1
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Zoccarato M, Grisold W. Paraneoplastic neurologic manifestations of neuroendocrine tumors. HANDBOOK OF CLINICAL NEUROLOGY 2024; 200:397-407. [PMID: 38494292 DOI: 10.1016/b978-0-12-823912-4.00023-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Neuroendocrine neoplasms (NENs) are a heterogeneous group of tumors arising from the transformation of neuroendocrine cells in several organs, most notably the gastro-entero-pancreatic system and respiratory tract. The classification was recently revised in the 5th Edition of the WHO Classification of Endocrine and Neuroendocrine Tumors. NENs can rarely spread to the central or peripheral nervous systems. Neurologic involvement is determined by the rare development of paraneoplastic syndromes, which are remote effects of cancer. Mechanisms depend on immunologic response to a tumor, leading to the immune attack on the nervous system or the production of biologically active ("functioning") substances, which can determine humoral (endocrine) effects with neurologic manifestations. Paraneoplastic neurologic syndromes (PNS) are immunologically mediated and frequently detected in small cell lung cancer but rarely seen in other forms of NEN. PNS and Merkel cell carcinoma is increasingly reported, especially with Lambert Eaton myasthenic syndrome. Endocrine manifestations are found in a wide spectrum of NENs. They can develop at any stage of the diseases and determine neurologic manifestations. Patient outcomes are influenced by tumor prognosis, neurologic complications, and the severity of endocrine effects.
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Affiliation(s)
- Marco Zoccarato
- Neurology Unit O.S.A., Azienda Ospedale-Università di Padova, Padova, Italy
| | - Wolfgang Grisold
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.
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2
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Gaburak P, Brown TA, Pursel AJ, Cardenas Contreras L, Chun M. The Evaluation and Treatment of Merkel Cell Carcinoma and Brain Metastasis: A Case Report and Review of the Literature. Cureus 2023; 15:e51295. [PMID: 38283504 PMCID: PMC10822684 DOI: 10.7759/cureus.51295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2023] [Indexed: 01/30/2024] Open
Abstract
Merkel cell carcinoma (MCC) is a rare and aggressive neuroendocrine tumor associated with high mortality if metastases are identified. Currently, there is no standardized nor curative treatment for neurometastatic MCC. In this study, we have reviewed the more recent cases and the use of immunotherapy in a population. In this case report and review, we present a case of MCC with brain metastasis currently undergoing treatment with immunotherapy (pembrolizumab) resulting in an initial complete response with a progression-free survival time of five months. We also review the past reported literature and the 11 newly presented cases on their clinical presentation of neurometastatic MCC, immunohistochemical markers, and treatment outcomes. In summary, immunotherapy initially showed a promising response with the complete elimination of MCC brain metastasis. The early aggressive treatment of pembrolizumab with stereotactic radiosurgery should be considered as this treatment plan has shown improved therapeutic effects compared to the standard chemoradiation therapy. Further investigations are needed to determine the efficacy and response of immunotherapy use for neurometastatic MCC.
