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[The neuroendocrine Merkel cell carcinoma of the skin]
Abstract:
Seven primary skin tumors from 5 women and 2 men were analyzed by light and electron microscopy and immunocytochemistry. The tumors were localized on the face (3 tumors) and on the extremities. The maximum diameter was between 1 and 3.5 cm. Two tumors metastasized to the regional lymph nodes 4 months after excision of the primary, 1 tumor metastasize to the regional lymph nodes after 5 years and the patient died of multiple metastases 8 years after excision of the primary on the forearm. No local recurrences developed. The tumors occurred in the dermis with frequent infiltration of the subcutaneous tissue. The epidermis was intact. The tumor cells formed large solid clusters, while their cytoplasm was faintly basophilic and formed a small rim round the large pale nucleus. In electron microscopy many cells displayed cytoplasmic electron-dense secretory granules with a mean diameter of approx. 100 nm. Immunocytochemistry showed that a large number of cells in all tumors contained neuron specific enolase and many cells of 4 tumors yielded formaldehyde-induced fluorescence. The tumors are therefore of neuroendocrine origin and may derive from merkel cells. They frequently give rise to erroneous diagnosis of metastasis of carcinoma or malignant lymphoma to the skin.
Insights
Primary skin tumors, potentially from Merkel cells, were analyzed. These neuroendocrine tumors can be misdiagnosed as skin metastases or lymphoma.
Area of Science:
- Dermatopathology
- Surgical Pathology
- Oncology
Context:
- Primary skin tumors present diagnostic challenges.
- Distinguishing primary skin neoplasms from cutaneous metastases is crucial for patient management.
Purpose:
- To characterize the histopathological and immunocytochemical features of seven primary skin tumors.
- To determine the origin of these tumors and assess their metastatic potential.
Summary:
- Seven primary skin tumors (3 on the face, 4 on extremities) were examined using light and electron microscopy, and immunocytochemistry.
- Tumor cells exhibited neuroendocrine differentiation, suggesting a Merkel cell origin.
- Metastasis to regional lymph nodes occurred in some cases, with one patient succumbing to widespread metastases eight years post-excision.
Impact:
- These findings aid in the accurate diagnosis of primary neuroendocrine skin tumors.
- Highlights the potential for misdiagnosis as metastatic carcinoma or lymphoma.
- Provides insights into the behavior and metastatic potential of these rare neoplasms.