvard University, Cambridge, MA 02138, USA; (M.M.A.); (C.H.C.)
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - James A. DeCaprio
- Program in Virology, Graduate School of Arts and Sciences, Harvard University, Cambridge, MA 02138, USA; (M.M.A.); (C.H.C.)
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Correspondence:
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12
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Merkel Cell Carcinoma: From Pathobiology to Clinical Management. BIOLOGY 2021; 10:biology10121293. [PMID: 34943208 PMCID: PMC8698953 DOI: 10.3390/biology10121293] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/24/2021] [Accepted: 12/01/2021] [Indexed: 12/12/2022]
Abstract
Simple Summary Merkel cell carcinoma (MCC) is an uncommon type of skin cancer that carries a poor prognosis. It is seen predominantly in old age in sun-exposed body parts. Racial and geographical differences are seen in its occurrence. Viral infection and radiation exposure are the two leading factors implicated in its causation. Small, firm to hard nodule (usually in sun-exposed areas), red with a history of a rapid increase in size is a common personation of the disease. Other body parts such as upper limbs, trunk, and even lower limbs may be also involved. The disease is diagnosed by taking a tissue sample (biopsy) for examination, and other radiological investigations are needed to reach a proper diagnosis with the staging of the disease. There are various treatment options including surgery, radiotherapy, and chemotherapy. Surgery is the primary treatment option though some patients may not be the candidates for operation where other treatment options come into play. Abstract Merkel cell carcinoma (MCC) is an infrequent, rapidly growing skin neoplasm that carries a greater probability of regional lymph node involvement, and a grim prognosis in advanced cases. While it is seen predominantly in old age in sun-exposed body parts, the prevalence varies among different races and geographical regions. Merkel cell polyomavirus and UV radiation-induced mutations contribute to its etiopathogenesis. The clinical presentation of MCC lacks pathognomonic features and is rarely considered highly at the time of presentation. Histopathological examination frequently reveals hyperchromatic nuclei with high mitotic activity, but immunohistochemistry is required to confirm the diagnosis. Sentinel lymph node biopsy (SLNB) and imaging are advised for effective staging of the disease. Multimodal management including surgery, radiation therapy, and/or immunotherapy are deployed. Traditional cytotoxic chemotherapies may result in an initial response, but do not result in a significant survival benefit. Checkpoint inhibitors have dramatically improved the prognosis of patients with metastatic MCC, and are recommended first-line in advanced cases. There is a need for well-tolerated agents with good safety profiles in patients who have failed immunotherapies.
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13
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Nakamura M, Morita A. Immune activity in Merkel cell carcinoma. J Dermatol 2021; 49:68-74. [PMID: 34766373 PMCID: PMC9299685 DOI: 10.1111/1346-8138.16232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/24/2021] [Accepted: 11/02/2021] [Indexed: 12/11/2022]
Abstract
Merkel cell carcinoma (MCC) is widely known as a highly malignant skin cancer. The pathogenesis of MCC, however, remains mysterious due to the extremely small number of cases and its prevalence in the elderly. Despite its high‐grade malignancy, spontaneous regression occurs with some frequency. The immune activity of the tumor underlies this peculiar behavior. In recent years, immune checkpoint blockade therapies, including the anti‐programmed death ligand 1 antibody, have provided successful results. These therapies, however, are ineffective in approximately half the patients with advanced MCC and few treatments are available for those patients. In this review, we summarize the increasing body of evidence relating to the immune activity of MCC and immunological biomarkers. The interesting and sometimes peculiar behavior of MCC, such as their spontaneous regression, is largely due to their high immunosensitivity. Understanding the tumor immunokinetics of MCC should provide critical insight for understanding cancer immunotherapy. Here, we introduce a new classification for MCC according to its immune activity. Combined application of programmed death ligand 1 (a prognostic factor and predictor of the efficacy of immune checkpoint inhibitors in various cancers) with glucose‐6‐phosphate dehydrogenase (a new promising biomarker for MCC) may enable classification of MCC based on its immune status. Whether the new classification can be used to predict the efficacy of immune checkpoint blockade therapies remains to be evaluated in future studies, but the classification may facilitate future treatment selection.
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Affiliation(s)
- Motoki Nakamura
- 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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14
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García-Mesa Y, Feito J, González-Gay M, Martínez I, García-Piqueras J, Martín-Cruces J, Viña E, Cobo T, García-Suárez O. Involvement of Cutaneous Sensory Corpuscles in Non-Painful and Painful Diabetic Neuropathy. J Clin Med 2021; 10:jcm10194609. [PMID: 34640627 PMCID: PMC8509589 DOI: 10.3390/jcm10194609] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/02/2021] [Accepted: 10/05/2021] [Indexed: 12/18/2022] Open
Abstract
Distal diabetic sensorimotor polyneuropathy (DDSP) is the most prevalent form of diabetic neuropathy, and some of the patients develop gradual pain. Specialized sensory structures present in the skin encode different modalities of somatosensitivity such as temperature, touch, and pain. The cutaneous sensory structures responsible for the qualities of mechanosensitivity (fine touch, vibration) are collectively known as cutaneous mechanoreceptors (Meissner corpuscles, Pacinian corpuscles, and Merkel cell-axonal complexes), which results are altered during diabetes. Here, we used immunohistochemistry to analyze the density, localization within the dermis, arrangement of corpuscular components (axons and Schwann-like cells), and expression of putative mechanoproteins (PIEZO2, ASIC2, and TRPV4) in cutaneous mechanoreceptors of subjects suffering clinically diagnosed non-painful and painful distal diabetic sensorimotor polyneuropathy. The number of Meissner corpuscles, Pacinian corpuscles, and Merkel cells was found to be severely decreased in the non-painful presentation of the disease, and almost disappeared in the painful presentation. Furthermore, there was a marked reduction in the expression of axonal and Schwann-like cell markers (with are characteristics of corpuscular denervation) as well as of all investigated mechanoproteins in the non-painful distal diabetic sensorimotor polyneuropathy, and these were absent in the painful form. Taken together, these alterations might explain, at least partly, the impairment of mechanosensitivity system associated with distal diabetic sensorimotor polyneuropathy. Furthermore, our results support that an increasing severity of DDSP may increase the risk of developing painful neuropathic symptoms. However, why the absence of cutaneous mechanoreceptors is associated with pain remains to be elucidated.
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Affiliation(s)
- Yolanda García-Mesa
- Grupo SINPOS, Departamento de Morfología y Biología Celular, Universidad de Oviedo, 33006 Oviedo, Spain; (Y.G.-M.); (J.F.); (J.G.-P.); (J.M.-C.); (E.V.)
| | - Jorge Feito
- Grupo SINPOS, Departamento de Morfología y Biología Celular, Universidad de Oviedo, 33006 Oviedo, Spain; (Y.G.-M.); (J.F.); (J.G.-P.); (J.M.-C.); (E.V.)
- Servicio de Anatomía Patológica, Complejo Asistencial Universitario de Salamanca, 37007 Salamanca, Spain
| | - Mario González-Gay
- Sercivio de Angiología y Cirugía Vascular, Fundación Hospital de Jove, 33290 Gijón, Spain;
| | - Irene Martínez
- Sercivio de Cirugía Plástica y Reparadora, Fundación Hospital de Jove, 33290 Gijón, Spain;
| | - Jorge García-Piqueras
- Grupo SINPOS, Departamento de Morfología y Biología Celular, Universidad de Oviedo, 33006 Oviedo, Spain; (Y.G.-M.); (J.F.); (J.G.-P.); (J.M.-C.); (E.V.)
| | - José Martín-Cruces
- Grupo SINPOS, Departamento de Morfología y Biología Celular, Universidad de Oviedo, 33006 Oviedo, Spain; (Y.G.-M.); (J.F.); (J.G.-P.); (J.M.-C.); (E.V.)
| | - Eliseo Viña
- Grupo SINPOS, Departamento de Morfología y Biología Celular, Universidad de Oviedo, 33006 Oviedo, Spain; (Y.G.-M.); (J.F.); (J.G.-P.); (J.M.-C.); (E.V.)
- Servicio de Cardiología, Unidad de Hemodinámica y Cardiología Intervencionista, Hospital de Cabueñes, 33206 Gijón, Spain
| | - Teresa Cobo
- Departamento de Cirugía y Especialidades Médico-Quirúrgicas, Universidad de Oviedo, 33006 Oviedo, Spain;
| | - Olivia García-Suárez
- Grupo SINPOS, Departamento de Morfología y Biología Celular, Universidad de Oviedo, 33006 Oviedo, Spain; (Y.G.-M.); (J.F.); (J.G.-P.); (J.M.-C.); (E.V.)