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Affiliation(s)
- Petr Gaburak
- Department of Orthopedic Surgery, Elson S. Floyd College of Medicine, Spokane, USA
| | - Taylor A Brown
- College of Medicine, Elson S. Floyd College of Medicine, Spokane, USA
| | | | | | - Michael Chun
- Department of Neurology, The Everett Clinic, Everett, USA
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3
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Subacute sensory neuronopathy associated with Merkel cell carcinoma with unknown primary: a case report with literature review. J Neurol 2022; 269:4080-4088. [DOI: 10.1007/s00415-022-11116-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 11/26/2022]
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4
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Apostolidis L, Schrader J, Jann H, Rinke A, Krug S. Leptomeningeal Carcinomatosis: A Clinical Dilemma in Neuroendocrine Neoplasms. BIOLOGY 2021; 10:biology10040277. [PMID: 33800581 PMCID: PMC8066280 DOI: 10.3390/biology10040277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/21/2021] [Accepted: 03/26/2021] [Indexed: 11/16/2022]
Abstract
Central nervous system (CNS) involvement by paraneoplastic syndromes, brain metastases, or leptomeningeal carcinomatosis (LC) in patients with neuroendocrine neoplasms (NEN) has only been described in individual case reports. We evaluated patients with LC in four neuroendocrine tumor (NET) centers (Halle/Saale, Hamburg, Heidelberg, and Marburg) and characterized them clinically. In the study, 17 patients with a LC were defined with respect to diagnosis, clinic, and therapy. The prognosis of a LC is very poor, with 10 months in median overall survival (mOS). This is reflected by an even worse course in neuroendocrine carcinoma (NEC) G3 Ki-67 >55%, with a mOS of 2 months. Motor and sensory deficits together with vigilance abnormalities were common symptoms. In most cases, targeted radiation or temozolomide therapy was used against the LC. LC appears to be similarly devastating to brain metastases in NEN patients. Therefore, the indication for CNS imaging should be discussed in certain cases.
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Affiliation(s)
- Leonidas Apostolidis
- Department of Medical Oncology, National Center for Tumor Diseases, University Hospital Heidelberg, 69120 Heidelberg, Germany;
| | - Jörg Schrader
- I. Medical Department—Gastroenterology and Hepatology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany;
| | - Henning Jann
- Department of Gastroenterology and Hepatology, Charité—University Medical Center Berlin, Campus Virchow Klinikum and Charité Mitte, Augustenburger Platz 1, 13353 Berlin, Germany;
| | - Anja Rinke
- Department of Gastroenterology and Endocrinology, University Hospital Marburg, Baldinger Strasse, 35043 Marburg, Germany
- Correspondence: (A.R.); (S.K.); Tel.: +49-0345-557-2661 (S.K.); Fax: +49-0345-557-2253 (S.K.)
| | - Sebastian Krug
- Clinic for Internal Medicine I, Martin-Luther University Halle/Wittenberg, Ernst-Grube-Straße 40, 06120 Halle, Germany
- Correspondence: (A.R.); (S.K.); Tel.: +49-0345-557-2661 (S.K.); Fax: +49-0345-557-2253 (S.K.)
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5
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Grubb AF, Hankollari E. Cerebral metastasis of Merkel cell carcinoma following resection with negative margins and adjuvant external beam radiation: a case report. J Med Case Rep 2021; 15:118. [PMID: 33714267 PMCID: PMC7956125 DOI: 10.1186/s13256-021-02690-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 01/21/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Merkel cell carcinoma (MCC) is a rare and aggressive neuroendocrine tumor of the skin. It is associated with advanced age, ultraviolet (UV) radiation, and Merkel cell polyomavirus. It has a predilection for the lymphatic system, but rarely spreads to the central nervous system. CASE PRESENTATION A 71-year-old Caucasian man with a history of rheumatoid arthritis and MCC of the right lower eyelid and cheek presented with left-sided hemineglect and word-finding difficulty. Twenty months earlier he had undergone local excision of a 3 cm lesion with negative margins, negative sentinel lymph node biopsy, and external beam radiation. On presentation he was found to have a 6.3 cm mass in the right frontotemporal region. He underwent prompt resection, with pathological analysis consistent with metastatic MCC. He subsequently underwent stereotactic radiosurgery (SRS) and adjunctive immunotherapy with pembrolizumab. He has since tolerated the therapy well and is currently without neurological symptoms or evidence of recurrence. CONCLUSIONS Cerebral metastasis of MCC is a rare event and should be considered when a patient with a history of MCC presents with neurological symptoms. Optimal treatment regimens of these rare cases are unclear; however, prompt resection, stereotactic radiosurgery, and adjunctive immunotherapy have shown an initial positive response in this patient.
