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目的:探讨Merkel细胞癌的临床病理特征、诊断和鉴别诊断、治疗及预后。方法:对2例Merkel细胞癌患者的临床病史、肿瘤组织的免疫组化及治疗过程进行回顾性分析,并复习相关文献。结果:Merkel细胞癌的临床表现及组织学均缺乏特异性,免疫表型常表现为CgA、NSE、EMA、NSE、Syn(+),CK、CgA、Vim、LCA(-),1例患者接受放射治疗+足叶泊甙和顺铂化疗,现随访3个月,目前无局部复发及转移;另1例患者行局部切除+多次化疗和放疗后出现淋巴结和右肺转移,因不能耐受肺部根治性手术,改行EC方案化疗(依托泊甙+顺铂),后死于多器官衰竭。结论:Merkel细胞癌是一种高度恶性的皮肤原发性神经内分泌癌,诊断主要依靠病理检查,即使综合治疗后仍有局部复发和远处转移的倾向,预后差。彻底切除病灶结合术后放疗或化疗是治疗Merkel细胞癌的主要手段。
Objective: To investigate the clinical and pathological features, diagnosis and differential diagnosis, treatment and prognosis of Merkel cell carcinoma. Methods: The clinical history, immunohistochemistry and treatment of 2 Merkel cell carcinoma patients were retrospectively analyzed and the related literatures were reviewed. Results: The clinical manifestations and histology of Merkel cell carcinoma were nonspecific. The immunophenotypes were usually CgA, NSE, EMA, NSE, Syn (+), CK, CgA, Vim and LCA Radiation therapy + allophan and cisplatin chemotherapy, are now followed up for 3 months, no local recurrence and metastasis; the other patients underwent partial resection + multiple chemotherapy and radiotherapy after the occurrence of lymph node and right lung metastasis, due to intolerance Radical lung surgery, diverted to EC regimen chemotherapy (etoposide cisplatin), died of multiple organ failure. Conclusions: Merkel cell carcinoma is a highly malignant primary neuroendocrine carcinoma of the skin. The diagnosis mainly depends on the pathological examination. Even though there is still a tendency of local recurrence and distant metastasis after the combination therapy, the prognosis is poor. Radical resection combined with postoperative radiotherapy or chemotherapy is the main means of treatment of Merkel cell carcinoma.