背景:慢性炎症性疾病患者发生侵袭性默克尔细胞癌(MCC)的风险较高。糖尿病是一种常见的慢性炎症性疾病,可能与MCC有关;然而,目前尚无乙型肝炎病毒(HBV)感染与MCC之间关联的报道。这三种疾病之间是否存在关联及其作用背后的具体机制值得未来进一步研究。
方法:我们在此报告了一个罕见的MCC与2型糖尿病和慢性HBV感染的亚洲个体的皮外和淋巴结侵犯,但没有免疫抑制或其他恶性肿瘤.这种情况并不常见,文献中很少报道。一名56岁的亚洲男性,其右颊上有明显的肿块,并接受了广泛的切除联合腮腺切除术。颈部淋巴结清扫术,和裂层植皮。根据组织病理学发现,涉及脂肪组织的MCC的诊断,肌肉,神经,并制作腮腺伴淋巴血管侵犯。随后,患者接受放疗,无不良反应。
结论:MCC是一种罕见的,侵袭性皮肤癌,局部复发频繁,淋巴结入侵,和转移,这通常出现在白种人的老年人身上。患有慢性炎性疾病的患者发展为侵袭性MCC的风险较高。诊断可通过组织学和免疫组织化学证实。对于本地化的MCC,手术是首选的治疗选择。然而,对于先进的MCC,放疗和化疗已被证明是有效的。在化疗无效或处于MCC晚期的情况下,免疫治疗在治疗中起着重要作用。和任何罕见疾病一样,MCC的管理对临床医生来说仍然是一个巨大的挑战;因此,后续行动应该是个性化的,未来的进展需要多学科的合作努力。此外,当医生遇到无痛时,应该将MCC纳入他们可能的诊断列表中,快速增长的病变,特别是在慢性HBV感染或糖尿病患者中,因为这些患者更容易受到这种情况的发展,并且它们往往更具攻击性。
BACKGROUND: Patients with chronic inflammatory disorders are at a higher risk of developing aggressive Merkel cell carcinoma (MCC). Diabetes is a common chronic inflammatory disease that is possibly associated with MCC; however, there are still no
reports on the association between hepatitis B virus (HBV) infection and MCC. Whether there is an association between these three diseases and the specific mechanisms behind their effects is worth further research in the future.
METHODS: We herein report a rare
case of MCC with extracutaneous and nodal invasion in an Asian individual with type 2 diabetes mellitus and chronic HBV infection, but no immunosuppression or other malignancies. Such cases are uncommon and have rarely been reported in the literature. A 56-year-old Asian male presented with a significant mass on his right cheek and underwent extensive resection combined with parotidectomy, neck lymphadenectomy, and split-thickness skin grafting. Based on the histopathological findings, a diagnosis of MCC involving the adipose tissue, muscle, nerve, and parotid gland with lymphovascular invasion was made. Subsequently, he received radiotherapy with no adverse reactions.
CONCLUSIONS: MCC is a rare, aggressive skin cancer with frequent local recurrence, nodal invasion, and metastasis, which usually arises in older people of the white race. Patients with chronic inflammatory disorders are at a higher risk of developing aggressive MCC. The diagnosis can be confirmed with histology and immunohistochemistry. For localized MCC, surgery is the preferred treatment option. However, for advanced MCC, radiotherapy and chemotherapy have proven to be effective. In cases where chemotherapy is not effective or in the advanced stages of MCC, immune therapy plays an important role in treatment. As with any rare disease, the management of MCC remains an enormous challenge for clinicians; thus, follow-up should be individualized and future progress needs multidisciplinary collaborative efforts. Furthermore, physicians should include MCC in their list of possible diagnoses when they come across painless, rapidly growing lesions, particularly in patients with chronic HBV infection or diabetes, as these patients are more susceptible to the development of this condition and it tends to be more aggressive in them.