Patterns of lymph node involvement by Merkel cell carcinoma
A. Pattern 1 was characterized by a solid, sheet-like proliferation of metastatic tumor. Immunohistochemistry was not needed to identify metastatic tumor in these cases (H&E).
B. Pattern 2 was characterized by a non-solid proliferation of tumor cells in the parafollicular lymph node cortex (CK20 immunohistochemical stain)
C. Pattern 3 was characterized by variable numbers of tumor cells in the subcapsular sinus (CK20 immunohistochemical stain).
D. Pattern 4 was characterized by clusters of tumor cells around larger vessels in the lymph node hilum. This was the least common pattern of metastasis (CK20 immunohistochemical stain).
E. Pattern 5 was characterized by isolated rare tumor cells in the lymph node parenchyma. This pattern of metastasis was only detected by immunohistochemistry (CK20 immunohistochemical stain).