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Bone Marrow Involvement From Merkel Cell Carcinoma: Case Study

By: Joseph Fanelli
Posted: Monday, September 28, 2020

Although bone marrow involvement is rare among patients diagnosed with Merkel cell carcinoma, findings presented in BMJ Cancer Reports suggest that physicians may want to consider bone marrow biopsies in patients with a compromised immune system. Steven Jubelirer, MD, of the Charleston Area Medical Center, West Virginia, and colleagues presented a case study of an 80-year-old woman with Merkel cell carcinoma who experienced extensive bone marrow involvement.

"Given the increasing incidence of Merkel cell carcinoma, it may be helpful to include bone marrow biopsy as a part of the staging process early on in all immunocompromised patients with Merkel cell carcinoma, especially when hematologic abnormalities such as pancytopenia or leukoerythroblastic-like reactions develop," the authors concluded. Bone marrow biopsy, although rare, may be underreported in cases of Merkel cell carcinoma and may most likely be associated with therapy-induced immunosuppression, they noted.

In this case study, the patient, who had a medical history of hypertension, squamous cell carcinomas of the skin after resection, and rheumatoid arthritis, was diagnosed with Merkel cell carcinoma following a skin biopsy. After a PET scan ruled out remnants of the disease and distant metastasis, the patient received adjuvant radiation therapy. However, after the first few sessions, she started to develop generalized weakness. During therapy, she continued to receive adalimumab, but methotrexate and leucovorin were discontinued.

After a peripheral blood smear, a bone marrow biopsy revealed hypercellular bone marrow and positive staining for cytokeratin 20 with a prominent perinuclear dot staining pattern. The patient received chemotherapy with carboplatin and etoposide. She also underwent platelet/red cell transfusions and was treated with intravenous steroids and antibiotics. She experienced rapid clinical deterioration despite treatment and died on day 16 in the hospital.

Disclosure: The authors reported no conflicts of interest.



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