An unusual case of Merkel cell carcinoma.

PURPOSE: Merkel cell carcinoma (MCC) is a rare aggressive neuroendocrine tumor of the skin mainly found in elderly white patients. Due to its poor prognosis with distant metastases in up to 33% and local recurrence in 25-33% and a 5 year disease-specific survival of 64% (1-2) its early diagnosis and appropriate treatment is mandatory. METHODS: The study is an exceptional clinical case of a patient with a large inoperable MCC unable to be treated according to treatment guidelines due to her old age. We review the literature addressing treatment options. RESULTS: The patient was treated with palliative definitive radiotherapy to her large MCC of the left lower leg. She showed a rapid clinical response to four palliative radiation doses of 7 Gy each, necrosis of tumor mass and persistent clearing at a follow-up of 32 weeks. Our patient was very unusual in terms of her extensive MCC and her rapid and complete response to palliative radiotherapy lasting for 6 months at present. CONCLUSIONS: As MCC is an aggressive tumor, best survival is achieved with early diagnosis in a localized stage and prompt adequate surgery and further stage-adjusted treatment. Thus, the differential diagnosis of MCC should not be dismissed in a reddish nodule on the leg, and every excision should be submitted to pathology. In accordance with the literature we demonstrate here that definitive radiotherapy is an effective treatment option for inoperable MCC, which in this individual patient produced necrosis of the extensive tumor mass after only four palliative doses.

Acrokeratosis paraneoplastica of Bazex as an indicator for underlying squamous cell carcinoma of the lung.

PURPOSE: Obligatory cutaneous paraneoplastic disorders comprising acanthosis nigricans maligna, erythema gyratum repens, paraneoplastic pemphigus, hypertrichosis lanuginosa acquisita, erythema necrolyticum migrans and acrokeratosis paraneoplastica are rare. However, as markers of an underlying internal malignancy they are of utmost importance for the patient. Acrokeratosis paraneoplastica (first described by Gougerot and Rupp in 1922) was named after Bazex who had then reported several cases in a French dermatological journal since 1965 (Bazex et al. in Bull Soc Fr Dermatol Syphiligr 72:182, 1965; Bazex and Griffiths in Br J Dermatol 102:301-306, 1980). METHOD: The study is a clinical case of a patient with acrokeratosis paraneoplastica. RESULTS: the patient was later diagnosed with a cervical lymph node metastasis and thereafter with a primary squamous cell carcinoma of the left upper lobe and upon treatment responded with the clearing of the skin changes. CONCLUSION: Identification of a paraneoplastic syndrome may enhance the earlier diagnosis of the associated tumor and may thus enable curative treatment.

[The centenary of Wassermann reaction--the future of serological diagnosis of syphilis, up-to-date studies]. / Stulecie odczynu Wassermanna--przyszlosc serologicznej diagnostyki kily w swietle najnowszych badan.

One hundred years after the discovery of the infectious agent of syphilis and implementation of the first serological test for the diagnosis of syphilis, important progress in the evaluation of host immune response against Treponema (T.) pallidum infection has been made. The paper focuses on the new modifications of non-treponemal tests (the use of synthetic cardiolipin and lecithin in Venereal Disease Research Laboratory--VDRL test and the application of the VDRL antigen to immunoenzymatic assays) as well as of treponemal tests. Original treponemal antigens are replaced by recombinant and synthetic antigens (TpN44,5- TmpA, TpN15, TpN17 and TpN47) and by antigens obtained after sequencing of the complete T. pallidum genome (Tp0453, Tp0257 and Tp92) in modifications of immunoenzymatic assays. The new diagnostic strategy, namely the examination of the number of cells producing T. pallidum specific antibodies is also presented. Despite the progress achieved in studies on humoral response in syphilis during last years, the practical application of new tests in diagnosis of the infection requires further studies.