- Correspondence:
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15
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Sakata Y, Inaba Y, Kunimoto K, Kaminaka C, Yamamoto Y, Iwahashi Y, Murata SI, Asamura S, Jinnin M. The clinical significance of cytokeratin 20 staining pattern in Merkel cell carcinoma. Drug Discov Ther 2021; 15:162-165. [PMID: 34234066 DOI: 10.5582/ddt.2021.01043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In the present study, to identify the clinical significance of the cytokeratin (CK) 20 staining pattern in Merkel cell carcinoma (MCC), we retrospectively analyzed the major clinicopathological and immunohistochemical characteristics of 12 cases of MCC. Typical dot-like pattern was seen in eight of our patients, while four patients showed peripheral staining pattern. Interestingly, all cases of MCC with dot-like CK20 tumor cells occurred in the head and neck region, while those with peripheral CK20 pattern tended to be located in other lesions (forearm, knee, or buttock): The difference of frequency in the head and neck regions was statistically significant. Dot-like CK20 staining pattern may therefore be resulted from ultraviolet exposure. Additionally, although without significance, metastasis was more frequent in those with dot-like CK20 than in peripheral CK20 staining: All patients with peripheral CK20 pattern had complete remission by surgical excision with or without radiation therapy. CK20 staining pattern may be a novel predictor of prognosis.
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Affiliation(s)
- Yasuhiro Sakata
- Department of Plastic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Yutaka Inaba
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
| | - Kayo Kunimoto
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
| | - Chikako Kaminaka
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
| | - Yuki Yamamoto
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
| | - Yoshifumi Iwahashi
- Department of Diagnostic Pathology, Wakayama Medical University, Wakayama, Japan
| | - Shin-Ichi Murata
- Department of Diagnostic Pathology, Wakayama Medical University, Wakayama, Japan
| | - Shinichi Asamura
- Department of Plastic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Masatoshi Jinnin
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
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Dellambra E, Carbone ML, Ricci F, Ricci F, Di Pietro FR, Moretta G, Verkoskaia S, Feudi E, Failla CM, Abeni D, Fania L. Merkel Cell Carcinoma. Biomedicines 2021; 9:718. [PMID: 34201709 PMCID: PMC8301416 DOI: 10.3390/biomedicines9070718] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/10/2021] [Accepted: 06/21/2021] [Indexed: 12/20/2022] Open
Abstract
Merkel cell carcinoma (MCC) is a rare and extremely aggressive neuroendocrine carcinoma of the skin, with increasing incidence worldwide. This review intends to propose a comprehensive evaluation of MCC epidemiology, clinical features, pathogenetic mechanisms, diagnosis, and therapies. A section is dedicated to immunological aspects and another to the involvement of angiogenesis and angiogenic growth factors in MCC progression, proposing novel diagnostic and therapeutic approaches. Advanced MCC tumors have been treated with immune checkpoint inhibitors with effective results. Therefore, the state of art of this immunotherapy is also examined, reporting on the most recent clinical trials in the field. We conclude by underlining the achievements in the understanding of MCC pathology and indicating the present needs for effective diagnosis and therapeutic management of the disease.
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Affiliation(s)
- Elena Dellambra
- Molecular and Cell Biology Laboratory, IDI-IRCCS, 00167 Rome, Italy;
| | - Maria Luigia Carbone
- Experimental Immunology Laboratory, IDI-IRCCS, 00167 Rome, Italy; (E.F.); (C.M.F.)
| | | | - Francesco Ricci
- Dermatology Department, IDI-IRCCS, 00167 Rome, Italy; (F.R.); (G.M.); (L.F.)
| | | | - Gaia Moretta
- Dermatology Department, IDI-IRCCS, 00167 Rome, Italy; (F.R.); (G.M.); (L.F.)
| | - Sofia Verkoskaia
- Oncology Department, IDI-IRCCS, 00167 Rome, Italy; (F.R.D.P.); (S.V.)
| | - Elisa Feudi
- Experimental Immunology Laboratory, IDI-IRCCS, 00167 Rome, Italy; (E.F.); (C.M.F.)
| | - Cristina M. Failla
- Experimental Immunology Laboratory, IDI-IRCCS, 00167 Rome, Italy; (E.F.); (C.M.F.)
| | - Damiano Abeni
- Clinical Epidemiology Unit, IDI-IRCCS, 00167 Rome, Italy;
| | - Luca Fania
- Dermatology Department, IDI-IRCCS, 00167 Rome, Italy; (F.R.); (G.M.); (L.F.)
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La Rosa S, Bonzini M, Sciarra A, Asioli S, Maragliano R, Arrigo M, Foschini MP, Righi A, Maletta F, Motolese A, Papotti M, Sessa F, Uccella S. Exploring the Prognostic Role of Ki67 Proliferative Index in Merkel Cell Carcinoma of the Skin: Clinico-Pathologic Analysis of 84 Cases and Review of the Literature. Endocr Pathol 2020; 31:392-400. [PMID: 32696301 PMCID: PMC7666272 DOI: 10.1007/s12022-020-09640-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/10/2020] [Indexed: 12/20/2022]
Abstract
The exact prediction of outcome of patients with Merkel cell carcinoma (MCC) of the skin is difficult to determine, although several attempts have been made to identify clinico-pathologic prognostic factors. The Ki67 proliferative index is a well-known marker routinely used to define the prognosis of patients with neuroendocrine neoplasms. However, its prognostic value has been poorly investigated in MCC, and available published results are often contradictory mainly because restricted to small series in the absence of standardized methods for Ki67 evaluation. For this reason, we explored the potential prognostic role of Ki67 proliferative index in a large series of MCCs using the WHO standardized method of counting positive cells in at least 500 tumor cells in hot spot areas on camera-captured printed images. In addition, since MCC may be considered as the cutaneous counterpart of digestive neuroendocrine carcinomas (NECs), we decided to stratify MCCs using the available and efficient Ki67 threshold of 55%, which was found prognostic in digestive NECs. This choice was also supported by the Youden index analysis. In addition, we analyzed the prognostic value of other clinico-pathologic parameters using both univariate and multivariate analysis. Ki67 index appeared significantly associated with prognosis at univariate analysis together with stage IV, lack of MCPyV, and p63 expression, but not at the multivariate analysis, where survival resulted independently influenced by p63 expression and tumor stage, only.
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Affiliation(s)
- Stefano La Rosa
- Institute of Pathology, University Hospital and University of Lausanne, Lausanne, Switzerland.
- Institut Universitaire de Pathologie, CHUV, 25 rue du Bugnon, CH-1011, Lausanne, Switzerland.
| | - Matteo Bonzini
- Department of Clinical Sciences and Community Health, University of Milan and IRCCS Policlinico Maggiore Hospital Foundation, Milan, Italy
| | - Amedeo Sciarra
- Division of Pathology, University of Milan and IRCCS Policlinico Maggiore Hospital Foundation, Milan, Italy. Current affiliation: Department of Histopathology, Central Institute, Valais Hospital, Sion, Switzerland
| | - Sofia Asioli
- Unit of Pathology, Bellaria Hospital and Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Roberta Maragliano
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | | | - Maria Pia Foschini
- Unit of Pathology, Bellaria Hospital and Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Alberto Righi
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Francesca Maletta
- Department of Oncology, City of Health and Science, University of Turin, Torino, Italy
| | | | - Mauro Papotti
- Department of Oncology, City of Health and Science, University of Turin, Torino, Italy
| | - Fausto Sessa
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Silvia Uccella
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
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18
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19
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Hoang MP, Donizy P, Wu CL, Kopczynski J, Pieniazek M, Miller DM, Ryś J. TdT Expression Is a Marker of Better Survival in Merkel Cell Carcinoma, and Expression of B-Cell Markers Is Associated With Merkel Cell Polyomavirus. Am J Clin Pathol 2020; 154:38-47. [PMID: 32134459 DOI: 10.1093/ajcp/aqaa017] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Merkel cell carcinoma is a rare but very aggressive cutaneous tumor. We evaluated the prognostic potential of B-cell markers (terminal deoxynucleotidyl transferase [TdT], PAX5, CD117), follicular stem cell markers (CK15, CK19), p63, p53, RB, and Merkel cell polyomavirus (MCPyV; CM2B4) in 136 primary cutaneous Merkel cell carcinomas. METHODS Clinical, histopathologic, and immunohistochemical analyses were performed. The results were correlated with patient outcomes by Fisher exact test, log-rank tests, and Cox multivariate models. RESULTS By Fisher exact test, although TdT significantly correlated with both lack of progression (P = .0087) and alive status (P = .0056), MCPyV status correlated only with alive status (P = .031). In univariate analyses, TdT, MCPyV, and RB significantly correlated with improved overall survival, whereas p63 and CK15 correlated with worse overall survival. However, in multivariate analyses, only TdT expression remained as an independent predictor of improved overall survival, Merkel cell carcinoma-specific survival, and progression-free survival. By linear regression analyses, significant correlations between MCPyV vs TdT, PAX5, and CD117 were observed. CONCLUSIONS TdT expression is a potential marker of better survival in Merkel cell carcinoma. Expression of B-cell markers is associated with MCPyV, suggesting that clonal viral integration might play a role in the expression of these markers.
