皮肤Merkel细胞癌临床病理分析及文献复习
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摘要
回顾性分析1例皮肤Merkel细胞癌患者的病史、肿瘤组织形态学特征及免疫组织化学表达情况,并复习相关文献。患者为老年男性,表现为皮肤孤立无痛结节,镜下肿瘤位于真皮层,瘤细胞呈片状及巢状分布,大小相对一致,嗜碱性,核质比高。免疫组织化学上皮及神经内分泌标志阳性,CK20胞质逗点状阳性,TTF-1,CD117,CD68,LCA均为阴性。Merkel细胞癌是皮肤原发的高度侵袭性神经内分泌肿瘤(amine precursor uptake and decarboxylation,APUD)肿瘤,需与皮肤转移性肺小细胞癌、恶性黑色素瘤及淋巴瘤等疾病进行鉴别。
The history, histomorphological features and immunohistochemical expression of 1 cases of cutaneous Merkel cell carcinoma was retrospectively analyzed, and reviewed the relevant literatures. This patient was an elderly men, manifested as a skin isolated painless nodule, tumor located in the dermis, oncocytes were flake and nests, relatively uniform in size, basophilic, karyoplasmic ratio under the microscope. Immunohistochemistry epithelia and neuroendocrine markers were positive, the positive expression of CK20 was cytoplasmic comma, and TTF-1, CD117, CD68 and LCA were negative. Merkel cell carcinoma is a highly aggressive amine precursor uptake and decarboxylation(APUD) of the skin. It is necessary to identify diseases such as metastatic pulmonary small cell carcinoma, malignant melanoma and lymphoma.
The history, histomorphological features and immunohistochemical expression of 1 cases of cutaneous Merkel cell carcinoma was retrospectively analyzed, and reviewed the relevant literatures. This patient was an elderly men, manifested as a skin isolated painless nodule, tumor located in the dermis, oncocytes were flake and nests, relatively uniform in size, basophilic, karyoplasmic ratio under the microscope. Immunohistochemistry epithelia and neuroendocrine markers were positive, the positive expression of CK20 was cytoplasmic comma, and TTF-1, CD117, CD68 and LCA were negative. Merkel cell carcinoma is a highly aggressive amine precursor uptake and decarboxylation(APUD) of the skin. It is necessary to identify diseases such as metastatic pulmonary small cell carcinoma, malignant melanoma and lymphoma.
引文
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2.Toker C.Trabecular carcinoma of the skin[J].Arch Dermatol,1972,105(1):107-110.
3.Feng H,Shuda M,Chang Y,et al.Clonal integration of a polyomavirus in human Merkel cell carcinoma[J].Science,2008,319(5866):1096-1100.
4.Engels EA,Frisch M,Goedert JJ,et al.Merkel cell carcinoma and HIVinfection[J].Lancet,2002,359(2):497-498.
5.Harms PW,Collie AM,Hovelson DH,et al.Next generation sequencing of cytokeratin 20-negative Merkel cell carcinoma reveals ultraviolet signature mutations and recurrent TP53 and RB1inactivation[J].Mod Pathol,2016,29(3):240-248.
6.Heath M,Jaimes N,Lemos B,et al.Clinical characteristics of Merkel cell carcinoma at diagnosis in 195 patients:the“AEIOU”features[J].JAm Acad Dermatol,2008,58(3):375-381.
7.Erovic I,Erovic BM.Merkel cell carcinoma:the past,the present,and the future[J].J Skin Cancer,2013,2013:929364.
8.Jaeger T,Ring J,Andres C.Histological,immunohistological,and clinical features of Merkel cell carcinoma in correlation to Merkel cell polyomavirus status[J].J Skin Cancer,2012,2012:983421.
9.Bobos M,Hytiroglou P,Kostopoulos I,et al.Immunohistochemical distinction between merkel cell carcinoma and small cell carcinoma of the lung[J].Am J Dermatopathol,2006,28(2):99-104.
10.Kontochristopoulos GJ,Stavropoulos PG,Krasagakis K,et al.Differentiation between merkel cell carcinoma and malignant melanoma:An immunohistochemical study[J].Dermatol,2000,201(2):123-126.
11.范晓春,张丰,郭英.皮肤基底细胞癌20例临床病理分析[J].现代肿瘤医学,2009,17(5):947-948.FAN Xiaochun,ZHANG Feng,GUO Ying.Clinical pathological analysis of 20 cases of basal cell carcinoma of the skin[J].Modern Oncology,2009,17(5):947-948.
12.Tai P.A practical update of surgical management of merkel cell carcinoma of the skin[J].ISRN Surg,2013,2013:850797.
13.Sihto H,Bohling T,Kavola H,et al.Tumor infiltrating immune cells and outcome of Merkel cell carcinoma:a population-based study[J].Clin Cancer Res,2012,18(10):2872-2881.
2.Toker C.Trabecular carcinoma of the skin[J].Arch Dermatol,1972,105(1):107-110.
3.Feng H,Shuda M,Chang Y,et al.Clonal integration of a polyomavirus in human Merkel cell carcinoma[J].Science,2008,319(5866):1096-1100.
4.Engels EA,Frisch M,Goedert JJ,et al.Merkel cell carcinoma and HIVinfection[J].Lancet,2002,359(2):497-498.
5.Harms PW,Collie AM,Hovelson DH,et al.Next generation sequencing of cytokeratin 20-negative Merkel cell carcinoma reveals ultraviolet signature mutations and recurrent TP53 and RB1inactivation[J].Mod Pathol,2016,29(3):240-248.
6.Heath M,Jaimes N,Lemos B,et al.Clinical characteristics of Merkel cell carcinoma at diagnosis in 195 patients:the“AEIOU”features[J].JAm Acad Dermatol,2008,58(3):375-381.
7.Erovic I,Erovic BM.Merkel cell carcinoma:the past,the present,and the future[J].J Skin Cancer,2013,2013:929364.
8.Jaeger T,Ring J,Andres C.Histological,immunohistological,and clinical features of Merkel cell carcinoma in correlation to Merkel cell polyomavirus status[J].J Skin Cancer,2012,2012:983421.
9.Bobos M,Hytiroglou P,Kostopoulos I,et al.Immunohistochemical distinction between merkel cell carcinoma and small cell carcinoma of the lung[J].Am J Dermatopathol,2006,28(2):99-104.
10.Kontochristopoulos GJ,Stavropoulos PG,Krasagakis K,et al.Differentiation between merkel cell carcinoma and malignant melanoma:An immunohistochemical study[J].Dermatol,2000,201(2):123-126.
11.范晓春,张丰,郭英.皮肤基底细胞癌20例临床病理分析[J].现代肿瘤医学,2009,17(5):947-948.FAN Xiaochun,ZHANG Feng,GUO Ying.Clinical pathological analysis of 20 cases of basal cell carcinoma of the skin[J].Modern Oncology,2009,17(5):947-948.
12.Tai P.A practical update of surgical management of merkel cell carcinoma of the skin[J].ISRN Surg,2013,2013:850797.
13.Sihto H,Bohling T,Kavola H,et al.Tumor infiltrating immune cells and outcome of Merkel cell carcinoma:a population-based study[J].Clin Cancer Res,2012,18(10):2872-2881.