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Authors
Ikeda, Ryoukichi Division of Otolaryngology, Tohoku Medical and Pharmaceutical University
Ohta, Nobuo Division of Otolaryngology, Tohoku Medical and Pharmaceutical University
Fukaya, Sachiko Division of Pathology, Tohoku Medical and Pharmaceutical University
Shoji, Fumi Division of Otolaryngology, Tohoku Medical and Pharmaceutical University
Suzuki, Takahiro Division of Otolaryngology, Tohoku Medical and Pharmaceutical University
Noguchi, Naoya Division of Otolaryngology, Tohoku Medical and Pharmaceutical University
Kakuta, Risako Division of Otolaryngology, Tohoku Medical and Pharmaceutical University
Hayashi, Kazuhiko Division of Molecular Pathology, Department of Pathology, Tottori University Faculty of Medicine Researchers DB KAKEN
Kida, Takayoshi Laboratory of Gastrointestinal Regenerative Medicine, Okayama University of Science
Murakami, Kazuhiro Division of Pathology, Tohoku Medical and Pharmaceutical University
Nakamura, Yasuhiro Division of Pathology, Tohoku Medical and Pharmaceutical University
Keywords
head and neck
lymph node
Merkel cell carcinoma
neck lymph node dissection
neuroendocrin
Abstract
Merkel cell carcinoma (MCC) is a rare but aggressive neuroendocrine skin cancer. To diagnose nodal MCC with an unknown primary disease is challenging, and it has to be separated from other nodal metastatic neoplasms. We report a unique case of nodal MCC in head and neck lesions with an unknown primary. A 70-year-old woman was admitted to our department with a right submandibular mass. Fine needle aspiration biopsy was performed and indicated malignancy. F-18-fluorodeoxyglucose positron emission tomography (PET) demonstrated abnormal accumulation in the right submandibular lymph node, right palatine tonsil, and right thyroid gland. For diagnostics and treatment, bilateral selective neck lymph node dissection, right tonsillectomy, and right thyroidectomy were performed. Histopathological examination revealed that most parts of the submandibular lymph node were occupied by diffuse sheets of tumor cells. Contrary to our expectation, malignant cells were not detected in the right palatine tonsil and right thyroid. Immunohistochemistry demonstrated a marked positive reaction for AE1/AE3, chromogranin A, synaptophysin, cytokeratin 20 (CK20) and CD56 and a negative reaction for vimentin, leucocyte common antigen (LCA), thyroid transcription factor-1 (TTF1) and cytokeratin 7 (CK7) in the tumor cells. Immunostaining of Merkel cell polyomavirus-large T antigen (MCPyV-LT) showed a positive reaction and MCPyV-positive MCCs were assessed by PCR analysis, demonstrating that viral copy number was 12.8 copies per cell. These histological findings confirmed the diagnosis of Merkel cell carcinoma of the lymph node. In cases of tumors in the lymph node with a neuroendocrine appearance in head and neck lesions, it is necessary to eliminate the possibility of metastasis from MCC.
Publisher
Tottori University Medical Press
Content Type
Journal Article
Link
ISSN・ISBN
05135710
NCID
AA00892882
Journal Title
Yonago Acta Medica
Current Journal Title
Yonago Acta Medica
Volume
62
Issue
3
Start Page
258
End Page
262
Patient Report
Published Date
2019-09-13
Publisher-DOI
Text Version
Publisher
Rights
注があるものを除き、この著作物は日本国著作権法により保護されています。 / This work is protected under Japanese Copyright Law unless otherwise noted.
Citation
Ikeda R, Ohta N, Fukaya S, Shoji F, Suzuki T, Noguchi N, et al. Nodal Merkel Cell Carcinoma in Head and Neck Lesions with an Unknown Primary: A Case Report in Light of the Literature. Yonago Acta Medica. 2019;62:258-262.
Department
Faculty of Medicine/Graduate School of Medical Sciences/University Hospital
Language
English