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- Title
Multidisciplinary approach – Merkel cell carcinoma in a young patient. Clinical case and review.
- Authors
Mihăilă, Raluca; Popescu, Liliana-Cristina; Mateianu, Elena; Komporaly, Isabela; Dragomir, Adelina Silvana; Seliuc, Claudia; Georgescu, Bogdan; Kajanto, Lidia; Mitulescu, Dragoş; Stănculeanu, Dana Lucia
- Abstract
Objective. Merkel cell carcinoma (MCC) is a rare form of cutaneous cancer, the fiveyear survival rate for metastatic disease being 25% (risk factors: UV radiation, the infection with Merkel cell polyomavirus [MCPyV], chronic immunosuppression). The multimodal treatment for MCC includes surgery, chemotherapy, radiotherapy and immunotherapeutic treatments. We present the case of a 21yearold patient diagnosed with metastatic MCC and treated in our department. Materials and method. The patient was diagnosed in 2018 with unknown primary Merkel cell carcinoma. The patient was referred to a plastic surgery department for an enlarged left inguinal adenopathy and excisional lymph node biopsy was recommended. The histopathological and immunohistochemistry and imaging scans reports confirmed a stage IV (pTxNxM1) unknown primary Merkel cell carcinoma with lymph node metastases. The multimodal treatment included postoperative local radiotherapy and immunotherapy as the firstline treatment option. The patient started the treatment with avelumab, relatively well tolerated, with mild iatrogenic hyperthyroidism and hypothyroidism. The followup during of cutaneous cancer, the fiveyear survival rate for metastatic disease being 25% (risk factors: UV radiation, the infection with Merkel cell polyomavirus [MCPyV], chronic immunosuppression). The multimodal treatment for MCC includes surgery, chemotherapy, radiotherapy and immunotherapeutic treatments. We present the case of a 21yearold patient diagnosed with metastatic MCC and treated in our department. Materials and method. The patient was diagnosed in 2018 with unknown primary Merkel cell carcinoma. The patient was referred to a plastic surgery department for an enlarged left inguinal adenopathy and excisional lymph node biopsy was recommended. The histopathological and immunohistochemistry and imaging scans reports confirmed a stage IV (pTxNxM1) unknown primary Merkel cell carcinoma with lymph node metastases. The multimodal treatment included postoperative local radiotherapy and immunotherapy as the firstline treatment option. The patient started the treatment with avelumab, relatively well tolerated, with mild iatrogenic hyperthyroidism and hypothyroidism. The followup dur ing treatment indicated partial regression at first evaluation and the PETCT examination from April 2019 showed no signs of metabolically active lesions. The treatment was discontinued due to personal problems and, unfortunately, at the next followup, new lymph node metastases in the left axillary region were detected at the PETCT, confirmed by biopsy. The treatment with avelumab was resumed, with complete response. Results. Although the patient has poor prognosis factors (young age, lymph node metastasis with no primary tumor), fortunately he maintained the remission, similar to data from literature. Regarding the adverse events, the patient presented reversible iatrogenic hyperthyroidism and hypothyroidism. Conclusions. Regarding the particularities of this case report, we can emphasize the young age of the patient at diagnosis, the rare form of skin cancer – Merkel cell carcinoma, the lymph node metastasis with no primary tumor, the limited treatment options and a favorable treatment response, with good quality of life and reversible adverse events.
- Subjects
MERKEL cell carcinoma; SKIN cancer; LIFE change events; LYMPHATIC metastasis; SURVIVAL rate; DIAGNOSIS; THYROID diseases
- Publication
Oncolog-Hematolog, 2021, Issue 55, p41
- ISSN
2066-8716
- Publication type
Article