皮肤Merkel细胞癌二例报告

皮肤Ｍｅｒｋｅｌ细胞癌二例报告泉州市第一医院欧阳永娥，庄建良Ｍｅｒｋｅｌ细胞癌是皮肤的神经内分泌肿瘤，国外文献报道２００余例（１），国内有零星的病例报告（２）。现报道２例如下。例１，患者，女性，１９岁。因发现左前臂无痛性肿块５个月，于１９９０年３月１...     

Merkel细胞瘤的诊断及治疗进展

Ｍｅｒｋｅｌ细胞瘤的诊断及治疗进展吴双，张伟综述郎锦义，王静波审校四川省肿瘤医院放疗科（成都６１００４１）Ｍｅｒｋｅｌ细胞瘤即原发性皮肤神经内分泌癌，是近年来认识的一种罕见的皮肤高度恶性肿瘤，尚无可供遵循的治疗规范，目前国内已有个案报道。本文通过文献...     

皮肤Merkel瘤伴急性粒细胞性白血病──附1例光镜电镜观察及文献复习

报告１例皮肤Ｍｅｒｋｅｌ瘤伴急性粒细胞性白血病，Ｍｅｒｋｅｌ瘤极为罕见，来自皮肤的Ｍｅｒｋｅｌ细胞，该细胞系感觉触觉功能细胞，属ＡＰＵＤ系统细胞，ＡＰＵＤ细胞分布全身各个脏器，具有分泌多肽类神经内分泌细胞。电镜下瘤细胞胞浆内含大量带膜神经内分泌颗粒。本病例同时患有两种性质完全不相同的肿瘤。文献上报导罕见。     

甲氰咪呱对鼠体内IL—2／LAK抗肿瘤作用的影响

为探讨甲氰咪呱（ＣＩＭ）对鼠体内ＩＬ２／ＬＡＫ抗肿瘤作用的影响,将Ｂ１６细胞经尾静脉接种于Ｃ５７ＢＬ／６小鼠,第３ｄ分别应用ＤＨａｎｋｓ液、ＣＩＭ（１０ｍｇ／ｍｌ）＋ＣＩＭ（１μｇ／ｍｌ）诱导的脾细胞,ＩＬ２＋ＩＬ２（５００Ｕ／ｍｌ）诱导的ＬＡＫ细胞,ＣＩＭ（１０ｍｇ／ｍｌ）＋ＩＬ２＋ＣＩＭ（１μｇ／ｍｌ）和ＩＬ２（５００Ｕ／ｍｌ）共同诱导的ＬＡＫ细胞,观察鼠肺转移结节和生存期。结果显示,单用ＣＩＭ并不能减少肺转移结节和延长生存期;ＣＩＭ＋ＩＬ２／ＬＡＫ治疗组与ＩＬ２／ＬＡＫ治疗组相比,可减少肺转移结节（Ｐ＜０．０５）和显著延长生存期（Ｐ＜０．０１）。结果表明,ＣＩＭ能够增强ＩＬ２／ＬＡＫ抗肿瘤作用,可用于治疗肿瘤。     

人绒毛膜促性腺激素的凝集素层析在判断滋养细胞肿瘤中的应用

目的　研究恶性滋养细胞肿瘤分泌的人绒毛膜促性腺激素（ｈＣＧ） 中的异常糖链结构应用于临床诊断的可能性。　方法　测定２２ 例正常孕妇（ＮＰ） 、１２ 例良性葡萄胎（ＨＭ） 、１８ 例侵蚀性葡萄胎（ＩＨＭ） 和１７ 例绒毛膜癌（ＣＣ） 患者一次性晨尿中ｈＣＧ 的含量及其在蔓陀罗凝集素（ＤＳＡ） 亲和柱上的结合率。　结果　滋养细胞疾病病人一次性尿中的ｈＣＧ 含量与ＮＰ 没有差别。ＨＭ 尿中ｈＣＧ 的ＤＳＡ 结合率与ＮＰ 无异,而ＩＨＭ 与ＣＣ 尿中ｈＣＧ 的ＤＳＡ 结合率则明显高于ＮＰ或ＨＭ,ＩＨＭＣＣ和ＮＰＨＭ 两组间没有交叉重叠。ＣＣ尿中ｈＣＧ 的ＤＳＡ 结合率更高于ＩＨＭ 组,但无统计学差别。ＩＨＭ 或ＣＣ 经化疗后,尿中ｈＣＧ 含量降低,但ｈＣＧ的ＤＳＡ 结合率的降低在统计学上较含量降低更为显著。　结论　尿ｈＣＧ 的ＤＳＡ 结合率可用于恶性滋养细胞疾病的诊断及疗效认定。     

