Scientific letter
Merkel cell carcinoma caused by Merkel cell polyomavirus following trauma
Carcinoma de células de Merkel por poliomavirus de células de Merkel tras traumatismo
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Visual acuity RE 20/100 LE Hand motion.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Gema Fernández-Rivas, Pablo Diaz-Aljaro, Marta Ávila, Susana Ruiz-Bilbao" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Gema" "apellidos" => "Fernández-Rivas" ] 1 => array:2 [ "nombre" => "Pablo" "apellidos" => "Diaz-Aljaro" ] 2 => array:2 [ "nombre" => "Marta" "apellidos" => "Ávila" ] 3 => array:2 [ "nombre" => "Susana" "apellidos" => "Ruiz-Bilbao" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529993X20300368?idApp=UINPBA00004N" "url" => "/2529993X/0000003800000003/v1_202003050625/S2529993X20300368/v1_202003050625/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific letter</span>" "titulo" => "Merkel cell carcinoma caused by Merkel cell polyomavirus following trauma" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "138" "paginaFinal" => "139" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Marta E. Álvarez-Argüelles, Susana Rojo Alba, Blanca Vivanco Allende, Santiago Melón García" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Marta E." "apellidos" => "Álvarez-Argüelles" "email" => array:1 [ 0 => "martaealvarez@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Susana" "apellidos" => "Rojo Alba" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Blanca" "apellidos" => "Vivanco Allende" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Santiago" "apellidos" => "Melón García" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Microbiología, Hospital Universitario Central de Asturias, Oviedo, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Universitario Central de Asturias, Oviedo, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Carcinoma de células de Merkel por poliomavirus de células de Merkel tras traumatismo" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1667 "Ancho" => 1667 "Tamanyo" => 951981 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(a) Image of cutaneous tumour which affected the dermis but not the epidermis showing the widespread growth of small round cells (haematoxylin eosin ×20). (b) Detail of the widespread growth of cells with little cytoplasm and granular chromatin nucleus with abundant mitosis and apoptosis. (c) Widespread positive Ck20 staining shown by paranuclear “dots” (Cytokeratin-20 ×400). (d). Ki67 staining showing elevated proliferation activity of around 80% (Ki67 ×400).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Merkel cell carcinoma (MCC) is a rare aggressive neuroendocrine tumour. Prognosis is poor and metastasis frequent. Merkel cell polyomavirus (MCPyV) is the principal aetiological agent, involved in 80% of cases.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> Pathogenesis is not well understood and there is no one agreed management.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of a 65-year old woman presenting in the emergency department with a circular, raised pigmented skin lesion of 2.0<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>2.0<span class="elsevierStyleHsp" style=""></span>cm, without signs of infection, on her left forearm which had appeared following a trauma three months earlier. Physical examination revealed no evidence of axillary adenopathy.</p><p id="par0015" class="elsevierStylePara elsevierViewall">An excisional biopsy was conducted under local anaesthetic and sent to the anatomical pathology service. Examination revealed MCC with dermal proliferation and subcutaneous cellular tissue comprising small round cells with a penetrating nodular growth pattern and a rate of 7<span class="elsevierStyleHsp" style=""></span>mitosis/mm<span class="elsevierStyleSup">2</span>, but no vascular or perineural invasion. Immunohistochemistry staining was positive for cytokeratin-20 in the form of paranuclear “dots” throughout the tumour, 80% of which stained positive for K167, and for synaptophysin and neuronal specific erolase (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Because tumoral edges were found in this sample, a second more extensive excision was performed. A core needle biopsy of the left axillary ganglion proved negative. One month later a PEC-TC was conducted and no metastasis at the axillary ganglion was found.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The first biopsy underwent genome purification (MagnaPureLC2.0, Roche) following overnight digestion with proteinaseK and trypsin. Genetic material was added to a PCR-TR mixture with MCPyV-specific primers and MGB-specific probes which targeted the VP1 gene,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> following the protocol of the laboratory. The betaglobin gene was also amplified simultaneously to test sample quality and obtain a normalised viral load should MCPyV be present.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The amplification identified 94,717,3416 (7.98log)copies/10<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>cells of MCPyV.</p><p id="par0030" class="elsevierStylePara elsevierViewall">MCC can often be confused with melanoma or lymphoma. Although the literature suggests MCC is more common in men, in this case the patient's age and the features and location of the lesion led to MCC being considered, and confirmed: patient over 50 years; painless, fast growing lesion on upper limb;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> lesion measuring more than average tumour size at diagnosis (1.7<span class="elsevierStyleHsp" style=""></span>cm), alongside presence of MCPyV.