Merkel Cell Tumor of the Back Detected During Pregnancy

Chao, Tzu‐Chieh; Park, Joon Man; Rhee, Hwaja L.; Greager, John A.

doi:10.1097/00006534-199008000-00028

Cited by 29 publications

(20 citation statements)

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“…Merkel cell carcinoma presenting with neurological complications is extremely rare [19]. There are only four cases [3,13,23,24] with spinal metastasis reported in literature, however none of them had significant neurological deficits. In two cases the metastasis was to the epidural space and in the other two cases to the osseous spine and epidural space.…”

Section: Discussionmentioning

confidence: 99%

Spinal extra-dural metastasis from Merkel cell carcinoma: a rare cause of paraplegia

Kamath

Venkateswaran²,

Shetty

et al. 2007

Eur Spine J

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We report a rare case of Merkel cell carcinoma with extra-dural spinal metastasis causing paraplegia. There are only four reported cases in literature. A 57-year-old lady presented with a breast lump, multiple truncal skin swellings, low back pain and rapidly progressive paraplegia. MRI showed multiple epidural soft tissue masses causing neural compression. A biopsy from the truncal skin lesion was diagnosed as Merkel cell carcinoma (MCC). Posterior decompression and tumor debulking at all three sites of neural compression was performed. Histopathology of the epidural tumor was consistent with MCC and the diagnosis was confirmed by immuno-histochemistry staining for cytokeratin-20. She was started on chemotherapy and radiotherapy. One month after diagnosis she died due to extensive metastasis. The short term palliative response seen in our patient demonstrates the poor prognosis for patients with spinal metastasis.Keywords Merkel cell carcinoma Á Spinal metastasis Á Secondaries Á Paraplegia Case reportA 57-year-old diabetic lady presented with persistent low back pain and bilateral radiculopathy of 2 months duration followed by rapidly progressive weakness and numbness of the lower limbs. She also had loss of bowel and bladder control since 1 week. Multiple painless skin lumps over the chest and abdomen had appeared spontaneously a few months prior to presentation. There were no constitutional symptoms. General examination revealed multiple firm nontender shiny skin lumps approximately 3-4 cm in diameter on the anterior abdominal wall, chest and on the right breast. There were also firm and non-tender mobile lymph-nodes of 2-3-cm size in the right posterior triangle of the neck (Fig. 1a). There was no tenderness or pain on movements of the spine. She had a flaccid paraplegia, a left extensor plantar response and sensory hypoesthesia below the ninth thoracic dermatome bilaterally. The radiographs and CT scan done prior to admission were normal (Fig. 1b, c). An MRI showed epidural soft tissue masses causing neural compression at the eighth thoracic, fourth lumbar and first sacral levels. There were also with multiple soft tissue lesions in the paraspinal and retroperitoneal space--features suggestive of metastasis. There was no history to suggest immuno-compromised status and human immunodeficiency virus infection was eliminated by the appropriate laboratory tests.An FNAC of the lymph node, anterior abdominal wall mass and right breast was reported as a small cell tumor. An incisional biopsy from a skin lesion was reported as MCC. A laminectomy and tumor debulking at all three sites of compression was performed. Epidural tumor tissue sent for histopathology was reported as a high grade malignancy composed of epitheliod cells with scanty cytoplasm, markedly pleomorphic nulei having a ''salt and pepper'' chromatin (highly reminiscent of a neuro-endocrine origin). The tumor cells with numerous mitosis were predominantly disposed in a trabercular and cribriform pattern and also arranged around necrotic space...

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Section: Discussionmentioning

confidence: 99%

Spinal extra-dural metastasis from Merkel cell carcinoma: a rare cause of paraplegia

Kamath

Venkateswaran²,

Shetty

et al. 2007

Eur Spine J

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“…8,9,15) Only three cases of metastatic MCC have involved the spine. 3,9,12) Our patient presented with signs and symptoms that were highly suggestive of lumbosacral intervertebral disc herniation. He had back- The course of MCC is often aggressive, despite rare spontaneous regression, and distant metastases are associated with poor prognosis and death regardless of any therapy.…”

Section: Discussionmentioning

confidence: 81%

“…3) Osseous involvement is usually located in the facial bones and cranium. 8,9,15) Only three cases of metastatic MCC have involved the spine.…”

Section: Discussionmentioning

confidence: 99%

Lumbosacral Metastatic Extradural Merkel Cell Carcinoma Causing Nerve Root Compression. Case Report.

Turğut

Gökpinar

Barutça

et al. 2002

Neurol. Med. Chir.(Tokyo)

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A 63-year-old man presented with a rare metastatic Merkel cell carcinoma (MCC) involving the lumbosacral spine and causing nerve root compression. Magnetic resonance (MR) imaging revealed an extradural soft tissue mass at the L5-S1 levels. The tumor was subtotally removed and chemotherapy was administered, but he died of multiple metastases from the primary epigastric tumor. Lumbosacral metastatic epidural tumor can manifest as lumbar disc disease symptoms, but MR imaging can noninvasively and rapidly reveal the presence of spinal epidural tumor and any extension to the spinal canal. Extradural MCC metastasis in the lumbosacral area should be considered in the differential diagnosis of radicular symptoms caused by disc herniation.

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“…Three of the four previously reported patients died early from extensive metastasis despite aggressive local treatment. 3,4,6 Two patients with metastatic Merkel cell tumor of the spine required surgery. The first report was of L5 radiculopathy in a 63-year-old male with a primary epigastric Merkel cell tumor.…”

Section: Discussionmentioning

confidence: 99%