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Affiliation(s)
- Alex F Grubb
- Department of Medicine, Duke University Hospital, 2301 Erwin Road, Durham, NC, 27710, USA.
| | - Elizabeth Hankollari
- Department of Medicine, Duke University Hospital, 2301 Erwin Road, Durham, NC, 27710, USA
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6
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Devine MF, Kothapalli N, Elkhooly M, Dubey D. Paraneoplastic neurological syndromes: clinical presentations and management. Ther Adv Neurol Disord 2021; 14:1756286420985323. [PMID: 33796141 PMCID: PMC7970694 DOI: 10.1177/1756286420985323] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 12/11/2020] [Indexed: 12/17/2022] Open
Abstract
We provide an overview of the varied presentations of paraneoplastic neurological syndromes. We also review the onconeural antibodies and their particular oncological and neurological associations. Recognition of these syndromes and their oncological associations is crucial, as early diagnosis and management has been associated with better patient outcomes. Specific management strategies and prognosis vary widely depending on the underlying etiology. An understanding of the relevant clinical details, imaging findings, and other diagnostic information can help tailor treatment approaches. We provide an outline of the diagnostic evaluation and treatment of various paraneoplastic neurological disorders, presenting with central and/or peripheral nervous system involvement. We briefly discuss neurologic immune checkpoint inhibitor-related adverse events, which can occasionally present with paraneoplastic neurological syndrome phenotypes.
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Affiliation(s)
- Michelle F Devine
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Naga Kothapalli
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburg, PA, USA
| | | | - Divyanshu Dubey
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905-0002, USA
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7
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Epileptic Seizure Provoked by Bone Metastasis of Chronic Lymphoid Leukemia and Merkel Cell Carcinoma. Case Rep Med 2020; 2020:4318638. [PMID: 33178284 PMCID: PMC7609155 DOI: 10.1155/2020/4318638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 07/28/2020] [Accepted: 09/08/2020] [Indexed: 11/18/2022] Open
Abstract
Background Merkel cell carcinoma (MCC) is a rare primary neuroendocrine cutaneous tumor, rarely metastasizing to the brain. Chronic lymphoid leukemia (CLL) is a disease predisposing to MCC. According to previous reports, headache and focal neurological deficits suggest disease progression to the brain. We present a patient with MCC whose seizure was not elicited by a cerebral metastasis, but by bone metastases compressing the brain. Case Presentation. A 62-year-old female patient had a history of CLL. A lesion with the appearance of an atheroma was removed from the right upper arm. Histology confirmed the diagnosis of MCC. She was admitted to the neurology department with her first GM seizure. The cranial MRI/MRA showed bone metastases in the right parietal and both frontal areas, compressing the brain. Flow cytometry of CSF did not reveal metastasis of MCC. Conclusions The case history of the patient was unique even among the rare cases of MCC with neurological involvement. The seizure was not elicited by a cerebral metastasis, but by bone metastases compressing the brain. In addition to patient history, clinical presentation and radiological findings enabled a suspected diagnosis of skull metastasis of MCC compressing the brain, causing symptomatic epileptic seizures.
