Merkel cell carcinoma presenting as a malignant pleural effusion post-COVID-19 hospitalization: A case report and literature review

Published on Oct 5, 2021in Diagnostic Cytopathology1.582
· DOI :10.1002/DC.24882
Joel Lanceta (Staten Island University Hospital), Mesut Toprak6
Estimated H-index: 6
(Staten Island University Hospital),
Oana Rosca2
Estimated H-index: 2
(Staten Island University Hospital)
Merkel cell carcinoma (MCC) is a rare, highly aggressive neuroendocrine carcinoma of the skin, associated with immunosuppression, UV light exposure, and the Merkel cell polyomavirus (MCPyV). Cases of metastatic MCC diagnosed in body fluid cytology are extremely rare; only five cases have been reported previously in the English literature. We present a case of a 65-year-old male with acute respiratory failure and an enlarged right pleural effusion. He had two hospitalizations for COVID-19 pneumonia 2 months prior, for which he received steroid treatment and tocilizumab. Emergent thoracentesis was done, with pleural fluid sent for cytologic evaluation. Both the Papanicolaou stained ThinPrep slide and cell block demonstrated clusters of predominantly small to medium sized blue round cells with hyperchromatic nuclei, scant cytoplasm and fine chromatin, in a background of rare mesothelial cells, macrophages and numerous lymphocytes. Tumor cells were positive for CD56, chromogranin, synaptophysin, SAT2B, MCPyV, and CK20 in perinuclear dot like pattern, while negative for TTF-1 and CD45 immunostains. Ki67 proliferative index was approximately 40%. The patient had a history of MCC of the right ulnar forearm 4 years before the current presentation, which was unknown to us at the time of cytologic evaluation. To the best of our knowledge, this is the sixth case of metastatic MCC diagnosed by fluid cytology and the first reported in a patient receiving immunosuppressive treatment for COVID-19. Further reporting of such cases may increase awareness, especially when prior history is not readily available, such as in our case.
#1Elise Kaspi (AMU: Aix-Marseille University)H-Index: 10
#2Shirley FritzH-Index: 1
Last. Patrice Roll (AMU: Aix-Marseille University)H-Index: 19
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#1Sean Hacking (Hofstra University)H-Index: 4
#2Hector Chavaria (Hofstra University)H-Index: 1
Last. Kasturi Das (Hofstra University)H-Index: 8
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Merkel cell carcinoma (MCC) is a rare entity that most commonly arises from the skin. Angiosarcoma (AS) is a rare malignancy with a predilection for elderly males, has endothelial differentiation a...
#1Aaron Jonathan Hughes (St. George's University)H-Index: 2
#2Matthew French (Croydon University Hospital)H-Index: 1
Last. Manuraj Singh (St. George's University)H-Index: 4
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#1Andrew M. Bellizzi (UIHC: University of Iowa Hospitals and Clinics)H-Index: 28
AIMS: Special AT-rich sequence-binding protein 2 (SATB2) is a transcriptional regulator with critical roles in brain, craniofacial and skeletal development. It has emerged as a key marker of lower gastrointestinal (GI) tract columnar epithelial and osteoblastic differentiation. Transcription factor immunohistochemistry is useful in assigning site of origin in well-differentiated neuroendocrine tumours (NETs), and has had a limited role in poorly differentiated neuroendocrine carcinomas (NECs). T...
#1Thibault Kervarrec (François Rabelais University)H-Index: 11
#2Anne Tallet (François Rabelais University)H-Index: 6
Last. Serge Guyétant (François Rabelais University)H-Index: 25
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Merkel cell carcinoma is a rare neuroendocrine carcinoma of the skin mostly induced by Merkel cell polyomavirus integration. Cytokeratin 20 (CK20) positivity is currently used to distinguish Merkel cell carcinomas from other neuroendocrine carcinomas. However, this distinction may be challenging in CK20-negative cases and in cases without a primary skin tumor. The objectives of this study were first to evaluate the diagnostic accuracy of previously described markers for the diagnosis of Merkel c...
#1Seoyoung C. Kim (Brigham and Women's Hospital)H-Index: 43
#2Ajinkya Pawar (Brigham and Women's Hospital)H-Index: 12
Last. Sebastian Schneeweiss (Brigham and Women's Hospital)H-Index: 113
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Abstract Objectives To examine the rate of incident malignancies excluding non-melanoma skin cancer (NMSC) in patients with rheumatoid arthritis (RA) newly treated with tocilizumab versus other biologic drugs. Methods We conducted a cohort study using data from 3 U.S. insurance claims databases – Medicare (2010–2015), ‘IMS’ PharMetrics Plus (2011–2015) and Truven ‘MarketScan’ (2011–2015). Adults with RA who newly started tocilizumab or a TNF inhibitor (TNFi) after failing a different TNFi, abata...
#1Wei Liu (UPenn: University of Pennsylvania)H-Index: 7
#2Nathan A. Krump (UPenn: University of Pennsylvania)H-Index: 6
Last. Jianxin You (UPenn: University of Pennsylvania)H-Index: 23
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Merkel cell polyomavirus (MCPyV) infection can lead to Merkel cell carcinoma (MCC), a highly aggressive form of skin cancer. Mechanistic studies to fully investigate MCPyV molecular biology and oncogenic mechanisms have been hampered by a lack of adequate cell culture models. Here, we describe a set of protocols for performing and detecting MCPyV infection of primary human skin cells. The protocols describe the isolation of human dermal fibroblasts, preparation of recombinant MCPyV virions, and ...
#1Justin P. BandinoH-Index: 4
#2Caitlin G. Purvis (USC: University of South Carolina)H-Index: 1
Last. Dirk M. ElstonH-Index: 28
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Background:Merkel cell carcinoma (MCC) is a rare neuroendocrine cutaneous malignancy that shares cytologic, histopathologic, and immunohistochemical features with other small round blue cell (SRBC) tumors. Although the trabecular pattern is anecdotally associated with MCC, objective data are lacking
#1Graeme Jones (Hobart Corporation)H-Index: 97
#2Elena Panova (Hobart Corporation)H-Index: 3
Rheumatoid arthritis is a leading musculoskeletal cause of disability in Western society. Therapeutic options have expanded rapidly with the advent of biological agents as treatment options. One of these, tocilizumab, targets the interleukin-6 receptor and has been approved since the late 2000s in many jurisdictions. This approval was based on 6-12 month trials. It is now appropriate to look at longer-term studies and what new insights they have provided into this agent. Data are based largely o...
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