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In most cases, cell transformation occurs through virus replication in mechanoreceptors<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a> and other cell types.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a> However, the specifics of MCPyV host cell tropism(s) remain unclear, and it may be that the mechanism is mediated by oncogenes. One known trigger is UVA light although other trigger mechanisms have been identified in experimental trials,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> including, as in this case, trauma injury. That said, only one other clinical similar case has been described in the literature, in a patient who received a blow to an area affected by Bowen's disease.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In general MCCs produced by MCPyV have a better prognosis<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> when detected and diagnosed early, mortality being 30% at 2 years in such circumstances compared to 50% in patients diagnosed at advanced stages, where life expectancy can be as little as 9 months following diagnosis.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">There is no consensus in terms of treatment for MCC, although surgery is recommended at diagnosis, which may be complemented with radiotherapy and/or chemotherapy.</p><p id="par0050" class="elsevierStylePara elsevierViewall">With this patient, two excisions were carried out as the first showed the tumour edges were affected. The second was thus made employing a safety margin of 1–2<span class="elsevierStyleHsp" style=""></span>cm.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a> Since no metastasis was found, radiotherapy or any other therapy was delayed.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The high viral load found suggests very active viral reproduction, and could imply rapid clinical progression (as is usual with this type of tumour). It also indicates the lesion was at an early stage, as does the absence of any metastasis in the axillary ganglion, which is observed in 70% of patients at diagnosis, and thus surgery was considered sufficient treatment to eradicate the tumour.</p><p id="par0060" class="elsevierStylePara elsevierViewall">In conclusion, in undifferentiated skin lesions, when other common pathologies can be discounted and the patient has experienced a trauma, MCC should be considered and MCPyV tested for early.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0065" class="elsevierStylePara elsevierViewall">There is no external funding source.</p><p id="par0070" class="elsevierStylePara elsevierViewall">This study has been approved by the Ethics Committee of the Central University Hospital of Asturias (HUCA).</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interest</span><p id="par0075" class="elsevierStylePara elsevierViewall">No.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflict of interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1667 "Ancho" => 1667 "Tamanyo" => 951981 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(a) Image of cutaneous tumour which affected the dermis but not the epidermis showing the widespread growth of small round cells (haematoxylin eosin ×20). (b) Detail of the widespread growth of cells with little cytoplasm and granular chromatin nucleus with abundant mitosis and apoptosis. (c) Widespread positive Ck20 staining shown by paranuclear “dots” (Cytokeratin-20 ×400). (d). Ki67 staining showing elevated proliferation activity of around 80% (Ki67 ×400).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0045" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Frequent detection of Merkel cell polyomavirus in human Merkel cell carcinomas and identification of a unique deletion in the VP1 gene" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Kassem" 1 => "A. Schopflin" 2 => "C. Diaz" 3 => "W. Weyers" 4 => "E. Stickeler" 5 => "M. 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| 2024 July | 9 | 3 | 12 |
| 2024 June | 7 | 6 | 13 |
| 2024 May | 11 | 1 | 12 |
| 2024 April | 9 | 3 | 12 |
| 2024 March | 13 | 3 | 16 |
| 2024 February | 8 | 6 | 14 |
| 2024 January | 9 | 3 | 12 |
| 2023 December | 9 | 2 | 11 |
| 2023 November | 12 | 4 | 16 |
| 2023 October | 18 | 2 | 20 |
| 2023 September | 13 | 2 | 15 |
| 2023 August | 9 | 1 | 10 |
| 2023 July | 4 | 1 | 5 |
| 2023 June | 8 | 1 | 9 |
| 2023 May | 15 | 1 | 16 |
| 2023 April | 13 | 0 | 13 |
| 2023 March | 7 | 2 | 9 |
| 2023 February | 13 | 3 | 16 |
| 2023 January | 3 | 4 | 7 |
| 2022 December | 13 | 5 | 18 |
| 2022 November | 11 | 4 | 15 |
| 2022 October | 11 | 7 | 18 |
| 2022 September | 11 | 8 | 19 |
| 2022 August | 14 | 5 | 19 |
| 2022 July | 11 | 6 | 17 |
| 2022 June | 8 | 8 | 16 |
| 2022 May | 8 | 8 | 16 |
| 2022 April | 7 | 5 | 12 |
| 2022 March | 6 | 8 | 14 |
| 2022 February | 7 | 5 | 12 |
| 2022 January | 13 | 6 | 19 |
| 2021 December | 12 | 6 | 18 |
| 2021 November | 7 | 5 | 12 |
| 2021 October | 9 | 9 | 18 |
| 2021 September | 4 | 9 | 13 |
| 2021 August | 5 | 5 | 10 |
| 2021 July | 11 | 6 | 17 |
| 2021 June | 9 | 9 | 18 |
| 2021 May | 17 | 10 | 27 |
| 2021 April | 31 | 11 | 42 |
| 2021 March | 8 | 8 | 16 |
| 2021 February | 14 | 7 | 21 |
| 2021 January | 9 | 5 | 14 |
| 2020 December | 8 | 8 | 16 |
| 2020 November | 11 | 5 | 16 |
| 2020 October | 13 | 0 | 13 |
| 2020 September | 6 | 7 | 13 |
| 2020 August | 1 | 0 | 1 |
Show all