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Affiliation(s)
- Mai P Hoang
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Piotr Donizy
- Department of Pathomorphology and Oncological Cytology, Wroclaw Medical University, Wroclaw, Poland
| | - Cheng-Lin Wu
- Department of Pathology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Janusz Kopczynski
- Department of Surgical Pathology, Holy Cross Cancer Center, Kielce, Poland
| | - Malgorzata Pieniazek
- Department of Clinical Oncology, Tadeusz Koszarowski Regional Oncology Center, Opole, Poland
| | - David M Miller
- Departments of Dermatology and Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Janusz Ryś
- Department of Pathology, Center of Oncology, M. Sklodowska-Curie Memorial Institute, Krakow, Poland
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Naseri S, Steiniche T, Bæhr Georgsen J, Thomsen R, Ladekarl M, Heje M, Engberg Damsgaard T, Bønnelykke-Behrndtz ML. Tumor Ulceration, Reduced Infiltration of CD8-Lymphocytes, High Neutrophil-to-CD8-Lymphocyte Ratio and Absence of MC Virus are Negative Prognostic Markers for Patients with Merkel Cell Carcinoma. Cancers (Basel) 2020; 12:cancers12040888. [PMID: 32268526 PMCID: PMC7226107 DOI: 10.3390/cancers12040888] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/02/2020] [Accepted: 04/04/2020] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Merkel cell carcinoma (MCC) is caused by the Merkel cell polyomavirus and UV radiation. Understanding of the underlying biology is limited, but identification of prognostic markers may lead to better prognostic stratification for the patients. (2) Methods: Ninety patients diagnosed with MCC (1996–2012) were included. Virus status was estimated by polymerase chain reaction (qPCR) and immunohistochemistry (IHC). Ulceration status, PD-L1, cd66b neutrophils, cd8 lymphocytes and biomarkers of vascularization (cd34 endothelial cells) and migration (e-cadherin) were estimated by IHC and analyzed with digital pathology. (3) Results: Virus was present in 47% of patient samples and correlated with lower E-cadherin expression (p = 0.0005), lower neutrophil-to-CD8 lymphocyte ratio (N:CD8 ratio) (p = 0.02) and increased PD-L1 expression (p = 0.03). Ulceration was associated with absence of virus (p = 0.03), increased neutrophil infiltration (p < 0.0001) and reduced CD8 lymphocyte infiltration (p = 0.04). In multivariate analysis, presence of virus (p = 0.01), ulceration (p = 0.05) and increased CD8 lymphocyte infiltration (p = 0.001) showed independent prognostic impacts on MCC-specific survival. (3) Conclusions: In this study, we found that a high N:CD8 ratio, ulceration, virus-negative status and absence of CD8 lymphocytes are negative prognostic markers. Accurate prognostic stratification of the patients may be important in the clinical setting for determination of adjuvant treatment.
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Affiliation(s)
- Simon Naseri
- Department of Plastic Surgery, Aalborg University Hospital, 9000 Aalborg, Denmark
- Correspondence:
| | - Torben Steiniche
- Department of Pathology, Aarhus University Hospital, 8200 Aarhus, Denmark; (T.S.); (J.B.G.)
| | - Jeanette Bæhr Georgsen
- Department of Pathology, Aarhus University Hospital, 8200 Aarhus, Denmark; (T.S.); (J.B.G.)
| | - Rune Thomsen
- Department of Biomedicine, Aarhus University, 8200 Aarhus, Denmark;
| | - Morten Ladekarl
- Department of Oncology, Clinical Cancer Research Center, Aalborg University Hospital, 9000 Aalborg, Denmark;
| | - Martin Heje
- Department of Plastic Surgery, Vejle Hospital, 7100 Vejle, Denmark;
| | - Tine Engberg Damsgaard
- Department of Plastic Surgery and Burns Treatment, Rigshospitalet, 2100 Copenhagen, Denmark;
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Danger is only skin deep: aggressive epidermal carcinomas. An overview of the diagnosis, demographics, molecular-genetics, staging, prognostic biomarkers, and therapeutic advances in Merkel cell carcinoma. Mod Pathol 2020; 33:42-55. [PMID: 31676786 DOI: 10.1038/s41379-019-0394-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/27/2019] [Accepted: 10/14/2019] [Indexed: 12/19/2022]
Abstract
Merkel cell carcinoma (MCC) is a high grade primary cutaneous neuroendocrine carcinoma and is among the most aggressive cutaneous malignancies. The rising incidence of MCC, together with its often rapidly aggressive course, underscore a critical need to recognize the histopathologic and the immunohistochemical features that inform its accurate diagnosis. In the current review, we summarize the current state of knowledge regarding the accurate diagnosis of MCC and the exclusion of other entities in the differential diagnosis. We provide a comprehensive review of genomic studies that identified the molecular-genetic drivers of MCC as well as a summary of studies identifying prognostic biomarkers that can facilitate risk stratification. Importantly, Merkel cell polyomavirus (MCPyV) appears to be causative in most cases of MCC and represents both a diagnostic and prognostic marker. Finally, as staging of MCC has undergone critical refinements with the introduction of the 8th Edition of the American Joint Committee on Cancer staging system, we provide an update on MCC staging. In particular, the prognostic significance of the sentinel lymph node (SLN) in MCC necessitates a systematic approach to its evaluation and diagnosis to ensure accurate and consistent risk stratification for patients, and we therefore provide a comprehensive overview of SLN evaluation in MCC. Finally, the intimate relationship between MCC and the integrity of the host immune system has led to paradigm-shifting therapeutic advances with the successful application of immune checkpoint blockade to treat patients with advanced disease, and we therefore summarize those studies and the correlative studies in which predictive biomarkers have been identified.
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22
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Primary Ovarian High-grade Neuroendocrine Carcinoma With Merkel Cell–like Immunophenotype Arising in a Teratoma. Int J Gynecol Pathol 2019; 39:478-484. [DOI: 10.1097/pgp.0000000000000641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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24
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Cells to Surgery Quiz: August 2019. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.06.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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25
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Lucandri G, Mazzocchi P, Bascone B, Giordano M, Castaldi M, Lazzarini A, Carotenuto F. Unusual Ulcerated Merkel Cell Carcinoma of the Skin: Report of a Case. TUMORI JOURNAL 2019; 92:555-8. [PMID: 17260502 DOI: 10.1177/030089160609200618] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Merkel cell carcinoma is an aggressive skin cancer, usually related to a severe prognosis. Treatment consists of wide surgical excision, adjuvant radiotherapy and/or polychemotherapy, but local-regional and distant relapses are common. Detection of histopathological and biological factors may select subgroups of patients suitable for different treatments. Herein we report the case of a patient treated for a wide bleeding and ulcerated Merkel cell carcinoma. Ulceration represents an uncommon feature because the tumor usually spreads from the dermis into subcutaneous fat, so it may be added to poor prognostic indicators. After surgical excision and postoperative radiotherapy, the patient recurred at regional nodes. Axillary lymphadenectomy was followed by courses of polychemotherapy. We obtained a satisfactory survival (31 months) by timing these different therapeutic possibilities.
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Affiliation(s)
- Giorgio Lucandri
- 3rd Department of Surgery, Hospital S. Giovanni, Addolorata, Rome, Italy.
