The Department of Anatomical Pathology, Royal North Shore Hospital, Sydney, 2065 Australia.
Hum Pathol. 2011 Oct;42(10):1385-90. doi: 10.1016/j.humpath.2010.12.013. Epub 2011 Mar 30.
Recent studies have demonstrated a high frequency of detection of Merkel cell polyomavirus in Merkel cell carcinoma. However, most of these studies are from European or North American centers that have relatively low sun exposure and may have a higher incidence of virus-driven oncogenesis compared with the highly sun-exposed but predominantly fair-skinned Australian population. We performed immunohistochemistry for Merkel cell polyomavirus on 104 cases of Merkel cell carcinoma and 74 cases of noncutaneous small cell-undifferentiated carcinoma from 3 major Australian centers. Nineteen (18.3%) cases of Merkel cell carcinoma showed positive staining for Merkel cell polyomavirus versus 1 (1.3%) of small cell-undifferentiated carcinoma. All 15 cases (14.3%) of Merkel cell carcinoma with areas of mixed squamous differentiation showed negative staining. We found positive staining in only 3 (7.7%) of 39 Merkel cell carcinoma from the head and neck (the most sun-exposed area) versus 16 (24.6%) of 65 of tumors from other sites (P < .05). Our findings support the concept of a Merkel cell polyomavirus-driven and a non-Merkel cell polyomavirus-driven (primarily sun-dependent) pathway in Merkel cell carcinoma carcinogenesis, with the latter being significantly more frequent in Australia and in mixed squamous-Merkel cell carcinoma (which is also more frequent in Australia). Although immunohistochemistry for Merkel cell polyomavirus seems to be highly specific in all populations, the low incidence of Merkel cell polyomavirus-positive Merkel cell carcinoma in a highly sun-exposed population limits its diagnostic utility in this setting.
最近的研究表明，在 Merkel 细胞癌中检测到 Merkel 细胞多瘤病毒的频率很高。然而，这些研究大多来自欧洲或北美中心，那里的阳光照射相对较少，与高度暴露于阳光下但主要是白皮肤的澳大利亚人群相比，病毒驱动的致癌作用的发生率可能更高。我们在澳大利亚的 3 个主要中心对 104 例 Merkel 细胞癌和 74 例非皮肤小细胞未分化癌进行了 Merkel 细胞多瘤病毒免疫组化检测。19 例（18.3%）Merkel 细胞癌显示 Merkel 细胞多瘤病毒阳性染色，而 1 例（1.3%）小细胞未分化癌呈阳性。所有 15 例（14.3%）具有混合鳞状分化的 Merkel 细胞癌均显示阴性染色。我们仅在 39 例头颈部（暴露于阳光最多的部位）Merkel 细胞癌中的 3 例（7.7%）中发现阳性染色，而在其他部位的 65 例肿瘤中的 16 例（24.6%）中发现阳性染色（P <.05）。我们的研究结果支持 Merkel 细胞多瘤病毒驱动和非 Merkel 细胞多瘤病毒驱动（主要依赖阳光）途径在 Merkel 细胞癌发生中的概念，后者在澳大利亚和混合鳞状 Merkel 细胞癌中更为常见（这在澳大利亚也更为常见）。尽管 Merkel 细胞多瘤病毒免疫组化在所有人群中似乎都具有高度特异性，但在高度暴露于阳光下的人群中，Merkel 细胞多瘤病毒阳性 Merkel 细胞癌的发生率较低，限制了其在这种情况下的诊断实用性。
