Merkel cell carcinoma (MCC) is a rare and aggressive neuroendocrine skin carcinoma.1 Owing to the recent isolation of a new human polyomavirus from MCC called Merkel cell polyomavirus (MCV),2 this malignancy has attracted much attention. Meanwhile, several groups have confirmed that MCV is detectable in 70% to 80% of MCC. Herein, we report how sequencing of the MCV genome may help to discern between delayed metastasis and multiple primary MCCs.
Large T antigen (LTA) in our patient's Merkel cell carcinoma (MCC) samples taken in 2002 (MCC-1) and 2008 (MCC-2). A, Merkel cell polyomavirus (MCV) DNA obtained from MCC-1 and MCC-2 were quantified as normalized reporter (Rn) for long interspersed nuclear elements (LINE) (brown) serving as endogenous controls, MCV-specific regions of LTA (LT3) (green), and viral protein 1 (VP1) (blue). (The value of Rn is automatically calculated by the real-time polymerase chain reaction analyzer as the fluorescence emission intensity of the reporter dye divided by the fluorescence emission intensity of the passive reference dye.) The black horizontal dotted line serves as the threshold line. B and C, Immunohistologic detection of LTA expression in MCC-1 (B) and MCC-2 (C). Sections of the respective lesions were stained with a monoclonal antibody (clone CM2B4 at 1:1000 dilution) specific for MCV LTA (red) and counterstained with hematoxylin-eosin (blue). D, Partial sequence alignment of LTA from MCC-1 and MCC-2. On the left side, the alignment demonstrates 2 base mismatches between MCC-1 and MCC-2 and the base deletion for MCC-1. On the right side, the original sequence data contain a mismatch, and the deletion is shown.
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