PMC8495228_01
Pre-surgery photography of ulcerated violet tumor of the right zygomatic region.
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She underwent incisional biopsy under surgical services and was referred to our oncology service (Figure 1).
Contrast-enhanced CT of the head demonstrates a large vaulted solid heterogeneously enhancing mass lesion (size 45x35 mm) in the right infraorbital space with thinning the wall of the maxillary sinus. There is minimal mucosal thickening in the left maxillary sinus and nasal cavity.
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Contrast enhanced CT demonstrated large prominent lesion of the right zygomatic region with adjacent bone invasion but showed no distant metastatic spread (Figure 2).
Axial enhanced T1-weighted MR imaging demonstrates a circumscribed enhancing tumor extending from subcutaneous tissue in the right infraorbital space (size 42x31 mm) with oppression of the anterior wall of the maxillary sinus.
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MRI of the head region confirmed this finding in the right zygomatic region (Figure 3).
Incisional biopsy (HE, 40x): specimen taken from the center of the tumor mass. Malignant solid tumors involved dermis and margin.
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Tumor cells stained for CD56, as well as synaptophysin and chromogranin (Figures 4-7).
Merkel cell carcinoma. Detail 400x. Small to medium-sized tumor cells with inconspicuous cytoplasm display a salt-and-pepper chromatin pattern.
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Tumor cells stained for CD56, as well as synaptophysin and chromogranin (Figures 4-7).
Merkel cell carcinoma. Detail 400x. Immunoexpression of CK20 in the tumor cells in a characteristic perinuclear dot-like pattern.
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Tumor cells stained for CD56, as well as synaptophysin and chromogranin (Figures 4-7).
Merkel cell carcinoma. Detail 400x. Tumor cells are immunoreactive for neuroendocrine marker CD56 (as well as synaptophysin and chromogranin, not shown).
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Tumor cells stained for CD56, as well as synaptophysin and chromogranin (Figures 4-7).
Excisional biopsy (HE, 20x). Regressive changes in the dermis, represented by fibrotization, permeated by chronic inflammatory infiltrate, sporadic neutrophils, and giant cell response. The epidermis histologically corresponds to inflamed seborrheic keratosis, with undulated and slightly acanthotic epithelium, with marked hyperkeratosis and formation of keratin pseudocysts, partially covered with mixed inflammatory exudate.
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No MCC cells were found in the specimen anymore (Figures 8 and 9).
Detail, HE, 200x. Chronic inflammatory infiltrate consists of a mixture of T- and B-lymphocytes, with numerous plasma cells and histiocytes. Focal giant cell reaction and neutrophils. Residual Merkel cell carcinoma was excluded by negativity with cytokeratins (OSCAR, CK20) and neuroendocrine markers (synaptophysin, chromogranin).
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No MCC cells were found in the specimen anymore (Figures 8 and 9).
First follow- up control, 3 months after plastic surgery. Skin flap covering the original tumor bed, no evidence of local disease progression.
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After surgery, she was well and was attending our follow-up clinic (Figure 10).