棘层松解性鳞状细胞癌1例

棘层松解性鳞状细胞癌(ASCC)由Lever等在1947年首次报道,是鳞状细胞癌组织学上的一种亚型[1].ASCC多见于老年患者皮肤暴露部位,占所有皮肤鳞状细胞癌的2％～4％.现报道1例我科诊治的ASCC.     

皮肤Merkel细胞癌伴鳞状细胞癌1例

患者女,76岁。左面颊部肿物1年,明显增大1个月。皮损特点为紫红色球形肿物。皮损组织病理示:表皮见团块状鳞状上皮中-重度异型增生,突破基底膜;真皮全层见形态一致的肿瘤细胞浸润,巢状或片状分布,圆形或卵圆形,胞质少、嗜碱性,核大、散点状分布染色质,核仁明显,可见多数核分裂相。免疫组化:CK20(部分+),P63及CKH(鳞状分化的细胞+),Syn(+),CgA(+),CD56(+),LCA(-),CK7(-),S100(-)。诊断:皮肤Merkel细胞癌伴鳞状细胞癌。     

p53、Gadd45α蛋白在皮肤鳞状细胞癌、基底细胞癌中的表达

目的:检测p53和Gadd45α蛋白在皮肤鳞状细胞癌和基底细胞癌组织中的表达.方法:应用免疫组化法对30例皮肤鳞状细胞癌和25例基底细胞癌组织中的p53和Gadd45α蛋白表达进行检测.结果:p53蛋白在皮肤鳞状细胞癌和基底细胞癌组织中的表达阳性率分别为56.67%、48%,与正常皮肤组织比较差异均有显著性(P=0.006;0.025);Gadd45α在皮肤鳞状细胞癌和基底细胞癌中表达分别为43.33%、52%,均高于正常皮肤组织的表达(P=0.031;0.010).高分化皮肤鳞状细胞癌组阳性表达率为75%,高于中低分化组的22.22%(P=0.008).结论:皮肤鳞状细胞癌和基底细胞癌组织中p53、Gadd45α异常表达可能参与了发病过程.     

135例皮肤鳞状细胞癌发病相关因素回顾性分析

目的通过对近7年来皮肤鳞状细胞癌发生情况及发病相关因素的分析,从而反映该院所属地区的皮肤鳞状细胞癌发病情况及发病原因,为进一步临床研究提供参考。方法对2004年1月—2010年12月华西医院烧伤整形科收治的135例皮肤鳞状细胞癌患者临床资料进行回顾性分析。结果近7年来皮肤鳞状细胞癌患病人数逐渐增加,好发年龄为50～59岁(35.56%),其中在文化程度较低尤其在农民中发病率明显高于文化程度较高及其他职业者(P0.05)。多数患者在慢性溃疡(17.04%)、瘢痕(17.04%)及各种外源性刺激后(28.15%)发病,分化程度与原发疾病之间无明显差异性。结论本地区的皮肤鳞状细胞癌的发病人数在逐年增加,皮肤鳞状细胞癌的发生是由一种或多种因素综合作用的结果,与外源性损伤关系较为密切。     

Merkel细胞癌一例

Merkel细胞癌是一种罕见的皮肤恶性肿瘤 ,好发于暴露部位 ,有明显局部复发及早期转移倾向。我们见到一例 Merkel细胞癌 ,并出现眼睑、额部及胸部等多处转移 ,现报道如下。 患者男 ,66岁 ,2年前发现左前臂伸侧有一肿物 ,2.5 cm× 2.5 cm× 3 cm,质硬 ,活动 ,左上肢感觉运动正常 ,腋窝淋巴结不大。行手术切除 ,病理示表皮正常 ,真皮乳头层无浸润 ,真皮中下层广泛片状及条带状单一核细胞浸润 ,细胞核呈圆形、椭圆形 ,较一致 ,灰蓝染色 ,胞浆稀少 ,胞膜不明显 ,伴淋巴细胞浸润 ,可见分裂象（图 1,2）。免疫组化示突触素 (SY38)(＋ )(图 3)、嗜…     

