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{{Merkel cell cancer}}
{{Merkel cell cancer}}
{{CMG}}
{{CMG}} {{AE}} {{VKG}}
==Overview==
==Overview==
[[Merkel cell carcinoma]] is classified into 3 subgroups: trabecular, intermediate, and small cell.
==Classification==
==Classification==
Histologically, MCC has been classified into three distinct subtypes:
Histologically, [[MCC]] has been classified into three distinct subtypes:<ref name="pmid16466578">{{cite journal |vauthors=Koljonen V |title=Merkel cell carcinoma |journal=World J Surg Oncol |volume=4 |issue= |pages=7 |date=February 2006 |pmid=16466578 |pmc=1382229 |doi=10.1186/1477-7819-4-7 |url=}}</ref><ref name="pmid3724197">{{cite journal |vauthors=Suster S, Ronnen M, Lin E, Shewach-Millet M |title=Trabecular carcinoma of the skin simulating metastatic disease |journal=J Surg Oncol |volume=32 |issue=2 |pages=73–5 |date=June 1986 |pmid=3724197 |doi= |url=}}</ref><ref name="pmid1698390">{{cite journal |vauthors=Johansson L, Tennvall J, Akerman M |title=Immunohistochemical examination of 25 cases of Merkel cell carcinoma: a comparison with small cell carcinoma of the lung and oesophagus, and a review of the literature |journal=APMIS |volume=98 |issue=8 |pages=741–52 |date=August 1990 |pmid=1698390 |doi= |url=}}</ref>
* Trabecular: classic pattern, large-cell type, high density or granules on ultrasound examination.
{| class="wikitable"
* Intermediate: solid pattern (most common).
|+
* Small cell: diffuse, few high density granules on ultrasound examination (second most common).
!Subtype
==Staging==
!Pattern
 
!Histology studies
* According to the [TNM staging system], there are four stages of Merkel cell carcinoma based on the tumor size, presence of [[lymph nodes]] and [[metastasis]]. Each stage is assigned a letter/number.
* The stages of Merkel cell carcinoma are shown in the table below: <ref>{{Cite web | title = Merkel cell carcinoma| url = http://www.merkelcell.org/staging/}}</ref>
 
{| {{table}}
| align="center" style="background:#f0f0f0;"|'''Stage'''
| align="center" style="background:#f0f0f0;"|'''Primary Tumor'''
| align="center" style="background:#f0f0f0;"|'''Lymph Node'''
| align="center" style="background:#f0f0f0;"|'''Metastasis'''
|-
| 0||In situ primary tumor||No regional lymph node metastasis||No distant metastasis
|-
| IA||Less than or equal to 2 cm maximum tumor dimension||Nodes negative by pathologic exam||No distant metastasis
|-
|-
| IB||Less than or equal to 2 cm maximum tumor dimension||Nodes negative by clinical exam (no pathologic node exam performed)||No distant metastasis
|'''Trabecular type'''
|Classic pattern
|
* Large-cells
* High density [[granules]]
* Organoid [[Cluster (epidemiology)|clusters]] of cells
* [[Trabeculae]] with ribbons
* Most commonly occurs in [[hair follicles]]
|-
|-
| IIA||Greater than 2 cm tumor dimension||Nodes negative by pathologic exam||No distant metastasis
|'''Intermediate''' '''type'''
|[[Solid]] pattern
|
* Most common subtype
* Compactly arranged cells
* [[Cytoplasm]] is less abundant in the cells
* [[Mitotic]] figures are positive 
* [[Necrosis]] is positive 
* Intermediate type may invade the [[Epidermis (skin)|epidermis]]
* More aggressive subtype when compared to the trabecular type 
*
|-
|-
| IIB||Greater than 2 cm tumor dimension||Nodes negative by clinical exam (no pathologic node exam performed)||No distant metastasis
|'''Small cell type'''
|-
|[[Diffuse]] pattern
| IIC||Primary tumor invades bone, muscle, fascia, or cartilage||No regional lymph node metastasis||No distant metastasis
|
|-
* Few high density [[granules]]
|  IIIA||Any size tumor (includes invading tumors)||Micrometastasis (diagnosed after sentinel or elective lymphadenectom)||No distant metastasis
* Arises in the [[dermis]]
|-
* Sheets of solid and clusters of cells
|  IIIB||Any size tumor (includes invading tumors)||Macrometastasis (defined as clinically detectable nodal metastases confirmed by therapeutic lymphadenectomy or needle biopsy) OR In transit metastasis (a tumor distinct from the primary lesion and located either between the primary lesion and the draining regional lymph nodes or distal to the primary lesion)||No distant metastasis
* Mimics other small cell tumours
|-
|  IV||Any size tumor (includes invading tumors)||Any lymph node metastasis||Metastasis beyond regional lymph nodes
|}
|}
''Adapted from AJCC's Cancer Staging Manual 2009''


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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[[Category:Disease]]
[[Category:Disease]]
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[[Category:Dermatology]]
[[Category:Surgery]]

Latest revision as of 15:35, 9 January 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Vamsikrishna Gunnam M.B.B.S [2]

Overview

Merkel cell carcinoma is classified into 3 subgroups: trabecular, intermediate, and small cell.

Classification

Histologically, MCC has been classified into three distinct subtypes:[1][2][3]

Subtype Pattern Histology studies
Trabecular type Classic pattern
Intermediate type Solid pattern
  • Most common subtype
  • Compactly arranged cells
  • Cytoplasm is less abundant in the cells
  • Mitotic figures are positive
  • Necrosis is positive
  • Intermediate type may invade the epidermis
  • More aggressive subtype when compared to the trabecular type
Small cell type Diffuse pattern
  • Few high density granules
  • Arises in the dermis
  • Sheets of solid and clusters of cells
  • Mimics other small cell tumours

References

  1. ↑ Koljonen V (February 2006). "Merkel cell carcinoma". World J Surg Oncol. 4: 7. doi:10.1186/1477-7819-4-7. PMC 1382229. PMID 16466578.
  2. ↑ Suster S, Ronnen M, Lin E, Shewach-Millet M (June 1986). "Trabecular carcinoma of the skin simulating metastatic disease". J Surg Oncol. 32 (2): 73–5. PMID 3724197.
  3. ↑ Johansson L, Tennvall J, Akerman M (August 1990). "Immunohistochemical examination of 25 cases of Merkel cell carcinoma: a comparison with small cell carcinoma of the lung and oesophagus, and a review of the literature". APMIS. 98 (8): 741–52. PMID 1698390.
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