- 期刊
Merkel Cell Carcinoma Arising in the Oral Mucobuccal Fold: A Case Report with Immunohistochemical Study
源自口腔黏膜頰側轉摺之莫克細胞瘤病例報告及免疫組織化學研究
摘要
莫克細胞癌(Merkel cell carcinoma)是一種罕見的原發性皮膚小細胞神經內分泌癌，它常發生在頭頸部區域，但很少發生於口腔內。截自目前為止，英文文獻記載之口內莫克細胞癌僅有兩例，本病例且為第二例發生於口腔黏膜頰側轉摺之病例。患者為六十二歲台籍女性，她於三個月前即注意到右頰部有一微痛質地堅實之腫瘤，口內檢查發現此腫瘤位於右下後黏膜頬側轉摺及右下臼齒後區。口內活體切片檢查發現此腫瘤係白大量形態相似，小而圓，細胞質稀少之癌細胞所組成，時常可見典型或非典型細胞分裂；大部分癌細胞緻密聚集形成癌細胞巢侵犯周圍組織。免疫組織化學染色發現癌細胞內含細胞角質及神經元特異性烯醇酶，而且此兩種蛋白質分佈於細胞核旁，成小球狀，類似包涵體，上述細胞化學特徵證明這些癌細胞來源為莫克細胞，因而診斷為莫克細胞癌。本病例明顯表現了莫克細胞癌的高度侵犯性；除腫瘤本身生長快速外，也迅速造成局部淋巴結及遠處癌轉移，患者於病理診斷後約8個月死亡。
並列摘要
Merkel cell carcinoma (MCC) is an unusual primary cutaneous small cell neuroendocrine carcinoma that occurs predominantly in the head and neck region, but rarely in the oral cavity. A review of the English-language literature revealed only 2 cases of MCC that occurred intraorally and the present case was the second reported case of oral MCC arising in the oral mucobuccal fold. The patient, a 62-year-old Taiwanese female, noted a firm and painful swelling at her right cheek for three months. Intraoral examination of the lesion revealed an erythematous bulging mass involving both the right lower posterior mucobuccal fold and the right lower retromolar area. Incisional biopsy of the lesion via intraoral approach showed numerous uniform, small round cells with scanty cytoplasm and frequent mitoses, either typical or atypical. These cells were densely packed into nests infiltrating in a loose connective tissue stroma. The Merkel cell origin of the tumor is suggested by results from immunohistochemical studies. In these studies, most neoplastic cells showed a paranuclear, globular, and inclusion-like pattern of immunostaining with the antibodies to pancytokeratin (AE1+AE3) and neuron-specific enolase, features that are characteristic of MCC. The aggressiveness of the tumor was characterized by rapid growth, frequent regional lymph node and distant metastases. The patient died 8 months after the initial diagnostic biopsy.