An Unusual Presentation of Merkel Cell Carcinoma

Abstract

We describe a 71-year-old male patient admitted to the hospital with posterior chest pain. Following the detection of a paravetebral mass at the level of the 2nd thoracic vertebra, the patient underwent a surgical en bloc resection of the mass. The histopathologic examination revealed a Merkel cell carcinoma. One month after the operation, magnetic resonance imaging showed an inoperable mass in the same location, which indicated a rapid progression of the tumor. The patient died of progressive respiratory failure due to pneumonia on the 6th day after the onset of radiochemotherapy. Although this appears to be an isolated case, Merkel cell carcinoma must be included in the differential diagnosis of intrathoracic masses. Turkish Başlık: Merkel Hücreli Karsinomun Nadir Bir Presentasyonu Anahtar Kelimeler: Merkel hücreli karsinom, intratorasik, ekstrakütanöz Yetmişbir yaşındaki erkek hastanın sırt ağrısı şikayetiyle hastaneye başvurusu sonrasında yapılan tetkiklerinde sol paravertebral alan ikinci vertebra düzeyinde kitle tespit edilmiş ve kitlenin en blok rezeksiyonu sonrasında histopatolojik olarak Merkel hücreli karsinom tanısı konmuştur. Postoperatif birinci ayında manyetik rezonans incelemede aynı alanda tespit edilen ve inoperabl olarak değerlendirilen kitle hastalığın hızlı ilerlediğini düşündürdü. Hasta radyokemoterapinin 6. gününde pnömoni sonucunda ortaya çıkan solunum yetersizliği nedeniyle hayatını kaybetti. Bu çok nadir görülebilecek bir olgu olmakla birlikte, intratorasik kitlelerin ayırıcı tanısında Merkel hücreli karsinom da düşünülmelidir.

Keywords

• Merkel cell carcinoma, intrathoracic, extracutaneous

An Unusual Presentation of Merkel Cell Carcinoma

Öz

References

1. Miller RW, Rabkin CS. Merkel cell carcinoma and melanoma: etio- logical similarities and differences. Cancer Epidemiol Biomarkers Prev 1999;8:153-8.
2. Buell JF, Trofe J, Hanaway MJ, Beebe TM, Gross TG, Alloway RR et al. Immunosuppression and Merkel cell cancer. Transplant Proc 2002;34:1780-1. [CrossRef]
3. The Rockwell Merkel Cell Carcinoma Group. Merkel cell carci- noma: recent progress and current priorities on etiology, patho- genesis, and clinical management. J Clin Oncol 2009;27:4021-6. [CrossRef]
4. Temiz P, Ayhan S, Adiguzel L, Kara E, Okcu G. Gastric Metastasis of Merkel Cell Carcinoma: Case Report. Trakya Univ Tip Fak Derg 2010;27:323-6.
5. Albores-Saavedra J, Batich K, Chable-Montero F, Sagy N, Schwartz AM, Henson DE. Merkel cell carcinoma demograph- ics, morphology, and survival based on 3870 cases: a population based study. J Cutan Pathol 2010;37:20-7. [CrossRef]
6. Huber GF, Khalil M, Falck V, Matthews TW, Dort JC. Merkel cell carcinoma with solitary parotid metastasis: diagnostic dilemma in the absence of a primary site. J Otolaryngol Head Neck Surg 2008;37:E19-21.
7. Fotia G, Barni R, Bellan C, Neri A. Lymph nodal Merkel cell car- cinoma: primary or metastatic disease? a clinical case. Tumori 2002;88:424-6.
8. Huang GS, Chang WC, Lee HS, Taylor JA, Cheng TY, Chen CY. Merkel cell carcinoma arising from the subcutaneous fat of the arm with intact skin. Dermatol Surg 2005;31:717-9. [CrossRef]

9. Engels EA, Frisch M, Goedert JJ, Biggar RJ, Miller RW. Merkel cell carcinoma and HIV infection. Lancet 2002;359:497-8. [CrossRef]
10. Lanoy E, Dores GM, Madeleine MM, Toro JR, Fraumeni JF Jr, En- gels EA. Epidemiology of nonkeratinocytic skin cancers among persons with AIDS in the United States. AIDS 2009;28;23:385-93. [CrossRef]
11. Lunder EJ, Stern RS. Merkel-cell carcinomas in patients treated with methoxsalen and ultraviolet A radiation. N Engl J Med 1998;22;339:1247-8. [CrossRef]
12. Halata Z, Grim M, Bauman KI, Friedrich Sigmund. Merkel and his ‘‘Merkel cell’’ morphology, development and physiology: review and new results. Anat Rec 2003;271:225-39. [CrossRef]
13. Toker C. Trabecular carcinoma of the skin. Arch Derm 1972;105:107-10. [CrossRef]
14. Hanly A, Elgart G, Jorda M. Analysis of thyroid transcription fac- tor-1 and cytokeratin 20 separates Merkel cell carcinoma from small cell carcinoma of the lung. J Cutan Pathol 2000;27:118-20. [CrossRef]
15. McCardle TW, Sondak VK, Zager J, Messina JL. Merkel cell car- cinoma: pathologic findings and prognostic factors. Curr Probl Cancer 2010;34:47-64. [CrossRef]
16. Karkos PD, Sastry A, Hampal S, Al-Jafari M. Spontaneous re- gression of Merkel cell carcinoma of the nose. Head Neck 2010;32:411-4.
17. Silberstein E, Koretz M, Cagnano E, Katchko L, Rosenberg L. Neuroendocrine (Merkel cell) carcinoma in regional lymph nodes without primary site. Isr Med Assoc J 2003;5:450-1.
18. Bichakjian CK, Lowe L, Lao CD, Sandler HM, Bradford CR, John- son TM et al. Merkel cell carcinoma: critical review with guide- lines for multidisciplinary management. Cancer 2007;110:1-12. [CrossRef]
19. Koh CS, Veness MJ. Role of definitive radiotherapy in treating patients with inoperable Merkel cell carcinoma: the Westmead Hospital experience and a review of the literature. Australas J Dermatol 2009;50:249-56. [CrossRef]
20. Asioli S, Righi A, Volante M, Eusebi V, Bussolati G. p63 expres- sion as a new prognostic marker in merkel cell carcinoma. Cancer 2007;110:640-7. [CrossRef]