人肺腺癌细胞经化疗药物作用后对LAK细胞的敏感性

在体外实验中研究了８种化疗药物作用后的个旧人肺腺癌细胞（ＧＬＣ－８２）对ＬＡＫ细胞的敏感性。ＧＬＣ－８２细胞本身对化疗药物不敏感，经药物作用２４小时后用３Ｈ－ＴｄＲ释放法检测ＬＡＫ细胞对其杀伤率。结果表明：顺铂（ＣＤＤＰ）、卡铂（Ｃａｒｂｏ）、阿霉素（ＡＤＭ）、丝裂霉素（ＭＭＣ）及长春新硷（ＶＣＲ）处理后的ＧＬＣ－８２细胞对ＬＡＫ细胞的敏感性增强；环磷酰胺（ＣＴＸ）、足叶乙甙（ＶＰ１６）及５－氟脲嘧啶（５－Ｆｕ）则无明显影响。实验提示：对化疗不敏感的肺腺癌用ＣＤＤＰ、Ｃａｒｂｏ、ＡＤＭ、ＭＭＣ及ＶＣＲ后加用ＬＡＫ细胞可提高肺癌治疗的有效率。     

IMP方案与CAP方案治疗非小细胞肺癌疗效比较

肺癌为常见恶性肿瘤之一,临床上广泛应用ＣＡＰ（环磷酰胺（ＣＴＸ）,阿霉素（ＡＤＭ）,顺铂（ＰＤＤ））方案治疗晚期非小细胞肺癌,并已取得较为明确的疗效。本研究重点观察ＩＭＰ（异环磷酰胺（ＩＦＯ）,丝裂霉素（ＭＭＣ）,顺铂（ＰＤＤ））方案治疗非小细胞肺癌...     

MEP与MVP方案治疗非小细胞性肺癌的疗效比较

ＭＥＰ与ＭＶＰ方案治疗非小细胞性肺癌的疗效比较张家港市第一人民医院（张家港市２１５６００）左云陈亚楠ＭＥＰ方案和ＭＶＰ方案是目前公认的两个治疗非小细胞性肺癌（ＮＳＣＬＣ）比较有效的方案，各有优缺点，我们分别采用这两个方案治疗了４８例非小细胞肺癌，报告...     

人脐血和外周血单个核细胞增生活性及紫外线B照射抑制作用的研究

目的：比较人脐血（ＣＢ）和外周血（ＰＢ）单个核细胞（ＭＣｓ）的增生活性及其紫外线Ｂ照射（ＵＶＢ）在增生活性上的抑制作用。方法：应用ＰＨＡ诱导细胞增生以＾３Ｈ－ＴｄＲ结合检测增生活性（ｃｐｍ）；ＵＶＢ照射后的ＰＨＡ刺激和ＭＬＣ抑制作用，以未照射细胞的活性面分数表示。结果：人ＣＢＭＣｓ和ＰＢＭＣｓ ｃｐｍ平均值无统计学差异，但单个实验的标准偏差均显示人ＣＢＭＣｓ的ｃｐｍ高于ＰＢＭＣｓ，二者对小剂量ＵＶ     

