Merkel cell carcinoma:: a clinicopathological study of 11 cases
Merkel cell carcinoma:: a clinicopathological study of 11 cases
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DOI：
10.1111/j.1468-3083.2005.01224.x
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发表时间：
2005-09-01
影响因子：
9.2
通讯作者：
Díaz-Pérez, JL
中科院分区：
文献类型：
--
作者：
Acebo, E;Vidaurrazaga, N;Díaz-Pérez, JL
目的总结1991~2002年间收治的11例Merkel细胞癌(MCC)的临床和病理资料。收集了年龄、性别、位置、大小、分期、治疗和随访数据。采用组织病理学方法和免疫组织化学方法检测CAM5.2、细胞角蛋白20(CK20)、CK7、Ber EP4、神经丝、突触素、嗜铬粒蛋白、S100蛋白、P53蛋白、CD117、白细胞共同抗原(LCA)和Ki-67的表达。肿瘤位于面部6例，四肢3例，躯干1例。确诊时，1名患者处于1a期，6名患者处于ib期，3名患者处于II期，1名患者处于III期。除1名患者外，所有患者都接受了广泛的手术切除。附加治疗包括2例淋巴清扫，4例放疗，1例全身化疗。5例患者出现局部复发。经14个月随访，3例因MCC死亡。所有病例均可见中等大小的圆形细胞增殖。7例可见小细胞样改变，6例可见小梁样改变。3例有小汗腺和鳞状细胞分化。CAM5.2和神经细丝均呈点状核旁分布，而CK20则有%的病例呈点状核旁分布。Ber Ep4、嗜铬颗粒、突触素阳性率为75%，P53阳性率为70%，S 100蛋白阳性率为22%，CD117阳性率为55%，LCA阴性。Ki-67平均存在于75%的肿瘤细胞中。50%的MCC与CK7呈阳性反应，并呈分泌区分化。结论MCC是一种侵袭性的老年神经内分泌肿瘤。广泛的手术切除是推荐的治疗方法。淋巴清扫、辅助放疗和化疗可减少区域复发，但尚未被证明能提高存活率。免疫组织化学显示，MCC是一种具有神经内分泌特征的上皮细胞。
Objective To report our 12-year experience with Merkel cell carcinomas (MCCs) from a clinical and pathological point of view.Subjects and setting Eleven MCCs were diagnosed at our institution between 1991 and 2002.Methods A retrospective clinical, histopathological and immunohistochemical study was performed. Age, gender, location, size, stage, treatment and follow-up data were collected. Histopathological pattern and immunohistochemical study with CAM 5.2, cytokeratin 20 (CK20), CK7, Ber EP4, neurofilaments, synaptophysin, chromogranin, S100 protein, p53 protein, CD117, leucocyte common antigen (LCA) and Ki-67 were accomplished.Results Six females and five males with a mean age of 82 years were identified. Tumours were located on the face (n = 6), extremities (n = 3) and trunk (n = 1). At diagnosis, one patient was in stage la, six in stage Ib, three in stage II and one in stage III. All but one patient experienced wide surgical excision of the turnout. Additional treatment consisted of lymph node dissection in two patients, radiotherapy in four patients and systemic chemotherapy in one patient. Local recurrence developed in five patients. Three patients died because of MCC after 14 months of follow-up. Intermediate-size round cell proliferation was found in all cases. Additional small-size-cell pattern and trabecular pattern were observed in seven and six cases, respectively. Eccrine and squamous cell differentiation were found in three cases. A dot-like paranuclear pattern was observed in all cases with CAM 5.2 and neurofilaments, and in 89% of cases with CK20. Seventy-five per cent of cases reacted with Ber EP4, chromogranin and synaptophysin, 70% with p53, 22% with S 100 protein, 55% with CD117 and none with LCA. Ki-67 was found in 75% of tumoral cells on average. Fifty per cent of MCCs reacted with CK7 and showed eccrine differentiation areas.Conclusions MCC is an aggressive neuroendocrine turnout of the elderly. Wide surgical excision is the recommended treatment. Lymph node dissection, adjuvant radiotherapy and chemotherapy decrease regional recurrences but have not been demonstrated to increase survival. Immunohistochemically, MCC is an epithelial turnout with neuroendocrine features.