Survivin和COX-2在皮肤基底细胞癌和鳞状细胞癌组织中的表达及相关性

目的了解皮肤基底细胞癌和皮肤鳞状细胞癌中Survivin和COX-2的表达情况及两者的关系。方法采用免疫组化法检测10例正常对照组、23例基底细胞癌、18例鳞状细胞癌组织中Survivin和COX-2的表达情况。结果 Survivin蛋白在正常组织中不表达,基底细胞癌和鳞状细胞癌中Survivin蛋白的表达率分别为60.87%和66.67%。COX-2在正常组织中的表达率为10%,基底细胞癌和鳞状细胞癌中COX-2的表达率分别为65.22%和66.67%,且明显高于其在正常组织中的表达率。Survivin的表达和COX-2的表达呈显著正相关(P0.05)。结论 Survivin蛋白和COX-2在皮肤基底细胞癌和皮肤鳞状细胞癌中高表达,两者呈正相关。     

MIC-1和uPA蛋白在皮肤鳞状细胞癌组织中的表达及与组织学分级和发病部位的关系

目的 探讨MIC-1和uPA蛋白在皮肤鳞状细胞癌中的表达及与组织学分级和发病部位的关系。方法 应用免疫组化SP法检测42例皮肤鳞状细胞癌组织及42例正常对照皮肤中MIC-1及uPA蛋白的表达,并分析其与组织学分级及发病部位的关系。结果 皮肤鳞状细胞癌组织中MIC-1(66.67%)及uPA蛋白(78.57%)阳性表达率均显著高于正常对照皮肤组织中的阳性表达率(16.67%和28.57%),差异均有统计学意义(P均<0.05);皮肤鳞状细胞癌组织中MIC-1及uPA蛋白阳性表达率均与鳞状细胞癌病理组织学分级密切相关(P均<0.05);MIC-1与uPA蛋白的表达呈正相关(P<0.05)。结论 皮肤鳞状细胞癌组织中MIC-1和uPA蛋白的表达均显著升高,其高表达可能与皮肤鳞状细胞癌发生和发展有关。     

皮肤Merkel细胞癌伴前列腺癌1例

患者男,78岁,右侧跟腱结节2个月。手术切除皮损组织病理示：真皮深部见嗜碱性细胞团块,胞浆呈颗粒状,部分细胞核大深染、有异型性。免疫组织化学结果示：CK(2+)、CK19(+)、CK20(点状+)、CD56(+)、CgA(+)、Syn(+)、vimentim(+)、Ki-67(50%+)。诊断考虑Merkel细胞癌。全身PET-CT检查发现前列腺肿瘤,前列腺组织病理回报腺泡腺癌。诊断：皮肤Merkel细胞癌合并前列腺癌。     

皮肤鳞状细胞癌,基底细胞癌,恶性黑素瘤449例统计分析

皮肤鳞状细胞癌、基底细胞癌、恶性黑素瘤４４９例统计分析孙桂珍，张宗琴，朱晓琳，蓝毓滨，李春梅，宁晓明皮肤鳞状细胞癌（ＳＣＣ），基底细胞癌（ＢＣＣ），恶性黑素瘤（ＭＭ）是皮肤科常见的恶性肿瘤，我们统计了１９７８年１月～１９９２年１２月（１９９０年末统计...     

Merkel细胞癌多瘤病毒阳性的皮肤原发性Merkel细胞癌二例

【摘要】 目的 报道Merkel细胞癌多瘤病毒阳性的Merkel细胞癌2例。 方法 对诊治的2例Merkel细胞癌进行光镜观察及免疫组化标记,聚合酶链反应（PCR）检测Merkel细胞癌多瘤病毒并测序。 结果 2例均为男性,例1右下肢胫前肿物1年余,皮肤科检查见右胫前密集粉红色结节,融合成10 cm × 8 cm肿块,质硬,部分表面糜烂伴渗出及结痂,肿块周围亦可见多个大小不一的红色结节,活动性差。例2左膝肿物6月余,皮肤科检查见左膝内侧5 cm × 4 cm紫蓝色结节型肿物,质硬,边界不清,活动性差。2例患者皮损组织病理表现相似,肿瘤细胞大小一致,细胞核大、深染,染色质细腻,核分裂象易见;胞质少,红染。免疫组化：广谱细胞角蛋白（pan-CK）、细胞角蛋白20（CK20）、突触素（Syn）、嗜铬素（CgA）和神经元特异性烯醇化酶（NSE）均阳性,Ki-67（≥60%）阳性;细胞角蛋白7（CK7）、S100蛋白、HMB45、CD34、甲状腺转录因子1（TTF-1）和白细胞共同抗原（LCA）表达均阴性。2例Merkel细胞癌均经PCR检测到Merkel细胞癌多瘤病毒,而5例皮肤T细胞淋巴瘤、2例正常人皮肤和2例T细胞淋巴瘤细胞系MAC1和MAC2A均未检测到Merkel细胞癌多瘤病毒。 结论 Merkel细胞癌具有特征性的临床和组织病理表现,免疫组化标记、PCR检测Merkel细胞癌多瘤病毒对明确诊断具有重要作用。 【关键词】 癌,Merkel细胞; 多瘤病毒属     

Intraepidermal proliferation of Merkel cells within a seborrheic keratosis: Merkel cell carcinoma in situ or Merkel cell hyperplasia?

