Merkel cell polyomavirus on primary Merkel cell carcinoma of the skin with partial regression after biopsy


Merkel cell polyomavirus on primary Merkel cell carcinoma of the skin with partial regression after biopsy


Irene Moysset,MD (*), Juan Carlos Arias, MD (**); Beatriz Bellosillo, MD; PhD (***)

Department of Pathology (*), General Surgery (**) Consorci Sanitari Integral, L’Hospitalet de Llobregat. Department of Pathology and Molecular Biology (***) Hospital del Mar. Spain.


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Introduction: Merkel cell carcinoma (MCC) is an uncommon primary cutaneous tumour. The majority of these tumour (about 80%) have integration of the polyomavirus DNA into the genome of Merkel cell carcinoma. Reports about at least nine cases of partial regression in primary and or metastatic lesions have been published. It is likely that regression is an immunological response mediated by T cells.

Case Report: We report an 81year old woman who presented with a rapidly growing tumor in the left thigh. An incisional biopsy of the lesion was performed. Histopathologic and immunohistochemically diagnosis were consistent with Merkel cell carcinoma. Scant peritumoral lymphocytic infiltrate was CD3+, CD4+, and scant CD8+ was observed. The reporter test polymerase chain reaction (PCR) for Merkel virus yielded a positive result. Twenty days after the initial biopsy the lesion began to regress.

Conclusion: Merkel cell carcinoma is a rare and aggressive tumour. At least nine cases of partial regression on primary and or metastatic lesions have been published. It is likely that regression is a T cell-mediated immunological response. A reporter test (PCR) for Merkel virus and both types of lymphocytic infiltrate and distribution (intratumoral and peritumoral) in our case very important as there are several known mechanisms that can contribute to cellular immune escape in MCP y V positive Merkel cell carcinoma. Study of integration and regulation of the immunological system implies future development of individually of different immunological therapies.


Keywords: Skin, Merkel cell polyomavirus, Merkel cell carcinoma, partial regression, biopsy


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How to cite this article:

Irene Moysset, Juan Carlos Arias, Beatriz Bellosillo. Merkel cell polyomavirus on primary Merkel cell carcinoma of the skin with partial regression after biopsy. International Journal of Case Reports, 2020 4:129. DOI: 10.28933/ijcr-2020-04-1405


References:

1. Hodgson NC. Merkel cell carcinoma: changing incidence trends. J. Surg Oncol 2005; 89:1-4.
2. Feng H, Suda M, Chang Y, Moore PS. Clonal integration of a polyomavirus in human Merkel cell carcinoma. Science 2008;319:1096-1100.
3. Houben R, Shuda M, Weinkam R et al. Merkel cell polyomavirus-infected Merkel cell carcinoma cells require expression of viral T antigens. J. Virol 2010; 84(14):7064-7072.
4. Pilotti S, Rilke F, Bartoli C et al. Clinicopathologic correlations of cutaneous neuroendocrine Merkel cell carcinoma. J. Clin Oncol 1988;6:1863-1873.
5. Umezawa Y, Ichikawa M, Hirata M et al. Merkel cell tumor with tendency to spontaneous regression. Hijubyoh Shinryoh 1995;17:553-556.
6. Ogiyama Y, Fuijii H, Mori H et al. Partial spontaneous regression in Merkel cell carcinoma. Jpn J Dermatol 1996;106:1097- 1102.
7. Takenaka H, Kishimoto S, Shibagaki R et al. Merkel cell carcinoma with partial spontaneous regression. An immunohistochemical, ultrastructural, and tunnel labellig study. Am J Dermatopathol 1997;19 (6):614-618.
8. Inoue T, Yoneda K, Manabe M et al. Spontaneous regression of Merkel cell carcinoma: a comparative study of TUNEL index and tumor-infiltrating lymphocytes between spontaneous regression and non-regression group. J Dermatol Sci 2000;24:203-211.
9. Kayashima K, Ono T, Johno M et al. Spontaneous regression in Merkel cell (neuroendocrine) carcinoma of the skin. Arch Dermatol 1991;127:550-553.
10. Maruo K, Kayashima K-I, Ono T. Regressing Merkel cell carcinoma a case showing replacement of tumour cells by foamy cells. British Journal of Dermatology 2000;142:1184-1189.
11. O’Rourke MG, Bell JR. Merkel cell tumour with spontaneous regression. J. Dermatol Surg Oncol 1986;12 (9):994-996.
12. Connelly T. Regarding complete spontaneous regression of Merkel cell carcinoma. Dermatol Surg 2009;35:721.
13. Yamamoto M, Inada R, Suehiro A et al. Merkel cell carcinoma with spontaneous regression after skin biopsy. Skin Cancer 1997;12:86-90.
14. Richetta AG, Mancini M. Torroni A, Lorè B et al. Total spontaneous regression of advanced merkel cell carcinoma after biopsy: review and a new case. Dermatol Surg 2008;34(6):815-822.
15. Yagi Y, Fujisawa A, Makiura M, Morita K. Spontaneous regression of Merkel cell carcinoma after biopsy. J Dermatol 2009;36(5):312-313.
16. Sais G, Admella C, Sole T. Spontaneous regression in primary cutaneous neuroendocrine (Merkel cell) carcinoma: a rare immune phenomenon? JEADV 2002;16:81-84.
17. Sihto H, Böhling T, Kavola H et al. Tumor infiltrating immune cells and outcome of Merkel Cell Carcinoma: A population-based study. Clin Cancer Res 2012;18:2872-2881
18. Kelly G. Paulson, Jayasri G. Iyer, Andrew R. Tegeder et al. Transcriptone-wide studies of Merkel cell carcinoma and validation of intratumoral CD8+ lymphocyte invasion as an independent predictor of survival. Journal of Clinical Oncology 2011;29(12):1539-1546.
19. Haque M, Ueda K, Nakano K et al. Major histocompatibility complex class I molecules are down-regulated at the cell surface by the K5 protein encoded by Kaposi’s sarcoma-associated herpesvirus/human herpesvirus-8. Journal of General Virology 2001;82:1175-1180.
20. Afanasiev OK, Yelistratova L, Miller N et al. Merkel Polyomavirus-Specific T cells fluctuate with Merkel Cell Carcinoma burden and express therapeutically targetable PD-1 and Tim-3 exhaustion markers. Clin Cancer Res 2013;19:5351-5360.
21. Afanasiev OK, Nagase K, Simonson W et al. Vascular E-selectin expression correlates with CD8 lymphocyte infiltration and improved outcome in Merkel cell carcinoma. J Invest Dermatol 2013;133(8):2065-2073