PMC3420371_01
Computed tomography scan showing the lymph nodes metastases of Merkel cell carcinoma.
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fig1
Cervical ultrasonography and computed tomography scan suggested enlarged cervical lymph nodes (Figure 1).
The dermis shows a proliferation of lobules in a lymphoid background (H&E, original magnification x40).
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fig2
The excised cutaneous specimen showed a dermal carcinomatous proliferation with features of LEL carcinoma, characterized by a nonneoplastic prominent lymphocytic infiltrate intermingled with a poorly differentiated epithelial proliferation with syncytial appearance (Figures 2 and 3).
Tumor cells are pleomorphic with vesicular nuclei and prominent nucleoli (H&E, original magnification x200).
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fig3
The excised cutaneous specimen showed a dermal carcinomatous proliferation with features of LEL carcinoma, characterized by a nonneoplastic prominent lymphocytic infiltrate intermingled with a poorly differentiated epithelial proliferation with syncytial appearance (Figures 2 and 3).
The lymph node is massively infiltrated by a proliferation of monotonous basophilic cells (H&E, original magnification x100).
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fig4
Cervical lymph node was massively infiltrated by a dense carcinomatous proliferation suggesting neuroendocrine differentiation, and it was made of monomorphous small basophilic cells with a very fine chromatin and minimal cytoplasm dispersed in a scanty stroma (Figure 4).
Tumor cells are positive for neurofilament (immunohistochemistry x400).
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fig5
Immunohistochemical stains of the cutaneous tumor and lymph node metastases showed immunoreactivity for neurofilament (Figure 5), chromogranin, synaptophysin, and a characteristic dot-like perinuclear staining for cytokeratin 20 (Figure 6).
Tumor cells are positive for cytokeratin 20 with a dot-like staining (immunohistochemistry x400).
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fig6
Immunohistochemical stains of the cutaneous tumor and lymph node metastases showed immunoreactivity for neurofilament (Figure 5), chromogranin, synaptophysin, and a characteristic dot-like perinuclear staining for cytokeratin 20 (Figure 6).