Merkel cell carcinoma with squamous differentiation – case report
Authors:
Ondrej Savka; Aleš Pastrňák
Authors‘ workplace:
Oddělení patologie Nemocnice Kyjov
Published in:
Čes.-slov. Patol., 56, 2020, No. 3, p. 177-180
Category:
Original Articles
Overview
We report a case of 81-year old female with Merkel cell carcinoma of skin with squamous differentiation and aberrant immunohistochemical profile. Primary skin tumor of left preauricular area was incompletely removed 6 months ago and diagnosed as poorly differentiated squamous cell carcinoma. After 6 months patient returns with relapse and new biopsy is made. Microscopically, mostly solid structures of poorly differentiated neoplasia with focal squamous differentiated are found. Neoplastic cells were small, polygonal, with scant cytoplasm and irregular oval dark nuclei with high mitotic activity. Immunohistochemically, tumor cells showed positivity for AE1/AE3, p63, CD56, chromogranin A, synaptophysin and in squamous parts p40. CK20 and other markers examined were negative. Merkel cell carcinoma is rare and highly aggressive skin tumor with characteristic expression of epithelial and neuroendocrine markers. In this report we want to point out that caution should be taken in excluding diagnosis of Merkel cell carcinoma from differential diagnosis based on atypical histological and immunohistochemical findings, especially the risk of confusion with less aggressive skin tumors.
Keywords:
Merkel cell carcinoma – squamous differentiation – aberrant immunohistochemical profile
Sources
1. Pulitzer M. Merkel cell carcinoma. Surg Pathol Clin 2017; 10: 399-408.
2. Campillo R, Gil-Carcedo E, Alonso D, Vallejo LA, Oñate JM, Gil-Carcedo LM. Primary cutaneous neuroendocrine carcinoma, Merkel cell carcinoma. Case series 1991-2012. Acta Otorrinolaringol Esp 2013; 64: 396-402.
3. Kieny, A , Cribier, B , Meyer, N , Velten, M, Jégu, J and Lipsker, D. Epidemiology of Merkel cell carcinoma. A population‐based study from 1985 to 2013, in northeastern of France. Int J Cancer 2019; 144: 741-745.
4. Adamicová K, Fetisovová Ž, Šingliar A, Maretta I. Histopatologické nálezy pri diagnostike karcinómu Merkelových buniek. Dermatologie pro praxi 2010; 10: 3–6.
5. Pulitzer MP, Brannon AR, Berger MF, et al. Cutaneous squamous and neuroendocrine carcinoma: genetically and immunohistochemically different from Merkel cell carcinoma. Mod Pathol 2015; 28(8): 1023.
6. Krejčí K; Zadražil J; Tichý T et al. Kožní karcinom z Merkelových buněk. Klin Onkol 2010; 23(4): 210-217.
7. Jirásek T, Matěj R, Pock L, Knotková I, Mandys V. Karcinom z Merkelových buněk – imunohistologická studie v souboru 11 pacientů. Cesk Patol 2009; 45: 9–13.
8. Harms KL, Healy MA, Nghiem P, et al. Analysis of prognostic factors from 9387 Merkel cell carcinoma cases forms the basis for the new 8th edition AJCC staging system. Ann Surg Oncol 2016; 23: 3564–3571.
9. Toker C. Trabecular carcinoma of the skin. Arch Dermatol 1972; 105(1): 107-110.
10. Halata Z, Grim M, Bauman KI. Merkelova buňka: morfologie, vývojový původ, funkce, Cas Lek Cesk 2003; 4-9.
11. Merkel FS. Tastzellen und Tastkörperchen bei den Hausthieren und beim Menschen. Archiv für mikroskopische Anatomie 1875; 11: 636-652.
12. Hausen A, Rennspiess D, Winnepenninck V, et al. Early B-cell differentiation in Merkel cell carcinomas: clues to cellular ancestry. Cancer Res 2013; 73: 4982-4987.
13. Tilling T, Moll I. Which are the cells of origin in Merkel cell carcinoma? J Skin Cancer 2012: 680410.
14. Feng H, Shuda M, Chang Y, Moore PS. Clonal integration of a polyomavirus in human Merkel cell carcinoma. Science 2008; 319(5866): 1096-1100.