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26
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Merkel cell carcinoma of the eyelid: A review. Surv Ophthalmol 2019; 64:659-667. [PMID: 30871952 DOI: 10.1016/j.survophthal.2019.03.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 02/28/2019] [Accepted: 03/04/2019] [Indexed: 12/16/2022]
Abstract
Merkel cell carcinoma (MCC) is a rare, aggressive tumor of both epithelial and neuroendocrine origin, which carries a mortality rate of up to 40%. MCC tumors typically present as painless, expanding nodules on the sun-exposed skin areas of older, white patients. Eyelid and periocular tumors comprise approximately 2.5% of all cases of MCC and may be mistaken for chalazia or basal cell carcinomas. Immunosuppression is a significant risk factor, particularly in solid-organ-transplant recipients, patients with chronic lymphocytic leukemia, and patients with HIV. Sentinel lymph node biopsy is often used for accurate staging of head and neck MCC. Treatment includes wide local excision, commonly with the addition of radiotherapy for improved locoregional disease control. Historically, adjuvant chemotherapy had been reserved for metastatic disease, but immunotherapy and targeted chemotherapies are currently being investigated for use in primary disease. The clinical characteristics of all available published cases of eyelid MCC are summarized in this article.
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27
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Nagase K, Kimura-Kaku H, Inoue T, Shinogi T, Narisawa Y. Usefulness of ulceration and hyperkeratosis as clinical predictors of Merkel cell polyomavirus-negative and combined Merkel cell carcinoma: A retrospective study. J Dermatol 2018; 46:103-109. [DOI: 10.1111/1346-8138.14743] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 11/13/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Kotaro Nagase
- Division of Dermatology; Department of Internal Medicine; Faculty of Medicine; Saga University; Saga Japan
| | - Hiromi Kimura-Kaku
- Division of Dermatology; Department of Internal Medicine; Faculty of Medicine; Saga University; Saga Japan
| | - Takuya Inoue
- Division of Dermatology; Department of Internal Medicine; Faculty of Medicine; Saga University; Saga Japan
| | - Taro Shinogi
- Division of Dermatology; Department of Internal Medicine; Faculty of Medicine; Saga University; Saga Japan
| | - Yutaka Narisawa
- Division of Dermatology; Department of Internal Medicine; Faculty of Medicine; Saga University; Saga Japan
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28
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Stanoszek LM, Chan MP, Palanisamy N, Carskadon S, Siddiqui J, Patel RM, Harms KL, Lowe L, Fullen DR, Harms PW. Neurofilament is superior to cytokeratin 20 in supporting cutaneous origin for neuroendocrine carcinoma. Histopathology 2018; 74:504-513. [PMID: 30239030 DOI: 10.1111/his.13758] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 09/17/2018] [Indexed: 11/28/2022]
Abstract
AIM Primary cutaneous neuroendocrine carcinoma, or Merkel cell carcinoma (MCC), cannot be distinguished morphologically from small-cell neuroendocrine carcinomas (SmCC) from other sites. Immunohistochemistry is required to confirm cutaneous origin, and is also used for detection of sentinel lymph node (SLN) metastases of MCC. Cytokeratin 20 (CK20) expression is commonly used for these purposes, but is negative in some MCC cases, and has unclear specificity. We evaluated immunohistochemistry for neurofilament and CK20 in MCC compared with SmCC from other sites. METHODS AND RESULTS We evaluated neurofilament expression in 55 MCC specimens from 39 unique patients, including nine CK20-negative MCC tumours. Neurofilament expression was observed in 42 of 55 (76.4%) MCC cases, including seven of nine (77.8%) CK20-negative MCC cases. Neurofilament was expressed in nine of 12 (75%) Merkel cell polyomavirus-positive tumours and five of 10 (50%) virus-negative tumours. Compared to a standard immunohistochemical panel (cytokeratin cocktail and CK20), neurofilament was 87.5% sensitive for detecting SLN metastases. Neurofilament and CK20 expression was also assessed in 61 extracutaneous SmCC from 60 unique patients, with primary sites including lung (27), bladder (18), cervix (3), gastrointestinal tract (3), sinonasal tract (2) and other sites (7). The specificity of neurofilament and CK20 for MCC versus non-cutaneous SmCC was 96.7% and 59.0%, respectively. CONCLUSIONS Neurofilament has superior specificity to CK20 in distinguishing MCC from non-cutaneous SmCC. Neurofilament is frequently expressed in CK20- and virus-negative MCC tumours. Limitations of neurofilament immunohistochemistry include lower sensitivity than CK20 and subtle staining in some tumours. However, our findings indicate that neurofilament is useful for excluding non-cutaneous SmCC.
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Affiliation(s)
- Lauren M Stanoszek
- Department of Pathology, Michigan Medicine/University of Michigan Health System, Ann Arbor, MI, USA
| | - May P Chan
- Department of Pathology, Michigan Medicine/University of Michigan Health System, Ann Arbor, MI, USA.,Department ofDermatology, Michigan Medicine/University of Michigan Health System, Ann Arbor, MI, USA
| | - Nallasivam Palanisamy
- Department of Urology, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Shannon Carskadon
- Department of Urology, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Javed Siddiqui
- Department of Pathology, Michigan Medicine/University of Michigan Health System, Ann Arbor, MI, USA
| | - Rajiv M Patel
- Department of Pathology, Michigan Medicine/University of Michigan Health System, Ann Arbor, MI, USA.,Department ofDermatology, Michigan Medicine/University of Michigan Health System, Ann Arbor, MI, USA
| | - Kelly L Harms
- Department ofDermatology, Michigan Medicine/University of Michigan Health System, Ann Arbor, MI, USA
| | - Lori Lowe
- Department of Pathology, Michigan Medicine/University of Michigan Health System, Ann Arbor, MI, USA.,Department ofDermatology, Michigan Medicine/University of Michigan Health System, Ann Arbor, MI, USA
| | - Douglas R Fullen
- Department of Pathology, Michigan Medicine/University of Michigan Health System, Ann Arbor, MI, USA.,Department ofDermatology, Michigan Medicine/University of Michigan Health System, Ann Arbor, MI, USA
| | - Paul W Harms
- Department of Pathology, Michigan Medicine/University of Michigan Health System, Ann Arbor, MI, USA.,Department ofDermatology, Michigan Medicine/University of Michigan Health System, Ann Arbor, MI, USA
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29
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Unusual Neuroendocrine Differentiation in a Small Round Cell Angiosarcoma: A Potential Histologic Mimicker of Superficial Ewing Sarcoma. Am J Dermatopathol 2018. [PMID: 29533277 DOI: 10.1097/dad.0000000000001130] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Neuroendocrine differentiation or aberrant expression of neuroendocrine markers is very uncommon in angiosarcomas (AS) and creates a challenging differential diagnosis with other superficial or soft tissue tumors. Herein, we report a new case of superficial AS presenting as a tumor lesion on the little finger of the right hand of a 52-year-old man. The tumor displayed CD56, chromogranin-A, and synaptophysin immunoreactivity. Tumor cells were positive for vascular markers (CD31, FLI1, ERG, D2-40, VE-cadherin, VEGR1,2, and 3), CD99, and EMA, but were negative for S100, CK (AE1/AE3), CK20, polyomavirus, and myogenic (desmin and myogenin) and melanocyte markers (melan-A and HMB45). Ki67 immunostains indicated high proliferative activity (>50%). The whole-body computed tomography did not reveal distant disease. The initial assessment considered several tumor subtypes as possible histological diagnoses, including Ewing sarcoma, Ewing-like sarcoma, Merkel cell carcinoma, and undifferentiated "small round cell sarcoma". Fluorescence in situ hybridization analysis was negative for EWSR1 translocation and molecular analysis failed to detect any EWSR1, CIC, SYT or BCOR rearrangement. As a follow-up investigation, we tested 17 cutaneous/superficial AS for neuroendocrine markers; however, only one of these showed focal CD56 and synaptophysin expression. In conclusion, the present findings indicate that neuroendocrine differentiation is a very infrequent feature in AS. We report an AS of the finger with an uncommon histological appearance and immunohistochemical profile: predominant round cell tumor proliferation and neuroendocrine differentiation. Pathologists should be aware of these potential histological and immunohistochemical pitfalls in AS.
