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Multimodal Therapeutic Approach to Aggressive Merkel Cell Carcinoma: Case Report

By: Joshua D. Madera, MS
Posted: Tuesday, December 8, 2020

For patients with Merkel cell carcinoma, therapeutic intervention using an early, aggressive multimodal approach may be the best option to effectively control the malignancy, according to a case report published in the Journal of Investigative Medicine High Impact Case Reports. The current literature advises a myriad of treatment regimens depending on the type and extent of the carcinoma, explained Rahal Khaled, PhD, of the Salah Azaiez Institute of the University of Tunis El Manar, Tunisia, and colleagues.

The patient was a 60-year-old man who presented with painless, left inguinal swelling that persisted for 3 months. Further examination revealed an 11 x 10 x 15 cm multilobular inguinal mass. The tumor compressed the left femoral pedicle and extended into the iliopsoas muscle. In addition, the inguinal lymph nodes were found to be pathologic. A biopsy confirmed the presence of Merkel cell carcinoma.

The tumor (13 x 10.5 x 9.5 cm) was removed via left inguinal dissection with satellite lymph node removal. Histologic analysis of the tumor demonstrated a diffuse growth pattern with monotonous cells, scant eosinophilia, and mitotic figures. Cytokeratin 20, chromogranin, and synaptophysin were positively identified with the tumor cells via immunohistochemistry. There was no evidence of cytokeratin 7, transcription factor-1, leukocyte common antigen, and S-100 in the tumor cells.

Two months after radiotherapy, the patient returned with evidence of local tumor recurrence. Following surgical intervention, the patient experienced active bleeding from the inguinal incision. While the artery was being ligated, a tumoral invasion of the femoral artery was revealed. This artery was also ligated, and the limb remained viable due to collateral circulation. The patient received platinum-based chemotherapy and was closely monitored.

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