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Editorial
. 2022 Sep;17(3):726-729.
doi: 10.26574/maedica.2022.17.3.726.

Treatment of Merkel Cell Carcinoma Using Intraoperative Flow Cytometry (iFC) Protocol, Optimized for Head and Neck Lesions, as a Means for Tumor Margin Evaluation - a Case Presentation

Athina Zarachi  1 , Evrysthenis Vartholomatos  2 , Alkistis Tsikou  1 , Ioannis Komnos  1 , Alexandra Papoudou-Bai  3 , Evangelia Lampri  3 , Angelos Liontos  4 , Vasilios Ragos  5
Affiliations
Editorial

Treatment of Merkel Cell Carcinoma Using Intraoperative Flow Cytometry (iFC) Protocol, Optimized for Head and Neck Lesions, as a Means for Tumor Margin Evaluation - a Case Presentation

Athina Zarachi et al. Maedica (Bucur). 2022 Sep.

Abstract

Background: We present the case of a patient with a Merkel cell carcinoma (MCC) of the left preauricular area. Case presentation:A 84-year-old Greek man was examined at the outpatient ENT Department of our clinic with a lesion in the preauricular area that had appeared four months ago. The patient history included antihypertensive and antihyperlipidemic therapy as well as treatment for dementia. The excision of the skin lesion was performed under local anesthesia. The histological examination revealed a Merkel cell carcinoma. The patient underwent a computed tomography (CT) scan that showed a lesion with clear limits in the left parotid gland and lymph nodes. Under general anesthesia, he underwent a left superficial parotidectomy, left submandibular gland excision and radical neck dissection. Histological preparations were analyzed using an intraoperative flow cytometry (iFC) protocol. A radiation therapy concluded the patient's treatment. Conclusion:Even if MCC appears as a less common and more aggressive skin cancer type, a clinician always has to include it in the differential diagnosis of a skin lesion. We found the use of iFC very useful for the diagnosis of this skin cancer.

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Figures

FIGURE 1.
FIGURE 1.
Facial nerve monitoring with a neurostimulator
FIGURE 2.
FIGURE 2.
Infiltrating Merkel cell carcinoma (right), metastatic to lymph node (left) (hematoxylin-eosin staining, magnificationx200). Immunohistochemically, the neoplastic cells were highlighted by synaptophysin, a neuroendocrine marker (DAB, magnificationx100)
FIGURE 3.
FIGURE 3.
Parotid gland parenchyma infiltration by Merkel cell carcinoma (a. hematoxylin-eosin staining, magnificationx100). Areas of necrosis were noted (b. hematoxylin-eosin staining, magnificationx200). By immunohistochemistry, the neoplastic cells were positive for synaptophysin (c. DAB, magnificationX100) and cytokeratin 20 (d. DAB, magnificationx600). Cytokeratin 20 staining pattern was dot-like perinuclear
FIGURE 4.
FIGURE 4.
Intraoperative Flow cytometry analysis of DNA content, following propidium iodide staining. (A) analysis of PBMCs, (B) analysis of lymph node, (C) analysis of tumor margin
See this image and copyright information in PMC

References

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