亚洲免费av电影一区二区三区,日韩爱爱视频,51精品视频一区二区三区,91视频爱爱,日韩欧美在线播放视频,中文字幕少妇AV,亚洲电影中文字幕,久久久久亚洲av成人网址,久久综合视频网站,国产在线不卡免费播放

        ?

        Concurrence of Merkel Cell Carcinoma and Squamous Cell Carcinoma in A Patient with Generalized Actinic Keratosis: A Case Report

        2022-04-15 04:08:02ZhangHuiYueYanWangFangFangJianFangSun
        關(guān)鍵詞:球晶蠟質(zhì)晶體結(jié)構(gòu)

        Zhang-Hui Yue, Yan Wang?, Fang Fang Jian-Fang Sun

        1Department of Pathology,Hospital for Skin Diseases(Institute of Dermatology),Chinese Academy of Medical Sciences and Peking Union Medical College,Nanjing,Jiangsu 210042,China; 2Department of Dermatologic Surgery, Hospital for Skin Diseases (Institute of Dermatology), Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, Jiangsu 210042, China.

        Abstract

        Keywords: Merkel cell carcinoma, squamous cell carcinoma, actinic keratosis, concurrence, case report

        Introduction

        Merkel cell carcinoma (MCC) is a rare cutaneous malignancy that has a high rate of metastasis and mortality and occurs mainly in Caucasians. Although MCC is a neuroendocrine tumor,its specific etiology is unclear and its origin remains controversial. Like actinic keratosis (AK),MCC is often associated with ultraviolet radiation.AK can be regarded as a precancerous lesion of squamous cell carcinoma(SCC),andseveralcasesofmixedMCCandSCC have been reported previously. However, whether MCC can arise from AK remains unclear. We herein describe a Chinese woman with facial MCC and SCC based on AK,which may provide a clue for this question.

        不同結(jié)晶時(shí)間下淀粉球晶熱力學(xué)性質(zhì)如表 2所示。由表2可以看出,淀粉球晶的起糊溫度(To)、峰值溫度(Tp)、終止溫度(Tc)和焓值(△H)顯著高于原淀粉,與Cai等[16]的研究結(jié)果一致;淀粉球晶的起糊溫度隨結(jié)晶時(shí)間的增加而升高,結(jié)晶24 h后淀粉球晶的起糊溫度、峰值溫度、終止溫度和焓值分別達(dá)到75.09 ℃、90.96 ℃、107.03 ℃和17.44 ℃。表明形成的淀粉球晶相對(duì)于蠟質(zhì)玉米淀粉結(jié)構(gòu)較為緊密,在較高溫度下才能破壞晶體結(jié)構(gòu);吸熱焓值和淀粉結(jié)晶度有一定的對(duì)應(yīng)關(guān)系[25],焓值越高,結(jié)晶度也相應(yīng)增加,這和XRD測(cè)得結(jié)果相吻合,也和Liu等[26]報(bào)道的結(jié)果一致。

        Case report

        An 86-year-old woman presented with a 3-year history of multiple dark brown patches on her face and hand. One year before presentation, a coin-sized patch appeared on her left cheek and slowly developed, and the patch easily bled after scratching. No treatment was administered.Lesions on the left cheek and forehead grew quickly in the following months. A dermatological examination was performed(Fig.1A–D),and no other obvious abnormalities were found in a physical examination.

        Figure 1. Clinical manifestations of the patient with the concurrence of generalized actinic keratosis,Merkel cell carcinoma,and squamous cell carcinoma. (A) Two similar cauliflower-shaped tumors were present on the patient’s left cheek and temple (3.0×4.5 and 3.0×2.0cm2,respectively).(B)Brown papules were scattered on her face and neck.(C and D)Several conical elevated lesions with scales were present on her right hand.

        A biopsy specimen taken from the patch two years ago revealed a diagnosis of AK(Fig.2A).Considering a clinical diagnosis of SCC, both tumors on her face were resected with a 1-cm margin.The histological characteristics of the left facial tumor suggested SCC (Fig. 2B), and immunohistochemical staining showed cytokeratin (CK) 20 positivity (Fig. 2C). The malignant cells were strongly positive for CAM5.2 (Fig. 2D) and partially positive for CD56 but negative for CK7,SOX-10,CK5/6,and S-100;these results confirmed the diagnosis of primary MCC.Additionally, based on the clinicopathological features of the frontal tumor, the diagnosis of SCC was confirmed(Fig.2E).The specimens from the patient’s right hand were pathologically diagnosed as AK (Fig. 2F). We recommended a combination of radiotherapy and chemotherapy after regional lymph node dissection, but the patient refused this treatment. She took Chinese herbal medicine for the next few years, and no abnormalities were noted after 3years of follow-up.The patient gave her agreement for this publication.

        Discussion

        Typical MCC usually presents in older patients with light skin tones and ranges in size from<1 to>2cm,appearing as a rapidly growing, painless, firm, nontender, shiny,flesh-colored, or bluish-red intracutaneous nodule that is most often located in sun-exposed areas.1The incidence has reportedly increased in the United States and European countries2but only a few cases of MCC have been reported in the Chinese population.

        The diagnosis of MCC mainly depends on histological findings. MCC typically presents as a dermal mass that frequently extends into the subcutis.The tumor is composed of strands or nests of monotonously uniform round blue cells containing minimal cytoplasm and large basophilic nuclei with powdery dispersed chromatin and inconspicuous nucleoli.3The three main histologic patterns of MCC,namely the intermediate type,small cell type,and trabecular type, may help differentiate it from other entities.3Immunoreactivity for CK20 and CK5/6 distinguishes MCC from other undifferentiated tumors.CK20 is a fairly specific and sensitive marker for MCC and exhibits a characteristic paranuclear dot-like staining pattern.3In the present case,small cell lung cancer was excluded by positive CAM5.2 and CK20 staining. Lymphoma and malignant melanoma can be distinguished by S-100 protein expression.