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30
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Louati S, Senhaji N, Chbani L, Bennis S. EWSR1 Rearrangement and CD99 Expression as Diagnostic Biomarkers for Ewing/PNET Sarcomas in a Moroccan Population. DISEASE MARKERS 2018; 2018:7971019. [PMID: 30319719 PMCID: PMC6167566 DOI: 10.1155/2018/7971019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 08/16/2018] [Accepted: 08/18/2018] [Indexed: 11/23/2022]
Abstract
Ewing sarcoma/primitive neuroectodermal tumor (Ewing/PNET sarcomas or EPS) are a group of round cell tumors. Malignant round cell tumors form a large and diverse group that includes rhabdomyosarcoma, synovial sarcoma, non-Hodgkin's lymphoma, neuroblastoma, hepatoblastoma, Wilm's tumor, desmoplastic small round cell tumor, and other morphologically similar entities. Differential diagnosis of Ewing sarcoma/primitive neuroectodermal tumor (Ewing/PNET sarcomas or EPS) is difficult. In addition to morphology and immunohistochemistry (IHC), differential diagnosis of these tumors is based on molecular analysis of the EWSR1 gene rearrangement using fluorescent in situ hybridization (FISH) technique. We investigated the diagnostic value of combined CD99 immunostaining and EWSR1 t(22q12) alteration using a dual-color, break-apart rearrangement probe in forty-one formalin-fixed paraffin-embedded (FFPE) tissue samples from pediatric and adult patients diagnosed with EPS. IHC was performed in all cases using the CD99 antibody and showed a positivity of 92.7% in the enrolled cases (38/41) followed by FISH analysis where 48.8% of the cases (20/41) were rearranged. Sensitivity and specificity for IHC assays were 88% and 58%, respectively. Notably, FISH had a sensitivity of 100% and a specificity of 87%. In addition, CD99 positivity was found to correlate with EWSR1 rearrangement (p < 0.05). This report shows that FISH has better sensitivity and specificity than IHC in the Moroccan population, and supports its combination with CD99 immunostaining as diagnostic biomarkers for this rare malignant entity."
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Affiliation(s)
- Sara Louati
- Bioactive Molecules, Structure and Functions Laboratory, Faculty of Sciences and Techniques, Sidi Mohamed ben Abdellah University of Fez, Morocco
- Pathological Anatomy and Molecular Pathology Department, Hassan II University Hospital of Fez, Morocco
| | - Nadia Senhaji
- Bioactive Molecules, Structure and Functions Laboratory, Faculty of Sciences and Techniques, Sidi Mohamed ben Abdellah University of Fez, Morocco
| | - Laila Chbani
- Pathological Anatomy and Molecular Pathology Department, Hassan II University Hospital of Fez, Morocco
- Biomedical and Translational Research Laboratory, Faculty of Medicine and Pharmacy, Sidi Mohamed ben Abdellah University of Fez, Morocco
| | - Sanae Bennis
- Pathological Anatomy and Molecular Pathology Department, Hassan II University Hospital of Fez, Morocco
- Biomedical and Translational Research Laboratory, Faculty of Medicine and Pharmacy, Sidi Mohamed ben Abdellah University of Fez, Morocco
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31
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A 21-year course of Merkel cell carcinoma with adjuvant Viscum album extract treatment: A case report. Complement Ther Med 2018; 38:58-60. [DOI: 10.1016/j.ctim.2018.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 04/04/2018] [Accepted: 04/04/2018] [Indexed: 12/26/2022] Open
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32
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Tarabadkar ES, Thomas H, Blom A, Parvathaneni U, Olencki T, Nghiem P, Bhatia S. Clinical Benefit from Tyrosine Kinase Inhibitors in Metastatic Merkel Cell Carcinoma: A Case Series of 5 Patients. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:505-511. [PMID: 29706615 PMCID: PMC5952731 DOI: 10.12659/ajcr.908649] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Case series Patients: Male, 58 • Male, 65 • Male, 75 • Male, 61 • Male, 69 Final Diagnosis: Merkel cell carcinoma Symptoms: Metastatic disease Medication: Pazopanib • Cabozantinib Clinical Procedure: Systemic therapy Specialty: Oncology
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Affiliation(s)
- Erica S Tarabadkar
- Department of Internal Medicine/Division of Dermatology, University of Washington, Seattle, WA, USA
| | - Hannah Thomas
- Department of Internal Medicine/Division of Dermatology, University of Washington, Seattle, WA, USA
| | - Astrid Blom
- Department of Dermatology, Hôpital Ambroise Paré, Boulogne-Billancourt, France
| | | | - Thomas Olencki
- Department of Internal Medicine/Division of Medical Oncology, The Ohio State University, Columbus, OH, USA
| | - Paul Nghiem
- Department of Internal Medicine/Division of Dermatology, University of Washington, Seattle, WA, USA
| | - Shailender Bhatia
- Department of Internal Medicine/Division of Medical Oncology, University of Washington, Seattle, WA, USA
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33
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Abstract
Merkel cell carcinoma (MCC) is an aggressive cutaneous neuroendocrine carcinoma. Incidence of MCC continues to rise, and risk factors include advanced age, pale skin, chronic sun exposure, and immune suppression. Diagnosing MCC utilizes a combination of morphology and immunohistochemistry. Merkel cell polyomavirus (MCPyV) is present in approximately 70-80% of MCCs and represents a key pathogenic driver in those MCCs. In contrast, MCPyV-negative MCCs arise through progressive accumulation of ultraviolet-light induced somatic mutations. Staging of MCC proceeds according to the American Joint Commission on Cancer (AJCC) 8th Edition, which utilizes features of the primary tumor together with regional lymph node(s) (clinically and/or pathologically detected) and/or distant metastases. Many potentially useful biomarkers have been studied to refine risk stratification in MCC. In recent years, the host immune infiltrate has been leveraged as immune checkpoint blockade has emerged as an efficacious mode of treatment for patients with advanced MCC.
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Affiliation(s)
- Michael T. Tetzlaff
- 0000 0001 2291 4776grid.240145.6Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 85, Houston, TX 77030 USA ,0000 0001 2291 4776grid.240145.6Department of Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 85, Houston, TX 77030 USA
| | - Priyadharsini Nagarajan
- 0000 0001 2291 4776grid.240145.6Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 85, Houston, TX 77030 USA
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34
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Cho K, Kim JH, Lee DC, Suh YL, Woo KI, Kim YD. Poorly Differentiated Neuroendocrine Carcinoma of the Eyelid. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2018. [DOI: 10.3341/jkos.2018.59.9.861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Kyuyeon Cho
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Hee Kim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong-Cheol Lee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yeon Lim Suh
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung In Woo
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoon-Duck Kim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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35
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Abstract
Merkel cell carcinoma (MCC) is an uncommon primary cutaneous neuroendocrine cancer. It most commonly presents as an indurated plaque or nodule on sun-damaged skin in elderly patients and is characterized by high rates of local recurrence and nodal metastasis. Survival at 5 years is 51% for local disease and as low as 14% for distant disease, which underscores the aggressive nature of this tumor and challenges in management. Advances in immunology and molecular genetics have broadened our understanding of the pathophysiology of MCC and expanded our therapeutic arsenal. With this comprehensive review, we provide an update of MCC epidemiology, pathogenesis, clinical presentation, diagnostic evaluation and prognostic markers. The second article in this continuing medical education series explores the evolving landscape in MCC management.
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36
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Lano IM, Rayson D, Arnason T, Walsh NMG. Primary large cell neuroendocrine carcinoma of the skin: An under-recognized entity and a mimic of metastatic disease. J Cutan Pathol 2017; 45:54-58. [PMID: 28960456 DOI: 10.1111/cup.13051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 09/21/2017] [Accepted: 09/22/2017] [Indexed: 11/27/2022]
Abstract
Primary large cell neuroendocrine carcinomas of the skin are exceptionally rare and can be diagnosed only when a metastasis from another organ has been excluded. We report the case of a 62-year-old woman with a cutaneous papule on the mid-chest which generated a differential diagnosis of vascular lesion and basal cell carcinoma. Following excision, microscopic evaluation revealed a dermal large cell undifferentiated carcinoma, with a brisk mitotic rate and focal geographic necrosis. Mucin production was absent. On immunohistochemistry, the lesion expressed CK7, AE1AE3, CK8/18, chromogranin, synaptophysin, CD56, calcitonin (patchy) and TTF-1 (minimal focal). Stains for neurofilament, CK20, CK5/6, p40, p63, SOX10, MART-1, EMA, CEA, ER/PR, GATA3, GCDFP, mammoglobin, PAX-8, CDX2, napsin, ERG and MCPyV proved negative. The histopathological diagnosis was of a large cell neuroendocrine carcinoma, probably metastatic. The patient underwent comprehensive clinical, laboratory and radiographic investigations and no underlying primary carcinoma was detected. During a 20-month follow-up period with an oncologist, the patient remains well and free of any apparent carcinoma. This suggests a primary large cell neuroendocrine carcinoma of skin. To date, 3 such cases have been reported in Japanese patients. This is the first in a Caucasian resident of North America.