慢性粒细胞白血病的治疗

慢性粒细胞白血病（ＣＭＬ）是造血细胞肿瘤性疾病 ,它以具有独特的Ｐｈ 染色体（约９０%～９５%病例）以及融合基因ｂｃｒ／ａｂｌ形成为特点 ,其克隆性增生进展不可避免的由慢性期进入加速期和急变期。尽管治疗ＣＭＬ的药物很多 ,尤其是干扰素应用以来 ,虽使ＣＭＬ患者生存期有所延长 ,但均难以达到根治。治疗ＣＭＬ首要目的是达到血液学完全缓解（ＣＨＲ） ,最终完全细胞遗传学缓解（ＣＣＲ） ,而达治愈。经多年研究及临床实践证实 ,到目前为止 ,只有异基因造血干细胞移植才是最有效的根治方法。ＣＭＬ未治疗的自然病程约为３１个月 ,如…     

Merkel细胞癌术后复发1例及相关文献复习

目的：探讨Merkel细胞癌的诊断、治疗及预后。方法：一位老年Merkel细胞癌患者，于2006年8月初发时先行化疗及放射治疗，1年后局部再发肿瘤，再次接受扩大性切除术及放疗和化疗。结果：术后1月Merkel细胞癌再次复发。结论：Merkel细胞癌是一种罕见且进展快的皮肤肿瘤。诊断主要依靠病理（包括免疫组化方法），即使综合治疗后仍有局部复发和远处转移的倾向，预后差。     

皮肤Merkel细胞癌3例

目的　探讨Merkel细胞癌的诊断、治疗及预后。方法　 1989～ 1999年间 ,共收治 3例Merkel细胞癌患者 ,均接受扩大性切除术及放疗和 或化疗。结果　 3例病例均于术后 5月内复发 ,中位存活期 2年。结论　Merekel细胞癌是一种罕见且进展快的皮肤肿瘤。诊断主要依靠病理 (包括免疫组化方法 ) ,即使综合治疗后仍有局部复发和远处转移的倾向 ,预后差。     

Merkel cell carcinoma

Merkel cell carcinoma (MCC) is a rare, aggressive cutaneous cancer that predominately affects elderly Caucasians with fair skin and has a propensity for local recurrence and regional lymph node metastases. A variety of terms have been used to describe this tumor, including trabecular cell carcinoma, neuroendocrine or primary small cell carcinoma of the skin, and anaplastic cancer of the skin. Although the skin lesion is most commonly found on sun-exposed areas of the head and neck or extremities, it can occur on the trunk, genitalia, and perianal region. The median age is 69 years, but it may occur earlier and more frequently in immunosuppressed patients. Patients with MCC frequently present with a nonspecific erythematous or violaceous firm nodule or small plaque that may be surrounded by small satellite tumors. MCC usually arises in the dermis and extends into the subcutis. It may be difficult to accurately diagnose MCC by light microscopy alone and ancillary techniques, including electron microscopy and immunohistochemistry, may be necessary to make a definitive diagnosis. Management of MCC is dependent on stage of the disease and is hampered by its rarity and lack of randomized trials. Nonetheless, for localized disease most guidelines include wide local excision of the primary tumor either alone or with radiation therapy. Sentinel lymph node biopsy can be helpful in staging and prognosis, but its benefit in survival remains to be seen. Systemic chemotherapy, akin to regimens for small cell carcinoma of the lung, may be considered as an adjuvant following surgery or to treat locoregional or distant disease. The prognosis of MCC is variable. Some patients with localized disease have an indolent course and are well controlled with local excision alone. On the other hand, many tumors are aggressive and have a tendency for locoregional recurrence and distant metastases. Such patients have a grim prognosis with a median survival of 9 months. Successful outcomes are most often seen in patients with early diagnosis and complete excision.     

Immunobiology of Merkel Cell Carcinoma: Implications for Immunotherapy of a Polyomavirus-Associated Cancer

Merkel cell carcinoma (MCC) is an aggressive skin malignancy with a high mortality rate and an increasing incidence. The recent discovery of Merkel cell polyomavirus has revolutionized our understanding of MCC pathogenesis. Viral oncoproteins appear to play a critical role in tumor progression and are expressed in the majority of MCC tumors. Virus-specific humoral and cellular immune responses are detectable in MCC patients and are linked to the natural history of the disease. Despite persistent expression of immunogenic viral proteins, however, MCC tumors are able to evade the immune system. Understanding of the mechanisms of immune evasion employed by MCC tumors is rapidly increasing and offers opportunities for development of rational immune therapies to improve patient outcomes. Here we review recent discoveries in MCC with a special focus on the pathogenic role of Merkel cell polyomavirus and the immunobiology of this virus-associated disease.     

