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Case Reports
. 2020 Feb 25;15(1):128-131.
doi: 10.4103/ajns.AJNS_5_18. eCollection 2020 Jan-Mar.

Spinal Metastasis from Merkel Cell Carcinoma in an Elderly Male

Kalah Jockisch  1 , Yazan Abdeen  2 , Carlisle Alderink  3 , Tony Flippin  4 , Sugabramya Kuru  5 , Hamid Shaaban  6
Affiliations
Case Reports

Spinal Metastasis from Merkel Cell Carcinoma in an Elderly Male

Kalah Jockisch et al. Asian J Neurosurg. .

Abstract

Merkel cell carcinoma is a cutaneous neuroendocrine malignancy that has an aggressive nature. Classically, it affects the elderly Caucasian population with a predilection for the sun-exposed areas of the body. Pathogenesis has been linked to ultraviolet radiation, immunosuppression, and the Merkel cell polyomavirus. Definitive diagnosis entails histologic evaluation and immunohistochemical staining. With its generalized appearance and tendency for metastasis, a high index of suspicion must be utilized. In this case, we present the unique presentation of Merkel cell carcinoma as a rapidly enlarging lymph node with metastatic disease to the spinal column presenting as new-onset low back and radicular pain.

Keywords: Elderly; merkel cell carcinoma; spinal metastasis.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Microscopic section showing a lymph node with near replacement by coalescing nests of malignant cells. The individual tumor cells have hyperchromatic nuclei and surrounding scant cytoplasm with abundant mitotic activity
Figure 2
Figure 2
Cytokeratin 20 staining is strongly positive
Figure 3
Figure 3
Whole-body positron emission tomography–computed tomography with contrast revealing hypermetabolic activity in the C5 vertebral body, in the left anterolateral soft tissue, as well as in the left foramen with a standardized uptake value of 5. There is also some suggestion of asymmetric soft-tissue attenuation of concern for a paraspinous mass
Figure 4
Figure 4
Pictured is a hypermetabolic paraspinous soft-tissue mass at the level of L4 that extends caudally. The mass is posterior to the left psoas muscle and measures 3.5 cm × 4.8 cm. This may be contiguous with another portion extending into the left paraspinous muscle measuring 3.9 cm × 4 cm. There is also an extension into the foramen at the L4–L5 and the L5–S1 levels, with some probable bony destruction of the L5 transverse process
See this image and copyright information in PMC

References

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