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• W2921701335 abstract "INTRODUCTION: Merkel cell carcinoma (MCC) is a rare neuroendocrine carcinoma. It is predominately seen on sun-exposed areas in elderly patients or in immunocompromised populations. About 80% of cases are associated with Merkel cell polyomavirus, suggesting a viral-induced oncogenesis. The most common presentation is a rapidly growing pink-red, dome-shaped nodule on the skin. We present a rare case of metastatic MCC diagnosed by endoscopic ultrasound of an incidentally discovered portacaval lymph node. CASE DESCRIPTION: An 81-year-old male with no dermatologic history presented to the emergency department with fever and chills. His fever was documented at 39.3 deg C, was tachycardic at a HR of 117, and a leukocyte count of 11.6. He also endorsed unintentional weight loss of nearly 20 lbs. The ED obtained abdomen/pelvis which noted radiographic evidence of diverticulitis as well as a large portacaval lymph node measuring 8.6 x 4.5 cm. He was discharged oral antibiotics for treatment of diverticulitis with plan for outpatient endoscopic evaluation of the enlarged lymph node. An upper endoscopy was performed and no intraluminal masses or lesions were noted. Next, linear endoscopic ultrasound was performed which identified the portacaval lymph node which measured 42.3 mm x 37.4 mm. We used a 25-gauge fine needle biopsy with on-site cytopathology confirming cellular adequacy. Cytology demonstrated positive CK20, CD56, and synaptophysin with high rate of KI-67 and negative TTF-1 consistent with neuroendocrine differentiation and a diagnosis of Merkel cell carcinoma. The patient was referred to oncology for further management. Staging workup with a PET/CT noted metastatic disease also involving the right shoulder and he was subsequently initiated on systemic immunotherapy with the checkpoint inhibitor pembrolizumab.1275_A.tif Figure 1: Coronal view of CT abdomen/pelvis which identified a bilobed porta-caval lymph node measuring 55.2 mm x 64.5 mm.1275_B.tif Figure 2: Endoscopic Ultrasound view of porta-caval lymph node measured at 48.5 mm sampled via FNA which diagnosed the finding of Merkel Cell Carcinoma.DISCUSSION: MCC is a rare, aggressive neuroendocrine carcinoma that usually presents with a skin lesion. Only 0.4% of cases have been reported in locations other than the skin. While there are multiple reports of recurrence of MCC in the gastrointestinal tract, very few cases present initially without an apparent skin lesion. Gastroenterologists should be aware of this uncommon neoplasm, given that MCC is an aggressive malignancy that requires prompt diagnosis and oncologic treatment in order to optimize patient outcomes." @default.
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• W2921701335 date "2018-10-01" @default.
• W2921701335 modified "2023-09-23" @default.
• W2921701335 title "A Unique Case of Metastatic Merkel Cell Carcinoma Without a Dermatologic Primary" @default.
• W2921701335 doi "https://doi.org/10.14309/00000434-201810001-01275" @default.
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