Global Advances in Health and Medicine
November 1, 2012
Natalie Vandeven, Paul Nghiem, MD, PhDDownload PDF
A 58-year-old white man noted a small lesion on the right side of his neck in August of 2006. The papule resembled an ingrown hair, was relatively uncomfortable, and slowly increased in size. Three months later, a reddish-purple nodule had grown to a diameter of 2 cm and was narrowly excised. Pathology revealed a nodular proliferation of atypical round cells with hyper-chromatic nuclei displaying “salt and pepper” chromatin. Numerous mitotic figures were observed, and there was both individual cell and en masse necrosis. Immunohistological staining indicated positivity for cytokeratin 7, cytokeratin 20 (in a perinuclear dot-like pattern), neuron-specific enolase, and focal positivity for chromogranin and synaptophysin. The tumor cells were negative for TTF1 and S-100. On the basis of these results, a diagnosis of an unusual (cytokeratin 7 positive) Merkel cell carcinoma (MCC) was made. Full-body computed tomography and Octreotide scans were performed 1 month later and showed no evidence of disease. The patient underwent a wide local re-excision and sentinel lymph node biopsy 1 month later. Two of three sentinel nodes were positive, and the following month, he underwent a lymphatic dissection of the neck. None of 39 nodes removed was positive for MCC. Two months later, the patient began radiation treatment at the primary site and draining lymph node basin with a total of 5000 rads in 25 fractions. A positron emission tomography (PET) scan 2 months after the completion of radiation therapy showed no evidence of disease.
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September 13, 2019