Lymph nodal Merkel cell carcinoma: primary or metastatic disease? a clinical case

We report a case of Merkel cell carcinoma (MCC) presenting in the lymph nodes in the absence of a primary cutaneous site. The MCC was treated by palliative radiotherapy, which controlled the disease locally. Eight months after diagnosis a mass appeared on the ipsilateral knee; histopathological examination of this lesion confirmed the diagnosis of MCC. The patient died two months later due to the development of pulmonary metastases. Interestingly, the neoplastic tissue was confined to the regional lymph nodes for several months before the primary site appeared. Primary lymph nodal MCC is rare and the diagnosis is difficult. In our opinion the only way to make a diagnosis of primary lymph nodal MCC is by appropriate clinical follow-up.     

Clinical emergence of neurometastatic merkel cell carcinoma: a surgical case series and literature review

Merkel cell carcinoma (MCC) is a rare cutaneous neuroendocrine neoplasm of possible viral origin and is known for its aggressive behavior. The incidence of MCC has increased in the last 15 years. Merkel cell carcinoma has the potential to metastasize, but rarely involves the central nervous system. Herein, we report three consecutive surgical cases of MCC presenting at a single institution within 1 year. We used intracavitary BCNU wafers (Gliadel^®) in two cases. Pathological features, including CK20 positivity, consistent with MCC, were present in all cases. We found 33 published cases of MCC with CNS involvement. We suggest that the incidence of neurometastatic MCC may be increasing, parallel to the increasing incidence of primary MCC. We propose a role for intracavitary BCNU wafers in the treatment of intra-axial neurometastatic MCC.     

Les tumeurs à cellules de Merkel,rôle de la radiothérapie. Analyse de la littérature

Merkel cell carcinoma (MCC) is a rare neuroendocrine carcinoma of the skin with features of epithelial differentiation. It occurs in older patients, appears on sun exposed areas and its incidence is increasing. The surgical excision with negative margins is the first treatment and adjuvant local irradiation now is well established but regional adjuvant (lymph nodes dissection or radiation therapy) remains discussed. MCC is chemosensitive but rarely chemocurable in patients with metastasis or locally advanced tumors. The most used therapy is platinum-based polychemotherapy.     

Gastric metastasis of Merkel cell carcinoma,a rare cause of gastrointestinal bleeding: case report and review of the literature

Merkel cell carcinoma (MCC) is a highly aggressive cutaneous tumor of neuroendocrine origin. It is usually seen in elderly Caucasian males and occurs in sun exposed areas of the body. Diagnosis of MCC can be challenging and requires confirmation by immunohistochemical studies. It has an aggressive biological behavior with early local and distant metastasis and carries a dismal prognosis. However, metastasis of MCC to the stomach is very uncommon and rarely reported in the literature. We hereby describe a patient with gastric metastasis of MCC, who presented with upper gastrointestinal (GI) bleeding.     

Merkel cell cancer of the skin.

Merkel cell carcinoma (MCC) is a rare malignant cutaneous tumor of the elderly with rapidly growing skin nodules found predominantly on sun-exposed areas of the body. The vast majority of patients present with localized disease, while up to 30% have regional lymph node metastases. Despite local excision and the incidence of local recurrence, regional lymph node metastases and distant metastases is high and usually occurs within 2 years of primary diagnosis. The optimal treatment for patients with MCC remains unclear. The best outcome is achieved with multidisciplinary management including surgical excision of primary tumor with adequate margins and post-operative radiotherapy (RT) to control local and regional disease. Patients with regional nodal metastases should be treated with lymph node dissection plus RT. Adjuvant chemotherapy (CT) should be considered as part of the initial management. In case of metastatic disease CT based on regimens used for small-cell lung cancer is the standard treatment of care.