Gastric Metastasis of Merkel Cell Carcinoma: Case Report

Abstract

Merkel cell carcinoma (MCC) of skin is a rare tumor with aggressive behavior. Local recurrences, regional lymph node and distant metastases of MCC are frequent but to date metastasis to upper gastrointestinal tract was reported only a few. We present a 75-yearold man who had primary MCC at his left thigh. The tumor was excised and the patient was directed to local radiotherapy. He had developed abdominal and thoracal subcutaneous metastatic nodules within 5 and 8 months after surgical excision, respectively. In the tenth month, a second operation had to be performed because of a perforated duodenal ulcer and incidentally a submucosal yellow-white nodule measuring 2 cm in diameter was found in the wall of gastric cardia and excised. This lesion was histologically identical to the primary tumor, hence, gastric metastasis of MCC. The patient rejected further therapy and died 17 months after the initial diagnosis. Differential diagnosis of MCC and distinction of gastrointestinal MCC metastasis from primary neuroendocrine tumors may be difficult. Clinical information and histopathological features along with the results of immunohistochemical stainings are very important in this distinction. Derinin Merkel hücreli karsinomu (MHK) agresif davranışlı, nadir bir tümördür. Merkel hücreli karsinomun lokal rekürrensleri, bölgesel lenf nodu ve uzak metastazları sık olmakla birlikte bildirilen üst gastrointestinal metastaz oldukça azdır. Yetmiş beş yaşındaki erkek hasta, sol bacağındaki MHK eksize edildikten sonra lokal radyoterapiye yönlendirilmiştir. Tümör eksizyonundan sonraki 5. ayda karında, 8. ayda toraks duvarında subkutan metastatik nodüller gelişmiştir. İlk operasyondan 10 ay sonra perfore duodenal ülser nedeniyle yapılan ikinci operasyon sırasında rastlantısal olarak midede, kardia duvarında farkedilen 2 cm çaplı, sarı-beyaz renkli, submukozal nodül eksize edilmiştir. Bu lezyon MHK'un mide metastazı tanısı almıştır. Hasta daha ileri bir tedaviyi reddetmiş ve başlangıçtaki tanıdan 17 ay sonra yaşamını yitirmiştir. MHK'un ayırıcı tanısı ile gastrointestinal MHK metastazlarının primer nöroendokrin tümörlerden ayrımı zorluk yaratabilir. Bu tür tanı sorunlarının çözümünde klinik bilgi, histopatolojik özellikler ve immunohistokimyasal çalışmalar oldukça önemlidir.

Keywords

• Merkel cell carcinoma; stomach; gastrointestinal; metastasis

Midede Merkel Hücreli Karsinom Metastazı: Olgu Sunumu

Öz

Derinin Merkel hücreli karsinomu (MHK) agresif davranışlı, nadir bir tümördür. Merkel hücreli karsinomun lokal rekürrensleri, bölgesel lenf nodu ve uzak metastazları sık olmakla birlikte bildirilen üst gastrointestinal metastaz oldukça azdır. Yetmiş beş yaşındaki erkek hasta, sol bacağındaki MHK eksize edildikten sonra lokal radyoterapiye yönlendirilmiştir. Tümör eksizyonundan sonraki 5. ayda karında, 8. ayda toraks duvarında subkutan metastatik nodüller gelişmiştir. İlk operasyondan 10 ay sonra perfore duodenal ülser nedeniyle yapılan ikinci operasyon sırasında rastlantısal olarak midede, kardia duvarında farkedilen 2 cm çaplı, sarı-beyaz renkli, submukozal nodül eksize edilmiştir. Bu lezyon MHK'un mide metastazı tanısı almıştır. Hasta daha ileri bir tedaviyi reddetmiş ve başlangıçtaki tanıdan 17 ay sonra yaşamını yitirmiştir. MHK'un ayırıcı tanısı ile gastrointestinal MHK metastazlarının primer nöroendokrin tümörlerden ayrımı zorluk yaratabilir. Bu tür tanı sorunlarının çözümünde klinik bilgi, histopatolojik özellikler ve immunohistokimyasal çalışmalar oldukça önemlidir.

Anahtar Kelimeler

• Merkel hücreli karsinom, mide, gastrointestinal, metastaz

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