Intradepidermal proliferation of Merkel cells without any dermal component has been interpreted as either a hyperplastic process secondary to chronic ultraviolet radiation or a neoplastic process, namely Merkel cell carcinoma (MCC) in situ. The recent criteria that have been proffered to diagnose MCC in situ, unfortunately, are identical to those that have been applied to Merkel cell hyperplasia in the past, posing a diagnostic quandary when faced with an intraepidermal proliferation of Merkel cells. Most previously reported cases of MCC in situ have occurred within associated epithelial lesion that includes solar (actinic) keratosis and squamous‐cell carcinoma in situ. Similarly, Merkel cell hyperplasia has been reported to occur in association with a variety of epithelial lesions as well as on chronically sun‐damaged skin. Herein, a case of an intraepidermal proliferation of Merkel cells within a seborrheic keratosis is presented accompanied by a discussion on whether the proliferation represents another case of Merkel cell carcinoma in situ or an incidental hyperplastic process on chronically sun‐damaged skin.     

Case of probable spontaneous regression of Merkel cell carcinoma combined with squamous cell carcinoma without surgical intervention

Merkel cell carcinoma (MCC) is a rare but more lethal cutaneous cancer than melanoma. However, spontaneous regression of a number of MCC has been reported, although the cause of this regression remains unclear. In most cases, MCC regresses after a surgical procedure, for example, biopsy. Herein, we report a case of Merkel cell polyomavirus‐negative MCC coincident with squamous cell carcinoma (SCC) that underwent true spontaneous regression without biopsy. One month after the patient's first visit, clinical examination revealed that the tumor had not grown, but its surface showed changes in texture and color. Histopathologically, the excised specimen was indicative of MCC coincident with SCC and showed extensive necrosis in the upper portion of the tumor, numerous caspase‐3‐positive apoptotic cells, an accumulation of CD68‐positive foam cells and vascular invasion. These findings suggested that the tumor had regressed. We hypothesize that extensive coagulative necrosis resulting from an insufficient local blood supply triggered the shedding of some products or components of MCC and SCC, which in turn induced antitumor immunity against both lesions.     

Multiple primary malignancies in patients with Merkel cell carcinoma1

Background Merkel cell carcinoma (MCC) is a rare malignant cutaneous tumour, the incidence of which is increasing. Second malignancies have been reported to occur with high incidence in these patients. Objectives We report the rate and nature of multiple malignancies in patients with MCC treated over a 10 year period in Addenbrooke’s Hospital in Cambridge, United Kingdom, as well as the temporal relationship of these additional malignancies to the diagnosis of MCC. Results The 27 patients had an approximately equal sex incidence with a median age at diagnosis of 79 years. Seventy percent (n=19) of patients had a second primary malignant tumour; and 7 of these patients had two or more tumours in addition to the MCC. Eighteen patients had additional cutaneous malignancies: melanoma, squamous cell carcinoma and basal cell carcinoma, and 8 patients presented non‐cutaneous malignancy including colorectal, haematological and breast tumours. Of the 28 additional tumours in our patients, half were diagnosed prior to presentation of MCC, 32% within 6 months of diagnosis, and 18% between 6 months and 3 years after diagnosis. Possible reasons for the high rate of additional tumours in this population are discussed. Conclusions Our figures reflect a higher incidence of multiple malignancies in those with Merkel cell tumour than has previously been reported. This has important implications for the care and surveillance of these patients.     

