皮肤Merkel细胞癌7例临床病理分析  

Merkel cell( neuroendocrine) carcinoma: a clinicopathologic study of 7 cases

作　　者：简燚[1] 陈易华[1] 曾冬梅[1] 罗艳[1] 范严严[1] 

机构地区：[1]成都军区总医院病理科,成都610083

出　　处：《诊断病理学杂志》2014年第2期69-72,共4页Chinese Journal of Diagnostic Pathology

摘　　要：目的 分析皮肤Merkel细胞癌的临床病理特点、免疫组化表型及其生物学行为.方法 对7例皮肤Merkel 细胞癌进行临床及病理资料分析、免疫组化检测及术后随访.结果 7例Merkel细胞癌患者中,男性5例,女性2例;发病年龄59 ～ 78岁,平均年龄67岁;发生部位为头颈部及四肢皮肤,多为暴露部位.临床主要表现为孤立性、无痛性、半球形结节或硬结样斑块,直径均＜2 cm,其中有2例形成溃疡.组织学主要表现为由嗜碱性、大小一致、胞质很少的瘤细胞构成,核呈圆形或卵圆形;肿瘤细胞在真皮内多呈弥漫状或实性巢状分布,其中1例伴灶状坏死并有鳞状分化,局灶区域癌变.免疫组化：肿瘤细胞上皮标记CK20和EMA均（＋）,神经内分泌标记Syn、CD56和NSE均（＋）,LCA、TTF-1、S-100和CD99为（-）.随访5例,3例预后良好,未见转移及复发,1例伴有鳞状细胞癌患者术后复发,并进展为浸润性鳞状细胞癌;另1例术后数月发现远处淋巴结转移.结论 Merkel细胞癌是一种较少见的、发生于真皮的神经内分泌肿瘤,可复发与转移,定期随访十分重要.病理诊断需要与基底细胞癌、恶性黑色素瘤、淋巴瘤、低分化鳞状细胞癌、原发性外周PNET、皮肤基底细胞癌以及转移性神经内分泌癌等鉴别.Objective To analyze the clinical and pathological features,immunohistochemical phenotype and biological behaviors in 7 cases of cutaneous Merkel cell carcinoma.Methods The 7 cases were collected and the clinical and pathological features were analyzed.Immunohistochemistry was carried out and postoperative follow-up conducted.Results In 7 cases of Merkel cell carcinoma,5 were males and 2 females; the age ranged from 59 to 78 years old,and the average age was 67 years old; It commonly occured at the skin of head,neck and limbs,mostly in the exposed anatomic site.The main clinical manifestations were a solitary,painless,hemispherical nodule or induration or sample plaque; the diameter was less than 2 cm,including two patients with ulcer.Histologically,tumor cells had a circular or ovoid nucleus,and less basophilic cytoplasm.The tumor cells in the dermis showed diffuse infiltration or solid nests.Immunohistochemical detection showed that tumor cells were positive for CK20 and EMA,Syn,CD56,NSE and other neuroendocrine markers,but negative for LCA,TTF-1,S-100 and CD99; 5 cases were followed up,3 of which had a good prognosis without recurrence and metastasis.Conclusions Merkel cell carcinoma is a rare neuroendocrine tumor in the dermis,recurrence and metastasis can occur,and thus regular follow-up is very important.This tumour should be differentiated from basal cell carcinoma,malignant melanoma,lymphoma and primary peripheral PNET.

关 键 词：皮肤 MERKEL细胞癌 临床病理 免疫组化 

分 类 号：R739.5[医药卫生—肿瘤]