15. Coggshall K, Tello TL, North JP, Yu SS. Merkel cell carcinoma: An update and review. J Am Acad Dermatol 2018; 78(3): 433-442.
16. Paulson KG, Park SY, Vandeven NA, et al. Merkel cell carcinoma: Current US incidence and projected increases based on changing demographics. J Am Acad Dermatol 2018; 78(3): 457–463.
17. Penn I, First MR. Merkel’s cell carcinoma in organ recipients: report of 41cases. Transplantation 1999; 68(11): 1717-1721.
18. Jalilian C, Chamberlain AJ, Haskett M, et al. Clinical and dermoscopic characteristics of Merkel cell carcinoma. Br J Dermatol 2013; 169: 294–297.
19. Engels EA, Frisch M, Goedert JJ, Biggar RJ, Miller RW. Merkel cell carcinoma and HIV infection. Lancet 2002; 359: 497-498.
20. Szabó A; Richter I, Frydrychová D, Saláková M, Jirásek T. Uzlinová metastáza karcinomu z Merkelových buněk bez kožního primárního ložiska – kazuistické sdělení. Cesk Patol 2017; 53: 135-138.
21. Miller RW, Rabkin CS. Merkel cell carcinoma and melanoma: etiological similarities and differences. Cancer Epidemiol Biomarkers Prev 1999; 8(2): 153–158.
22. Martin B, Poblet E, Rios JJ, et al. Merkel cell carcinoma with divergent differentiation: histopathological and immunohistochemical study of 15 cases with PCR analysis for Merkel cell polyomavirus. Histopathology 2013; 62(5): 711-722.
23. Saeb-Lima M, Montante-Montes de Oca D, Albores-Saavedra J. Merkel cell carcinoma with eccrine differentiation: a clinicopathologic study of 7 cases. Ann Diagn Pathol 2008; 12(6): 410-414.
24. Jensen, K., Kohler, S., Rouse, R. V. Cytokeratin staining in Merkel cell carcinoma: an immunohistochemical study of cytokeratins 5/6, 7, 17, and 20. Appl Immunohistochem Mol Morphol 2000; 8: 310–315.
25. Miner AG, Patel RM, Wilson DA, et al. Cytokeratin 20-negative Merkel cell carcinoma is infrequently associated with the Merkel cell polyomavirus. Mod Pathol 2015; 28: 498-504.
26. Narisawa Y, Koba S, Inoue T, Nagase K Histogenesis of pure and combined Merkel cell carcinomas: An immunohistochemical study of 14 cases. J Dermatol 2015; 42(5): 445-452.
27. Asioli S, Righi A, Volante M, Eusebi V, Bussolati G. p63 expression as a new prognostic marker in Merkel cell carcinoma. Cancer 2007; 110(3): 640-647.
28. Stetsenko GY, Malekirad J, Paulson KG, et al. p63 expression in Merkel cell carcinoma predicts poorer survival yet may have limited clinical utility. Am J Clin Pathol 2013; 140(6): 838–844.
29. Amin MB, Edge S, Greene F, et al. AJCC Cancer Staging Manual (8th edition). Springer International Publishing: American Joint Commission on Cancer.
30. Schadendorf D, Lebbé C, Zur Hausen A, et al. Merkel cell carcinoma: Epidemiology, prognosis, therapy and unmet medical needs. Eur J Cancer 2017; 71: 53-69.
Labels
Anatomical pathology Forensic medical examiner ToxicologyArticle was published in
Czecho-Slovak Pathology
![Issue 3](https://www.prolekare.cz/media/cache/resolve/journal_issue/media/image_pdf/012214f0bbfc771cec11dcc127e34b0d.jpeg)
2020 Issue 3
Most read in this issue
- Lymph node metastasis of parotid gland high-grade adenoid-cystic carcinoma
- Immunohistochemistry in hollow urinary tract
- Immunohistochemistry and renal neoplasias
- Immunohistochemistry in prostate pathology