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Affiliation(s)
- Ian Marie Lano
- Department of Pathology and Laboratory Medicine, Nova Scotia Health Authority (Central Zone), Halifax, Canada
| | - Daniel Rayson
- Department of Medicine, Nova Scotia Health Authority (Central Zone), Halifax, Canada.,Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - Thomas Arnason
- Department of Pathology and Laboratory Medicine, Nova Scotia Health Authority (Central Zone), Halifax, Canada.,Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - Noreen M G Walsh
- Department of Pathology and Laboratory Medicine, Nova Scotia Health Authority (Central Zone), Halifax, Canada.,Department of Medicine, Nova Scotia Health Authority (Central Zone), Halifax, Canada.,Faculty of Medicine, Dalhousie University, Halifax, Canada
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37
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Abstract
CONTEXT - Basal cell carcinoma (BCC) is the most common human malignant neoplasm and is a frequently encountered diagnosis in dermatopathology. Although BCC may be locally destructive, it rarely metastasizes. Many diagnostic entities display morphologic and immunophenotypic overlap with BCC, including nonneoplastic processes, such as follicular induction over dermatofibroma; benign follicular tumors, such as trichoblastoma, trichoepithelioma, or basaloid follicular hamartoma; and malignant tumors, such as sebaceous carcinoma or Merkel cell carcinoma. Thus, misdiagnosis has significant potential to result in overtreatment or undertreatment. OBJECTIVE - To review key features distinguishing BCC from histologic mimics, including current evidence regarding immunohistochemical markers useful for that distinction. DATA SOURCES - Review of pertinent literature on BCC immunohistochemistry and differential diagnosis. CONCLUSIONS - In most cases, BCC can be reliably diagnosed by histopathologic features. Immunohistochemistry may provide useful ancillary data in certain cases. Awareness of potential mimics is critical to avoid misdiagnosis and resulting inappropriate management.
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Affiliation(s)
- Lauren M Stanoszek
- From the Departments of Pathology (Drs Stanoszek, Wang, and Harms) and Dermatology (Dr Harms), University of Michigan Medical School, Ann Arbor. Drs Stanoszek and Wang contributed equally
| | - Grace Y Wang
- From the Departments of Pathology (Drs Stanoszek, Wang, and Harms) and Dermatology (Dr Harms), University of Michigan Medical School, Ann Arbor. Drs Stanoszek and Wang contributed equally
| | - Paul W Harms
- From the Departments of Pathology (Drs Stanoszek, Wang, and Harms) and Dermatology (Dr Harms), University of Michigan Medical School, Ann Arbor. Drs Stanoszek and Wang contributed equally
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38
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Abstract
Merkel cell carcinoma (MCC) is a rare but highly aggressive skin cancer with neuroendocrine features. MCC pathogenesis is associated with either the presence of Merkel cell polyomavirus or chronic exposure to ultraviolet light (UV), which can cause a characteristic pattern of multiple DNA mutations. Notably, in the Northern hemisphere, the majority of MCC cases are of viral aetiology; by contrast, in areas with high UV exposure, UV-mediated carcinogenesis is predominant. The two aetiologies share similar clinical, histopathological and prognostic characteristics. MCC presents with a solitary cutaneous or subcutaneous nodule, most frequently in sun-exposed areas. In fact, UV exposure is probably involved in both viral-mediated and non-viral-mediated carcinogenesis, by contributing to immunosuppression or DNA damage, respectively. Confirmation of diagnosis relies on analyses of histological features and immunological marker expression profiles of the lesion. At primary diagnosis, loco-regional metastases are already present in ∼30% of patients. Excision of the tumour is the first-line therapy; if not feasible, radiotherapy can often effectively control the disease. Chemotherapy was the only alternative in advanced-stage or refractory MCC until several clinical trials demonstrated the efficacy of immune-checkpoint inhibitors.
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39
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García-Mesa Y, García-Piqueras J, García B, Feito J, Cabo R, Cobo J, Vega JA, García-Suárez O. Merkel cells and Meissner's corpuscles in human digital skin display Piezo2 immunoreactivity. J Anat 2017; 231:978-989. [PMID: 28905996 DOI: 10.1111/joa.12688] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2017] [Indexed: 12/13/2022] Open
Abstract
The transformation of mechanical energy into electrical signals is the first step in mechanotransduction in the peripheral sensory nervous system and relies on the presence of mechanically gated ion channels within specialized sensory organs called mechanoreceptors. Piezo2 is a vertebrate stretch-gated ion channel necessary for mechanosensitive channels in mammalian cells. Functionally, it is related to light touch, which has been detected in murine cutaneous Merkel cell-neurite complexes, Meissner-like corpuscles and lanceolate nerve endings. To the best of our knowledge, the occurrence of Piezo2 in human cutaneous mechanoreceptors has never been investigated. Here, we used simple and double immunohistochemistry to investigate the occurrence of Piezo2 in human digital glabrous skin. Piezo2 immunoreactivity was detected in approximately 80% of morphologically and immunohistochemically characterized (cytokeratin 20+ , chromogranin A+ and synaptophisin+ ) Merkel cells. Most of them were in close contact with Piezo2- nerve fibre profiles. Moreover, the axon, but not the lamellar cells, of Meissner's corpuscles was also Piezo2+ , but other mechanoreceptors, i.e. Pacinian or Ruffini's corpuscles, were devoid of immunoreactivity. Piezo2 was also observed in non-nervous tissue, especially the basal keratinocytes, endothelial cells and sweat glands. The present results demonstrate the occurrence of Piezo2 in cutaneous sensory nerve formations that functionally work as slowly adapting (Merkel cells) and rapidly adapting (Meissner's corpuscles) low-threshold mechanoreceptors and are related to fine and discriminative touch but not to vibration or hard touch. These data offer additional insight into the molecular basis of mechanosensing in humans.
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Affiliation(s)
- Y García-Mesa
- Departamento de Morfología y Biología Celular, Grupo SINPOs, Sección de Anatomía y Embriología Humana, Universidad de Oviedo, Oviedo, Spain
| | - J García-Piqueras
- Departamento de Morfología y Biología Celular, Grupo SINPOs, Sección de Anatomía y Embriología Humana, Universidad de Oviedo, Oviedo, Spain
| | - B García
- Departamento de Biología Funcional, Universidad de Oviedo, Oviedo, Spain
| | - J Feito
- Servicio de Anatomía Patológica, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - R Cabo
- Departamento de Morfología y Biología Celular, Grupo SINPOs, Sección de Anatomía y Embriología Humana, Universidad de Oviedo, Oviedo, Spain
| | - J Cobo
- Departamento de Cirugía y Especialidades Médico-Quirúrgicas, Universidad de Oviedo, Oviedo, Spain.,Instituto Asturiano de Odontología, Oviedo, Spain
| | - J A Vega
- Departamento de Morfología y Biología Celular, Grupo SINPOs, Sección de Anatomía y Embriología Humana, Universidad de Oviedo, Oviedo, Spain.,Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Temuco, Chile
| | - O García-Suárez
- Departamento de Morfología y Biología Celular, Grupo SINPOs, Sección de Anatomía y Embriología Humana, Universidad de Oviedo, Oviedo, Spain
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40
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Ramani N, Aung PP, Hwu WJ, Nagarajan P, Tetzlaff MT, Curry JL, Ivan D, Prieto VG, Torres-Cabala CA. Aberrant expression of FLI-1 in melanoma. J Cutan Pathol 2017; 44:790-793. [PMID: 28605142 DOI: 10.1111/cup.12979] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 05/30/2017] [Accepted: 06/07/2017] [Indexed: 11/29/2022]
Abstract
Friend leukemia integration site 1 (FLI-1) nuclear transcription factor has been proposed as a suitable tool in the differential diagnosis of small round cell sarcomas. It has also been described as a nuclear marker of endothelial differentiation. Expression of FLI-1 has been demonstrated in Ewing's sarcoma/primitive neuroectodermal tumor (ES/PNET) and vascular neoplasms. In the present study, we describe 2 cases of metastatic melanoma with small round blue cell morphology that showed strong nuclear expression of FLI-1. Because of the small round blue cell morphology and negative immunohistochemical staining for pan-melanocytic cocktail (HMB45, anti MART1 and anti-tyrosinase) and SOX10 in both cases, FLI-1 immunostaining was requested as part of the tumors workup. Ultimately, both cases were established as being metastatic melanoma. Dermatopathologists should be aware that melanoma can be strongly positive for FLI-1 and not misinterpret these cases for ES/PNET or vascular lesions, especially when melanomas show unusual morphology.
