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{{Merkel cell cancer}}
{{Merkel cell cancer}}
{{CMG}} {{AE}} {{VKG}}
==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:
 
{| {{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
|-
| IIA||Greater than 2 cm tumor dimension||Nodes negative by pathologic exam||No distant metastasis
|-
|-
| IIB||Greater than 2 cm 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]]
|-
|-
| IIC||Primary tumor invades bone, muscle, fascia, or cartilage||No regional lymph node metastasis||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 
*
|-
|-
|   IIIA||Any size tumor (includes invading tumors)||Micrometastasis**||No distant metastasis
|'''Small cell type'''
|-
|[[Diffuse]] pattern
|  IIIB||Any size tumor (includes invading tumors)||"Macrometastasis*** -OR- In transit metastasis****"||No distant metastasis
|
|-
* Few high density [[granules]]
|  IV||Any size tumor (includes invading tumors)||Any lymph node metastasis||Metastasis beyond regional lymph nodes
* Arises in the [[dermis]]
* Sheets of solid and clusters of cells
* Mimics other small cell tumours
|}
|}


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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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.