Case of Merkel cell carcinoma with squamous cell carcinoma possibly arising in chronic radiodermatitis of the hand

We report a case of Merkel cell carcinoma (MCC) on the dorsal aspect of the right middle finger associated with multiple squamous cell carcinomas (SCC) possibly arising in chronic radiation dermatitis of the hand of an 80‐year‐old surgeon. In spite of resection of the primary lesion and right axillary lymph nodes, he died of the tumor 5 months after the first visit. Cutaneous and lymph node lesions of MCC were negative for Merkel cell polyoma virus (MCPyV) by immunostaining using monoclonal antibody (CM2B4) and anti‐large T antigen of MCPyV polyclonal antibody, and real‐time polymerase chain reaction. Several differences in clinicopathological findings have been found between MCPyV‐positive cases and negative ones. Several authors have reported that MCPyV‐negative cases have a worse prognosis than MCPyV‐positive ones. Furthermore, in cases of MCC associated with SCC, most tumors have been reported to be MCPyV‐negative. We should pay more attention to the relationship between the carcinogenesis of MCC and ionizing irradiation.     

Combined intraepidermal neuroendocrine (Merkel cell) and squamous cell carcinoma in situ with CM2B4 negativity and p53 overexpression(*)

Primary cutaneous neuroendocrine carcinoma, also known as Merkel cell carcinoma (MCC), usually presents as a dermal and/or subcutaneous tumor. Rarely, it is confined to the epidermis or adnexal epithelium [MCC in situ (MCCIS)]. Little is known about the spectrum of features and biology of MCCIS. Herein, we report a case of MCCIS arising on the cheek of a 77-year-old Caucasian male, which was associated with squamous cell carcinoma in situ. The tumor cells of both the neuroendocrine and squamous components prominently involved adnexal structures but did not invade the dermis. The tumor cells with neuroendocrine features were immunoreactive for cytokeratin-20, chromogranin and synaptophysin. They also expressed p53 but were non-reactive with the monoclonal antibody CM2B4. Lack of labeling for CM2B4 is in keeping with prior observations of combined squamous and MCC. Our findings support the concept of a distinct subtype of virus-independent cutaneous neuroendocrine carcinoma that differs from conventional MCC. The observed overexpression of p53 suggests that the development of this tumor type may be related to chronic ultraviolet damage.     

Merkel cell carcinoma with divergent differentiation

Merkel cell carcinoma (MCC) is a rare primary neuroendocrine carcinoma of the skin, usually occurring at sun-exposed sites in elderly people. Divergent differentiation in MCC, although rare, has been reported in previous case series. We describe two new cases of MCC with divergent differentiation. Patient 1 was a 96-year-old man with a scalp lesion; on biopsy, the morphology and immunoprofile suggested MCC with divergent squamous differentiation. Patient 2 was an 87-year-old woman with a lesion on her leg, originally reported as squamous cell carcinoma, later showing extensive local recurrence. On review, primary histology showed an MCC with divergent differentiation, most likely trichilemmal carcinoma; the recurrence showed only MCC. These cases illustrate that MCC is capable of divergent differentiation, including squamous and adnexal morphologies. Correct diagnosis is essential for appropriate prognosis and management, as later recurrence or metastases may only show the Merkel cell component.     

Cutaneous undifferentiated small (Merkel) cell carcinoma,that developed synchronously with multiple actinic keratoses,squamous cell carcinomas and basal cell carcinoma

Merkel Cell Carcinoma (MCC) is an uncommon undifferentiated neuroendocrine tumor, arising in skin mainly on sun-exposed areas. We present an unusual case of primary cutaneous undifferentiated small cell carcinoma that co-existed with six other lesions; 2 actinic keratoses, 3 squamous-cell carcinomas and a basal-cell carcinoma. HE stained sections revealed MCC located in the mid-dermis, co-existing with severe actinic keratosis. Immunohistochemically, the tumor cells reacted to cytokeratin 20, epithelial membrane antigen, chromogranin and neuron specific enolase. This is an unusual case of cutaneous MCC co-existing with six other different lesions. The concurrent development of MCC, squamous-cell and basal-cell carcinoma in the same patient indicates the pluripotent epidermal stem cell origin of these tumors. Further research is needed to enlighten the factors inducing this divergent differentiation.     

An unusual case of diffuse Merkel cell carcinoma successfully treated with low dose radiotherapy

Merkel cell carcinoma (MCC) is a rare and highly aggressive neuroendocrine carcinoma of the skin. MCC should be included in the diagnosis of a rapidly growing infiltrating mass and histology as well as laboratory investigations such as Merkel cell polyoma virus (MCPyV) detection are valuable in its diagnosis. We present an unusual case of giant MCC‐positive MCPyV in a Greek woman located on the lower leg. Our patient is very unusual in terms of her extensive MCC and her rapid and complete response to radiotherapy.