        Wide excision is the standard approach to the initial management of primary MCCs.A margin of at least 1 to 2cm of normal-appearing skin is recommended.4If the margins are close to or involved with the tumor,postoperative radiotherapy is indicated to increase the probability of achieving local disease control.In 2017,the USA Food and Drug Administration approved the first PD-1 receptor inhibitor,avelumab,for MCC treatment.4This approval has provided a new therapeutic choice for advanced MCCs, but avelumab is not yet available in China.The prognosis of MCC depends on diverse factors,including its histologic features, its Merkel cell polyomavirus (MCPyV) status, and the patient’s immune status.MCPyV-positive MCCs account for 80%of all MCCs and often have a better prognosis.5Although the 5-year overall survival rate is usually<55.8%,5localized primary tumors can be indolent and well-controlled with wide local excision alone in some patients.

        Figure 2. Histopathologic findings of the patient with the concurrence of generalized actinic keratosis,Merkel cell carcinoma,and squamous cell carcinoma.(A)A biopsy specimen was taken from the left cheek 1year before presentation revealed a diagnosis of actinic keratosis.(B)Small cell carcinoma was shown by H&E staining(×100).(C)CK20 was weakly positive with a paranuclear dot pattern(×400).(D)CAM5.2 was positive(×400).(E)Marked cytologic atypia and keratosis were present in the tumor tissue,and solar keratosis-like changes could be seen in part of the epidermis, revealing SCC (H&E stain, ×400). (F) Actinic keratosis was present on the left hand (H&E stain, ×400).

        MCCs occasionally coexist with other cutaneous tumors, such as basal cell carcinoma, SCC, AK, and seborrheic keratosis.MCC/SCC is the most common type of MCC-combined tumor with strong p53 and p63 labeling and MCPyV negativity.6Regrettably,an MCPyV detection test is not available in our institution.Ultraviolet irradiation and immunosuppression may be involved in the carcinogenesis of MCPyV-negative cases. In our case,the original AK lesion became MCC, and SCC occurred independently.Whether MCC transformed from AK in the present case is unclear because there was no continuity in the two cell types or the nonexistence of transitional cells.Based on the above theories and findings,we speculate that the three tumors in our patient originated from two distinct precursor cells and were influenced by a common carcinogen; alternatively, they may have arisen from the same pluripotent epidermal stem cell as a common reaction to chronic exposure to ultraviolet light and MCPyV.

        In summary,the present case is very unusual because this is a Chinese patient reported to have co-occurrence of AK,SCC, and MCC. One of the original hypotheses of MCC might be supported by our patient’s history of a general distribution of AK and the development of MCC at a site originally exhibiting AK. However, further research is needed to confirm our conjectures.

        猜你喜歡
        球晶蠟質(zhì)晶體結(jié)構(gòu)
        大麥表皮蠟質(zhì)組分及晶體結(jié)構(gòu)的差異性分析
        球晶的結(jié)構(gòu)和形成機(jī)理
        化學(xué)軟件在晶體結(jié)構(gòu)中的應(yīng)用
        淀粉球晶的制備及其理化性質(zhì)
        PLA/Talc復(fù)合材料結(jié)晶動(dòng)力學(xué)研究
        旗葉蠟質(zhì)含量不同小麥近等基因系的抗旱性
        鎳(II)配合物{[Ni(phen)2(2,4,6-TMBA)(H2O)]·(NO3)·1.5H2O}的合成、晶體結(jié)構(gòu)及量子化學(xué)研究
        含能配合物Zn4(C4N6O5H2)4(DMSO)4的晶體結(jié)構(gòu)及催化性能
        生物酶法制備蠟質(zhì)玉米淀粉納米晶及其表征
        鑒定出紐荷爾臍橙果皮蠟質(zhì)中的六甲氧基黃酮
        亚洲国产精品激情综合色婷婷| 特黄aa级毛片免费视频播放| 久久精品国产精品亚洲婷婷| 国产午夜视频高清在线观看| 图片小说视频一区二区| 久久亚洲国产成人精品性色| 熟妇无码AV| 亚洲色图少妇熟女偷拍自拍 | 热re99久久精品国产99热| 青青草视频华人绿色在线| 伊人狼人大香线蕉手机视频| 精品亚洲成a人在线观看| 亚洲综合色自拍一区| av资源在线看免费观看| 国产女人av一级一区二区三区| 中文字幕在线观看| 欧美人妻精品一区二区三区| 国产精品女同久久免费观看 | 国产无套中出学生姝| 亚洲欧美日韩人成在线播放| 亚洲精品国产老熟女久久| 深夜日韩在线观看视频| 熟妇人妻无码中文字幕老熟妇 | 97日日碰日日摸日日澡| 国产成人精品一区二三区在线观看| 国产高清在线观看av片| 国内精品无码一区二区三区| 九月色婷婷免费| 女同性恋一区二区三区av| 精品久久久无码中字| 亚洲情a成黄在线观看动漫尤物| 国产av一区二区制服丝袜美腿| 久久久久88色偷偷| 亚洲成a人v欧美综合天堂麻豆 | 久久国产亚洲av高清色| 2021国产精品视频网站| 免费人成无码大片在线观看| 国产极品美女到高潮视频| 激情五月开心五月麻豆| 亚洲成人色区| 成人永久福利在线观看不卡|