Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island 02903, USA.
J Am Acad Dermatol. 2010 Mar;62(3):463-8. doi: 10.1016/j.jaad.2009.06.023.
Merkel cell carcinoma (MCC), an aggressive malignancy that has been increasing in incidence, rarely presents with an epidermotropic pattern.
We conducted an immunohistochemical evaluation of 6 previously unpublished cases of epidermotropic MCC, focusing particularly on the staining characteristics of epithelial membrane antigen and cytokeratin-20 in the hope of providing insight into the mechanism of epidermotropism in MCC.
This study is a retrospective evaluation using light microscopy and immunohistochemistry.
Forty cases of MCC with pathology at Rhode Island Hospital and the Miriam Hospital in Providence, RI, from 1983 through 2009 were reviewed. Following exclusion criteria, 6 patients (5 men, 1 woman) with a mean age of 82.5 years (range, 72-92) demonstrated epidermotropism. Three of 6 patients had MCC of the eyelid. In cases 1, 3, and 6, the perinuclear dot pattern observed with cytokeratin-20 in the epidermotropic MCC cells was less pronounced than the pattern observed in the dermis, and in all 6 of the tumors, the epidermal staining pattern observed with epithelial membrane antigen was not more or less prominent than the staining observed in the dermis.
The small total number of cases of epidermotropic MCC is a limitation.
The data presented reinforce the differential diagnosis of tumors with an epidermotropic growth pattern and the importance of immunohistochemical staining in the histologic workup of such tumors: squamous cell carcinoma in situ, melanoma, mycosis fungoides, eccrine porocarcinoma, sebaceous carcinoma of the eyelid, mammary and extramammary Paget disease, MCC, and epidermotropic metastases. It is notable that 3 of 6 identified tumors were located on the eyelid; further study of epidermotropic MCC may shed more light on this finding, either as an unusual coincidence or a finding with unexplained significance.
默克尔细胞癌（Merkel 细胞癌）是一种侵袭性恶性肿瘤，发病率不断上升，其表皮内浸润模式较为罕见。
我们对 6 例以前未发表的表皮内浸润性 Merkel 细胞癌病例进行了免疫组织化学评估，特别关注上皮膜抗原和细胞角蛋白-20 的染色特征，希望能深入了解 Merkel 细胞癌表皮内浸润的机制。
本研究采用回顾性方法，结合光镜和免疫组织化学技术。
对 1983 年至 2009 年期间罗德岛医院和普罗维登斯米里亚姆医院的 40 例 Merkel 细胞癌病例进行了复习。经过排除标准，有 6 例（5 例男性，1 例女性）患者符合条件，平均年龄 82.5 岁（72-92 岁），表现为表皮内浸润。其中 3 例发生于眼睑。在病例 1、3 和 6 中，表皮内浸润性 Merkel 细胞癌中细胞角蛋白-20 观察到的核周点模式不如真皮中明显，在所有 6 例肿瘤中，上皮膜抗原的表皮染色模式与真皮中的染色模式相比，既不更明显也不更不明显。
表皮内浸润性 Merkel 细胞癌的总病例数较少是一个局限性。
所提供的数据加强了具有表皮内生长模式的肿瘤的鉴别诊断，并且强调了免疫组织化学染色在这些肿瘤的组织学检查中的重要性：原位鳞状细胞癌、黑色素瘤、蕈样真菌病、大汗腺癌、睑皮脂腺癌、乳腺和乳腺外 Paget 病、Merkel 细胞癌和表皮内转移。值得注意的是，所确定的 6 例肿瘤中有 3 例位于眼睑；对表皮内浸润性 Merkel 细胞癌的进一步研究可能会对这一发现有更多的了解，无论是作为一种不寻常的巧合，还是一种具有未知意义的发现。
