PMC6528093_01
a Dome-shaped purplish tumor on the scalp with focally hemorrhagic surface. b Tumor recurrence during the pregnancy invading the scalp and neck lymph nodes.
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F1
The tumor was tender, ulcerative and showed signs of secondary bacterial infection (Fig. 1a). Her general condition deteriorated drastically during the pregnancy and she had a recurrence of the tumor 5 months later with extensive lymph node involvement as demonstrated by PET-CT scanning (Fig. 1b, Fig. 3b).
a Extensive dermal invasion by MCC. A vaguely nested to more sheet-like growth pattern is seen (hematoxylin and eosin). b Associated multicentric, moderately differentiated keratinized SCC (hematoxylin and eosin). c Dot-like positivity for CK20 (original magnification x40). d Extensive positivity for synaptophysin stain (original magnification x20). e Variable positivity for neuron-specific enolase stain (original magnification x40). f Positive CD56 staining intensely and diffusely labeling cell membranes of tumor cells (original magnification x40). g Neurosecretory granules of the tumor cells illustrated on electron microscopy.
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F2
Histological examination of the scalp tumor showed an exophytic, ulcerated nodule consisting of extensively invaded dermis by a poorly differentiated tumor (Fig. 2a). Furthermore, a multicentric, moderately differentiated, keratinized SCC was seen adjacent to the tumor (Fig. 2b). Immunoperoxidase stains revealed paranuclear dot-like positivity for cytokeratin CK20 (Fig. 2c), extensive positivity for neuroendocrine markers: synaptophysin and neuron-specific enolase, and for CD56 (Fig. 2d, e, f). The electron microscopy illustrated neurosecretory granules within the cytoplasm (Fig. 2g) confirming the diagnosis of MCC.
a Primary tumor: coronal post-contrast image with left scalp mass confined to the soft tissues. b Recurrent tumor: coronal post-contrast image demonstrating a new nonhomogeneous mass in the left preauricular/parotid area, adjacent and inferior to the previous lesion site. Left level IV cervical lymph node is present (thin arrow). Left jugular vein displacement (thick arrow).
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F3