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Affiliation(s)
- Nisha Ramani
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Pathology, SUNY Upstate Medical University, Syracuse, New York
| | - Phyu P Aung
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Wen-Jen Hwu
- Department Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Michael T Tetzlaff
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Johnathan L Curry
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Doina Ivan
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Victor G Prieto
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Carlos A Torres-Cabala
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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41
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Bob A, Nielen F, Krediet J, Schmitter J, Freundt D, Terhorst D, Röwert-Huber J, Kanitakis J, Stockfleth E, Ulrich C, Weichenthal M, Egberts F, Lange-Asschenfeldt B. Tumor vascularization and clinicopathologic parameters as prognostic factors in merkel cell carcinoma. J Cancer Res Clin Oncol 2017. [PMID: 28639083 DOI: 10.1007/s00432-017-2455-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE Merkel cell carcinoma (MCC) is a rare but aggressive neuroendocrine tumor of the skin with an increasing incidence. The clinical course is variable and reliable prognostic factors are scarce. Tumor angiogenesis has been shown to have prognostic impact in different types of cancer. The aim of our study was to determine potential prognostic factors, including tumor vascularization, for clinical outcome of MCC. METHODS The medical records of 46 patients with MCC diagnosed between 1997 and 2010 were analyzed retrospectively. Tissue samples were immune-stained for the lymphatic endothelial vessel marker podoplanin/D2-40 and the panvascular marker CD31. These immunostained sections were analyzed using computer-assisted morphometric image analyses. Aside from the parameters of tumor vascularization, clinicopathologic features were investigated, and progression-free survival (PFS) and tumor-specific survival (TSS) were assessed. Univariate and multivariate analyses were performed to determine prognostic factors. RESULTS Male sex of the MCC patients and a high cross-sectional whole vessel area (WVA) in relation to the entire tumor area as determined on CD31-stained tumor sections were found to be negative prognostic factors for PFS in a univariate and multivariate regression analysis. Ulceration of the primary tumor was significantly associated with both impaired PFS and TSS. CONCLUSIONS Our results indicate a high prognostic impact of tumor vascularization on the clinical outcome of MCC patients. Male sex and ulceration of the primary MCC were identified as independent unfavorable prognostic markers for the clinical outcome. As an outlook, MCC patients with increased angiogenesis might be identified and subjected to a targeted anti-angiogenic treatment.
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Affiliation(s)
- A Bob
- Department of Dermatology, Venerology and Allergology, Charité University Medicine Berlin, Berlin, Germany
| | - F Nielen
- Department of Dermatology, Schleswig-Holstein University Hospital, Campus Kiel, Kiel, Germany
| | - J Krediet
- Department of Dermatology, Venerology and Allergology, Charité University Medicine Berlin, Berlin, Germany
| | - J Schmitter
- Department of Dermatology, Venerology and Allergology, Charité University Medicine Berlin, Berlin, Germany.,Department of Dermatology, Schleswig-Holstein University Hospital, Campus Kiel, Kiel, Germany
| | - D Freundt
- Department of Dermatology, Venerology and Allergology, Charité University Medicine Berlin, Berlin, Germany
| | - D Terhorst
- Department of Dermatology, Venerology and Allergology, Charité University Medicine Berlin, Berlin, Germany
| | - J Röwert-Huber
- Department of Dermatology, Venerology and Allergology, Charité University Medicine Berlin, Berlin, Germany
| | - J Kanitakis
- Department of Dermatology and Pathology, Edouard Herriot Hospital Group, Hospices Civils de Lyon, Lyon, France
| | - E Stockfleth
- Department of Dermatology, Venerology and Allergology, Charité University Medicine Berlin, Berlin, Germany
| | - Ch Ulrich
- Department of Dermatology, Venerology and Allergology, Charité University Medicine Berlin, Berlin, Germany
| | - M Weichenthal
- Department of Dermatology, Schleswig-Holstein University Hospital, Campus Kiel, Kiel, Germany
| | - F Egberts
- Department of Dermatology, Schleswig-Holstein University Hospital, Campus Kiel, Kiel, Germany.
| | - B Lange-Asschenfeldt
- Department of Dermatology, Venerology and Allergology, Charité University Medicine Berlin, Berlin, Germany. .,Department of Dermatology, State Hospital Klagenfurt, Klagenfurt Am Wörthersee, Austria.
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42
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Abstract
Merkel cell carcinoma (MCC) is a rare, aggressive cutaneous neuroendocrine malignancy. Merkel cell polyomavirus, a tumorigenic DNA virus, is present in most MCC tumors, with implications for tumor biology, diagnosis, and management. Merkel cell polyomavirus-negative tumors have a high burden of UV-signature mutations, similar to melanoma. The histopathologic diagnosis of MCC requires immunohistochemistry to exclude morphologically similar entities. Therapies for advanced disease are currently lacking. Here, the features of MCC are reviewed, including recent molecular discoveries with implications for improved therapy for advanced disease.
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Affiliation(s)
- Paul W Harms
- Department of Pathology, University of Michigan Medical School, 3261 Medical Science I, 1301 Catherine Street, Ann Arbor, MI 48109-5602, USA; Department of Dermatology, University of Michigan Medical School, 3261 Medical Science I, 1301 Catherine Street, Ann Arbor, MI 48109-5602, USA.
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43
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Barton L, Zhao L, Doty JN, Stasko T, Conrad R. An elderly man with a solitary liver lesion. Cytojournal 2017; 14:11. [PMID: 28603540 PMCID: PMC5458409 DOI: 10.4103/1742-6413.207138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 10/03/2016] [Indexed: 11/25/2022] Open
Affiliation(s)
- Lisa Barton
- Address: Department of Pathology and Laboratory Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73104, USA
| | - Lichao Zhao
- Address: Department of Pathology and Laboratory Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73104, USA
| | - Jessica N Doty
- Department of Dermatology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73104, USA
| | - Thomas Stasko
- Department of Dermatology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73104, USA
| | - Rachel Conrad
- Address: Department of Pathology and Laboratory Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73104, USA
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44
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Abstract
Merkel cell carcinoma (MCC) encompasses neuroendocrine carcinomas primary to skin and occurs most commonly in association with clonally integrated Merkel cell polyomavirus with related retinoblastoma protein sequestration or in association with UV radiation-induced alterations involving the TP53 gene and mutations, heterozygous deletion, and hypermethylation of the Retinoblastoma gene. Molecular genetic signatures may provide therapeutic guidance. Morphologic features, although patterned, are associated with predictable diagnostic pitfalls, usually resolvable by immunohistochemistry. Therapeutic options for MCC, traditionally limited to surgical intervention and later chemotherapy and radiation, are growing, given promising early results of immunotherapeutic regimens.
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Affiliation(s)
- Melissa Pulitzer
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA.
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45
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Update on Merkel Cell Carcinoma: Epidemiology, Etiopathogenesis, Clinical Features, Diagnosis, and Staging. ACTAS DERMO-SIFILIOGRAFICAS 2017. [DOI: 10.1016/j.adengl.2016.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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46
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Merkel Cell Carcinoma: An Update of Key Imaging Techniques, Prognostic Factors, Treatment, and Follow-up. ACTAS DERMO-SIFILIOGRAFICAS 2017. [DOI: 10.1016/j.adengl.2016.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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47
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González-Vela MDC, Curiel-Olmo S, Derdak S, Beltran S, Santibañez M, Martínez N, Castillo-Trujillo A, Gut M, Sánchez-Pacheco R, Almaraz C, Cereceda L, Llombart B, Agraz-Doblas A, Revert-Arce J, López Guerrero JA, Mollejo M, Marrón PI, Ortiz-Romero P, Fernandez-Cuesta L, Varela I, Gut I, Cerroni L, Piris MÁ, Vaqué JP. Shared Oncogenic Pathways Implicated in Both Virus-Positive and UV-Induced Merkel Cell Carcinomas. J Invest Dermatol 2017; 137:197-206. [PMID: 27592799 DOI: 10.1016/j.jid.2016.08.015] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 08/03/2016] [Accepted: 08/04/2016] [Indexed: 12/27/2022]
Abstract
Merkel cell carcinoma (MCC) is a highly malignant neuroendocrine tumor of the skin whose molecular pathogenesis is not completely understood, despite the role that Merkel cell polyomavirus can play in 55-90% of cases. To study potential mechanisms driving this disease in clinically characterized cases, we searched for somatic mutations using whole-exome sequencing, and extrapolated our findings to study functional biomarkers reporting on the activity of the mutated pathways. Confirming previous results, Merkel cell polyomavirus-negative tumors had higher mutational loads with UV signatures and more frequent mutations in TP53 and RB compared with their Merkel cell polyomavirus-positive counterparts. Despite important genetic differences, the two Merkel cell carcinoma etiologies both exhibited nuclear accumulation of oncogenic transcription factors such as NFAT or nuclear factor of activated T cells (NFAT), P-CREB, and P-STAT3, indicating commonly deregulated pathogenic mechanisms with the potential to serve as targets for therapy. A multivariable analysis identified phosphorylated CRE-binding protein as an independent survival factor with respect to clinical variables and Merkel cell polyomavirus status in our cohort of Merkel cell carcinoma patients.