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8
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Shalhout SZ, Emerick KS, Sadow PM, Linnoila JJ, Miller DM. Regionally Metastatic Merkel Cell Carcinoma Associated with Paraneoplastic Anti- N-methyl-D-aspartate Receptor Encephalitis. Case Rep Oncol Med 2020; 2020:1257587. [PMID: 33062358 PMCID: PMC7533778 DOI: 10.1155/2020/1257587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 08/27/2020] [Accepted: 09/01/2020] [Indexed: 11/23/2022] Open
Abstract
Merkel cell carcinoma (MCC) is a rare and aggressive cutaneous neuroendocrine cancer with a high risk of recurrence and metastasis. MCC is generally associated with advanced age, fair skin, sun exposure, immunosuppression, and in the majority of cases, the Merkel cell polyomavirus. Neuroendocrine malignancies are associated with a variety of paraneoplastic neurological syndromes (PNS), characterized as autoimmune responses to malignancy-associated expression of neural antigens. Our literature review underscores previous case reports of MCC-associated PNS with voltage-gated calcium channel (VGCC) and anti-Hu (or ANNA-1) autoantibodies. We present the case of a 59-year-old male with regionally metastatic Merkel cell carcinoma complicated by the paraneoplastic manifestation of anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis. His primary lower neck subcutaneous MCC and metastasis were initially treated with surgery. Additional recurrent lymph node metastases were successfully treated with definitive intensity-modulated radiation therapy. His PNS improved with rituximab therapy. Although rare, this case highlights that in the setting of seizures and prominent psychiatric symptoms accompanying an MCC diagnosis, evaluation for autoimmune paraneoplastic encephalitis is warranted. Awareness and detection of preexisting PNS are crucial in the era of immune checkpoint inhibitors (ICI) for advanced MCC, where treatment with ICI has the potential to exacerbate preexisting autoimmune PNS and lead to worsened or even lethal neurologic immune-related adverse events (nirAEs).
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Affiliation(s)
- Sophia Z. Shalhout
- Division of Hematology/Oncology, Department of Medicine, and Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Kevin S. Emerick
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02114, USA
| | - Peter M. Sadow
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Jenny J. Linnoila
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - David M. Miller
- Division of Hematology/Oncology, Department of Medicine, and Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
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9
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Sherry AD, Bezzerides M, Khattab MH, Luo G, Ancell KK, Kirschner AN. An autoimmune-based, paraneoplastic neurologic syndrome following checkpoint inhibition and concurrent radiotherapy for merkel cell carcinoma: case report. Strahlenther Onkol 2020; 196:664-670. [PMID: 32006066 DOI: 10.1007/s00066-020-01582-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 01/11/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE Merkel cell carcinoma is highly sensitive to both radiation and immunotherapy. Moreover, concurrent radioimmunotherapy may capitalize on anti-tumor immune activity and improve Merkel cell treatment response, although an enhanced immune system may cross-react with native tissues and lead to significant sequelae. METHODS Here we present a case study of a patient with metastatic Merkel cell carcinoma treated with radiotherapy concurrent with pembrolizumab. RESULTS After radioimmunotherapy, the patient developed sensory neuropathy, visual hallucinations, and mixed motor neuron findings. Neurologic dysfunction progressed to profound gastrointestinal dysmotility necessitating parenteral nutrition and intubation with eventual expiration. CONCLUSION This case represents a unique autoimmune paraneoplastic neurologic syndrome, likely specific to neuroendocrine tumors and motivated by concurrent radioimmunotherapy. Recognition of the potential role of radioimmunotherapy may provide an advantage in anticipating these severe sequelae.
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MESH Headings
- Aged
- Antibodies, Monoclonal, Humanized/adverse effects
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antineoplastic Agents, Immunological/adverse effects
- Antineoplastic Agents, Immunological/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Autoimmune Diseases of the Nervous System/etiology
- Autoimmune Diseases of the Nervous System/immunology
- Axilla
- Carboplatin/administration & dosage
- Carcinoma, Merkel Cell/drug therapy
- Carcinoma, Merkel Cell/radiotherapy
- Carcinoma, Merkel Cell/secondary
- Combined Modality Therapy
- Deglutition Disorders/etiology
- Etoposide/administration & dosage
- Fatal Outcome
- Fingers
- Hallucinations/etiology
- Humans
- Lymphatic Metastasis/diagnostic imaging
- Lymphatic Metastasis/radiotherapy
- Male
- Neuralgia/drug therapy
- Neuralgia/etiology
- Palliative Care
- Paraneoplastic Syndromes, Nervous System/etiology
- Paraneoplastic Syndromes, Nervous System/immunology
- Parenteral Nutrition, Total
- Pneumonia, Aspiration/etiology
- Positron Emission Tomography Computed Tomography
- Radioimmunotherapy/adverse effects
- Radiotherapy, High-Energy
- Radiotherapy, Intensity-Modulated/adverse effects
- Skin Neoplasms/drug therapy
- Skin Neoplasms/radiotherapy
- Skin Neoplasms/secondary
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Affiliation(s)
| | | | - Mohamed H Khattab
- Department of Radiation Oncology, Vanderbilt University Medical Center, 2220 Pierce Avenue, PRB-B1003, Nashville, TN, USA
| | - Guozhen Luo
- Department of Radiation Oncology, Vanderbilt University Medical Center, 2220 Pierce Avenue, PRB-B1003, Nashville, TN, USA
| | - Kristin K Ancell
- Department of Medicine, Division of Hematology Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Austin N Kirschner
- Department of Radiation Oncology, Vanderbilt University Medical Center, 2220 Pierce Avenue, PRB-B1003, Nashville, TN, USA.
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10
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Ho KWD, Drew PA, Chuquilin M. Merkel Cell Carcinoma with Distant Metastasis to the Clivus Causing Symptoms Mimicking Tolosa-Hunt Syndrome: A Case Report and Literature Review. Front Neurol 2017; 8:409. [PMID: 28868044 PMCID: PMC5563365 DOI: 10.3389/fneur.2017.00409] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 07/28/2017] [Indexed: 01/03/2023] Open
Abstract
Merkel cell carcinoma (MCC) is an uncommon but highly malignant neuroendocrine tumor of the skin. MCC can metastasize, but involvement of the central nervous system is rare. Here, we report a case of rapidly progressing metastatic MCC to the clivus and bilateral cavernous sinus in an immunocompromised patient. This case is unique in that it is the first case report showing MCC metastasis to the clivus from a distant site. It also demonstrates that a MCC metastasis can masquerade with symptoms of Tolosa–Hunt syndrome. A literature review on MCC with CNS metastasis is presented.
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Affiliation(s)
- Kwo Wei David Ho
- Department of Neurology, University of Florida, Gainesville, FL, United States
| | - Peter A Drew
- Department of Pathology, University of Florida, Gainesville, FL, United States
| | - Miguel Chuquilin
- Department of Neurology, University of Florida, Gainesville, FL, United States
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11
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Sharobeam A, Ray J, Dong J, Chong V. Subacute Cerebellar Degeneration due to a Paraneoplastic Phenomenon Associated with Metastatic Merkel Cell Carcinoma: A Case Report. Case Rep Oncol 2017; 10:764-768. [PMID: 28878663 PMCID: PMC5582522 DOI: 10.1159/000479731] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 07/25/2017] [Indexed: 01/30/2023] Open
Abstract
Purpose The aim of this article is to illustrate the diagnostic challenges and management of paraneoplastic neurological syndromes in Merkel cell carcinoma. Materials and Methods We describe a previously functionally independent 85-year-old woman who presented with subacute onset of dizziness and gait ataxia in the setting of metastatic Merkel cell carcinoma. Results Diagnosis was made on biopsy after positron emission tomography imaging revealed increased metabolic activity in 2 left inguinofemoral lymph nodes. Cerebrospinal fluid analysis was positive for anti-Hu on subsequent admission. Her functional status improved with methylprednisolone treatment and radiotherapy. Conclusion The case highlights the challenge of the evaluation of patients who present with progressive cerebellar signs and the need to consider a paraneoplastic syndrome, especially in the setting of previous malignancy.
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Affiliation(s)
| | - Jason Ray
- Melbourne Health, Parkville, Victoria, Australia
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12
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Pavolucci L, Giannini G, Giannoccaro MP, Foschini MP, Lang B, Avoni P, Tinuper P, Vincent A, Liguori R. Paraneoplastic cerebellar degeneration and lambert-eaton myasthenia in a patient with merkel cell carcinoma and voltage-gated calcium channel antibodies. Muscle Nerve 2017; 56:998-1000. [PMID: 28006860 DOI: 10.1002/mus.25530] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2016] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Merkel cell carcinoma is a rare cutaneous, aggressive tumor. Although it shares many neuroendocrine features with small cell lung carcinoma, it has only occasionally been reported with paraneoplastic neurological syndromes. METHODS A healthy 67-year-old man developed acute ataxia, vertigo, and nausea. Subsequently he also developed dysarthria, diplopia, xerostomia, fatigability and progressive anorexia. He underwent a full diagnostic workup and was found to have a high titer of voltage-gated calcium channel antibodies in serum and cerebrospinal fluid, neurophysiological findings compatible with Lambert-Eaton myasthenia and neurological signs compatible with cerebellar degeneration. RESULTS A positron emission tomography study revealed a hypermetabolic lesion in the axilla, subsequently biopsied and consistent with Merkel cell carcinoma. CONCLUSIONS In most previous reports, neurological symptoms preceded the Merkel cell carcinoma diagnosis, and the primary localization was in lymph nodes. This tumor should be considered in patients with paraneoplastic syndrome, and particularly Lambert-Eaton myasthenia after exclusion of small cell lung carcinoma. Muscle Nerve 56: 998-1000, 2017.
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Affiliation(s)
- Lucia Pavolucci
- Department of Biomedical and Neuromotor Sciences (DiBiNeM), University of Bologna, Via Altura 3, 40139, Bologna, Italy
| | - Giulia Giannini
- Department of Biomedical and Neuromotor Sciences (DiBiNeM), University of Bologna, Via Altura 3, 40139, Bologna, Italy
| | - Maria Pia Giannoccaro
- Department of Biomedical and Neuromotor Sciences (DiBiNeM), University of Bologna, Via Altura 3, 40139, Bologna, Italy.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Maria Pia Foschini
- Department of Biomedical and Neuromotor Sciences (DiBiNeM), University of Bologna, Via Altura 3, 40139, Bologna, Italy
| | - Bethan Lang
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Patrizia Avoni
- Department of Biomedical and Neuromotor Sciences (DiBiNeM), University of Bologna, Via Altura 3, 40139, Bologna, Italy.,IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Paolo Tinuper
- Department of Biomedical and Neuromotor Sciences (DiBiNeM), University of Bologna, Via Altura 3, 40139, Bologna, Italy.,IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Angela Vincent
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Rocco Liguori
- Department of Biomedical and Neuromotor Sciences (DiBiNeM), University of Bologna, Via Altura 3, 40139, Bologna, Italy.,IRCCS Institute of Neurological Sciences, Bologna, Italy
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13
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Abstract
Merkel cell carcinoma is a rare primary cutaneous neuroendocrine tumour that is locally aggressive. In most cases the primary treatment is local surgical excision; however, there is a high incidence recurrence both local and distant. Cerebral metastases from Merkel cell carcinoma are extremely uncommon with only 12 cases published in the literature. This case is particularly unusual in that, not only was no established primary lesion identified, but also the patient has survived for 10 years following initial diagnosis and for 9 years following excision of a single brain metastasis.
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Affiliation(s)
- S Honeybul
- Department of Neurosurgery, Sir Charles Gairdner Hospital and Royal Perth Hospital , Perth, Western Australia
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14
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Iyer JG, Parvathaneni K, Bhatia S, Tarabadkar ES, Blom A, Doumani R, McKenzie J, Asgari MM, Nghiem P. Paraneoplastic syndromes (PNS) associated with Merkel cell carcinoma (MCC): A case series of 8 patients highlighting different clinical manifestations. J Am Acad Dermatol 2016; 75:541-547. [PMID: 27177440 DOI: 10.1016/j.jaad.2016.04.040] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 04/11/2016] [Accepted: 04/14/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND Paraneoplastic syndromes (PNS) are commonly associated with neuroendocrine cancers, such as small cell lung cancer. OBJECTIVES We examined the association of PNS in Merkel cell carcinoma (MCC), a rare neuroendocrine skin cancer. METHODS We identified PNS associated with MCC based on chart review of a Seattle-based repository and examined the incidence of MCC-associated hyponatremia in an independent cohort within Kaiser Permanente Northern California. RESULTS Eight PNS cases were identified from the Seattle repository. Three distinct PNS types were observed: cerebellar degeneration (1 case), Lambert-Eaton myasthenic syndrome (2 cases), and malignancy-associated hyponatremia (5 cases). Moreover, the incidence of severe hyponatremia (serum sodium <125 mmol/L) coincident with MCC was identified among 4.3% (9 of 211) patients with MCC in the Kaiser Permanente Northern California cohort. LIMITATIONS We did not have access to complete medical records on all patients so it was not possible to determine the prevalence of PNS in MCC. CONCLUSIONS MCC can be associated with PNS similar to those found in other neuroendocrine cancers. Clinicians should be aware of these presentations as PNS often precede the identification of the underlying malignancy and usually resolve with appropriate treatment of the cancer.
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Affiliation(s)
- Jayasri G Iyer
- Dermatology Division, Department of Medicine, University of Washington, Seattle, Washington
| | - Kaushik Parvathaneni
- Dermatology Division, Department of Medicine, University of Washington, Seattle, Washington
| | - Shailender Bhatia
- Medical Oncology Division, Department of Medicine, University of Washington, Seattle, Washington
| | - Erica S Tarabadkar
- Dermatology Division, Department of Medicine, University of Washington, Seattle, Washington
| | - Astrid Blom
- Dermatology Division, Department of Medicine, University of Washington, Seattle, Washington
| | - Ryan Doumani
- Dermatology Division, Department of Medicine, University of Washington, Seattle, Washington
| | - Jill McKenzie
- Dermatology Division, Department of Medicine, University of Washington, Seattle, Washington
| | - Maryam M Asgari
- Division of Research, Kaiser Permanente Northern California, Oakland, California; Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Paul Nghiem
- Dermatology Division, Department of Medicine, University of Washington, Seattle, Washington.
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15
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Simmons DB, Duginski TM, McClean JC, Amato AA, Sladky JH. Lambert-eaton myasthenic syndrome and merkel cell carcinoma. Muscle Nerve 2015; 53:325-6. [DOI: 10.1002/mus.24934] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 10/02/2015] [Accepted: 10/06/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Daniel B. Simmons
- Department of Neurology; San Antonio Military Medical Center (SAMMC), Fort Sam Houston; Texas USA
| | - Thomas M. Duginski
- Department of Neurology; San Antonio Military Medical Center (SAMMC), Fort Sam Houston; Texas USA
| | - Jeffrey C. McClean
- Department of Neurology; San Antonio Military Medical Center (SAMMC), Fort Sam Houston; Texas USA
| | - Anthony A. Amato
- Department of Neurology; Brigham and Women's Hospital and Harvard Medical School; Boston Massachusetts USA
| | - John H. Sladky
- Department of Neurology; San Antonio Military Medical Center (SAMMC), Fort Sam Houston; Texas USA
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16
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Abstract
Merkel cell carcinoma also known as neuroendocrine carcinoma of the skin is a very rare skin tumor. It commonly presents in the old age and the common sites are head, neck and extremities. The diagnosis requires histopathological examination with immunohistochemical correlation. We report a case of Merkel cell carcinoma stage IIIB with bilateral inguinal lymphadenopathy that on FNAB showed metastatic deposits of the tumor.
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Affiliation(s)
- Vandana L Gaopande
- Department of Pathology, Smt Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India
| | - Avinash R Joshi
- Department of Pathology, