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Presented by Ralph Hruban, M.D. and prepared by Natasha Rekhtman, M.D., Ph.D.
Case 4: This elderly patient developed a rapidly growing arm mass.
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1. Question
Week 230: Case 4
This elderly patient developed a rapidly growing arm mass.images/07 11 05 case 4 1.jpg
images/07 11 05 case 4 2.jpg
images/07 11 05 case 4 3.jpg
images/07 11 05 case 4 4.jpgCorrect
Answer: Merkel cell carcinoma
Histology: This neoplasm is composed of sheets of pleomorphic cells with large nuclei and “opaque glass-like” dispersed chromatin.
Discussion: Merkel cell carcinomas are primary neuroendocrine cancer of the skin. In addition their characteristic nuclear features, Merkel cell carcinoma are usually immunoreactive for chromogranin, synaptophysin and CK20 (in a dot like pattern). Other neoplasms in the differential diagnosis lymphoma (which would be CLA positive); Ewings group sarcoma (which would be 12E7 positive) and melanoma.
Incorrect
Answer: Merkel cell carcinoma
Histology: This neoplasm is composed of sheets of pleomorphic cells with large nuclei and “opaque glass-like” dispersed chromatin.
Discussion: Merkel cell carcinomas are primary neuroendocrine cancer of the skin. In addition their characteristic nuclear features, Merkel cell carcinoma are usually immunoreactive for chromogranin, synaptophysin and CK20 (in a dot like pattern). Other neoplasms in the differential diagnosis lymphoma (which would be CLA positive); Ewings group sarcoma (which would be 12E7 positive) and melanoma.