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Affiliation(s)
- María Del Carmen González-Vela
- Pathology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain; Cancer Genomics Laboratory, Instituto de Investigación Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Soraya Curiel-Olmo
- Cancer Genomics Laboratory, Instituto de Investigación Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Sophia Derdak
- CNAG-CRG, Centre for Genomic Regulation (CRG), Barcelona Institute of Science and Technology (BIST), Baldiri i Reixac 4, 08028, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Sergi Beltran
- CNAG-CRG, Centre for Genomic Regulation (CRG), Barcelona Institute of Science and Technology (BIST), Baldiri i Reixac 4, 08028, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | | | - Nerea Martínez
- Cancer Genomics Laboratory, Instituto de Investigación Marqués de Valdecilla, IDIVAL, Santander, Spain
| | | | - Martha Gut
- CNAG-CRG, Centre for Genomic Regulation (CRG), Barcelona Institute of Science and Technology (BIST), Baldiri i Reixac 4, 08028, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | | | - Carmen Almaraz
- Cancer Genomics Laboratory, Instituto de Investigación Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Laura Cereceda
- Cancer Genomics Laboratory, Instituto de Investigación Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Beatriz Llombart
- Department of Dermatology, Instituto Valenciano de Oncología, Valencia, Spain
| | - Antonio Agraz-Doblas
- IBBTEC-UC-CSIC-SODERCAN Instituto de Biomedicina y Biotecnología de Cantabria, Santander, Spain; Josep Carreras Leukemia Research Institute and School of Medicine, University of Barcelona, Barcelona, Spain
| | - José Revert-Arce
- Cancer Genomics Laboratory, Instituto de Investigación Marqués de Valdecilla, IDIVAL, Santander, Spain
| | | | | | | | - Pablo Ortiz-Romero
- Dermatology Service, Instituto I+12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Lynnette Fernandez-Cuesta
- International Agency for Research on Cancer (IARC-WHO), Lyon, France; Department of Translational Genomics, Center of Integrated Oncology Cologne-Bonn, Medical Faculty, University of Cologne, 50931 Cologne, Germany
| | - Ignacio Varela
- IBBTEC-UC-CSIC-SODERCAN Instituto de Biomedicina y Biotecnología de Cantabria, Santander, Spain
| | - Ivo Gut
- CNAG-CRG, Centre for Genomic Regulation (CRG), Barcelona Institute of Science and Technology (BIST), Baldiri i Reixac 4, 08028, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Lorenzo Cerroni
- Department of Dermatology Medical University of Graz, Austria
| | - Miguel Ángel Piris
- Pathology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain; Cancer Genomics Laboratory, Instituto de Investigación Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - José Pedro Vaqué
- Cancer Genomics Laboratory, Instituto de Investigación Marqués de Valdecilla, IDIVAL, Santander, Spain; IBBTEC-UC-CSIC-SODERCAN Instituto de Biomedicina y Biotecnología de Cantabria, Santander, Spain.
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Llombart B, Kindem S, Chust M. Merkel Cell Carcinoma: An Update of Key Imaging Techniques, Prognostic Factors, Treatment, and Follow-up. ACTAS DERMO-SIFILIOGRAFICAS 2016; 108:98-107. [PMID: 27919405 DOI: 10.1016/j.ad.2016.07.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Revised: 07/01/2016] [Accepted: 07/29/2016] [Indexed: 02/06/2023] Open
Abstract
Merkel cell carcinoma, though rare, is one of the most aggressive tumors a dermatologist faces. More than a third of patients with this diagnosis die from the disease. Numerous researchers have attempted to identify clinical and pathologic predictors to guide prognosis, but their studies have produced inconsistent results. Because the incidence of Merkel cell carcinoma is low and it appears in patients of advanced age, prospective studies have not been done and no clear treatment algorithm has been developed. This review aims to provide an exhaustive, up-to-date account of Merkel cell carcinoma for the dermatologist. We describe prognostic factors and the imaging techniques that are most appropriate for evaluating disease spread. We also discuss current debates on treating Merkel cell carcinoma.
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Affiliation(s)
- B Llombart
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España.
| | - S Kindem
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - M Chust
- Servicio de Radioterapia, Instituto Valenciano de Oncología, Valencia, España
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49
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Llombart B, Requena C, Cruz J. Update on Merkel Cell Carcinoma: Epidemiology, Etiopathogenesis, Clinical Features, Diagnosis, and Staging. ACTAS DERMO-SIFILIOGRAFICAS 2016; 108:108-119. [PMID: 27770997 DOI: 10.1016/j.ad.2016.07.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Revised: 07/01/2016] [Accepted: 07/29/2016] [Indexed: 10/20/2022] Open
Abstract
Merkel cell carcinoma (MCC) is a rare, highly aggressive tumor, and local or regional disease recurrence is common, as is metastasis. MCC usually develops in sun-exposed skin in patients of advanced age. Its incidence has risen 4-fold in recent decades as the population has aged and immunohistochemical techniques have led to more diagnoses. The pathogenesis of MCC remains unclear but UV radiation, immunosuppression, and the presence of Merkel cell polyomavirus in the tumor genome seem to play key roles. This review seeks to update our understanding of the epidemiology, etiology, pathogenesis, and clinical features of MCC. We also review histologic and immunohistochemical features required for diagnosis. MCC staging is discussed, given its great importance in establishing a prognosis for these patients.
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Affiliation(s)
- B Llombart
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España.
| | - C Requena
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - J Cruz
- Servicio de Anatomía Patológica, Instituto Valenciano de Oncología, Valencia, España
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50
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Domínguez-Malagón HR, Michal M, Kazakov DV, Caro-Sánchez CH, Lino-Silva LS. Utility of CD99 Paranuclear Expression in the Differential Diagnosis of Merkel Cell Carcinoma. Int J Surg Pathol 2016; 24:293-296. [DOI: 10.1177/1066896915623361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Background. Recent reviews have referred to the paranuclear dot-like staining pattern of CD99 in several neoplasms, including solid pseudopapillary tumors in the pancreas, colonic adenocarcinomas, and colonic adenomas as well as in Merkel cell carcinoma (MCC). The aim of this work was to explore the utility of CD99 paranuclear staining in the differential diagnosis of MCC. Material and Methods. We explore paranuclear dot-like CD99 expression in several small, round blue cell neoplasms, including neuroendocrine neoplasms, Ewing sarcomas/primitive neuroectodermal tumors (EWS/PNET), melanomas, small cell lung carcinomas (SCC), lymphoblastic lymphoma/leukemia, and rhabdomyosarcomas, in comparison with 33 cases of MCC, to determine the specificity of the paranuclear dot-like CD99 expression in MCC. Results. Twenty MCC (60%) demonstrated focal expression of CD99 and of those, 14 (42.4%) showed the characteristic paranuclear dot-like expression. CD99 was also paranuclear positive in 4 of 11 (36%) SCC, in 3 of 7 (43%) EWS/PNET, in 1 of 6 (16%) lymphoblastic lymphoma/leukemia cases, in 3 of 3 (100%) rhabdomyosarcomas and all melanomas were negative for the CD99 reaction. Conclusion. CD99 paranuclear dot-like expression was not exclusive of the MCC compared with several neoplasms included in its differential diagnosis. This expression is not a great diagnostic aid.
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Affiliation(s)
| | - Michal Michal
- Charles University Hospital Pilsen, Pilsen, Czech Republic
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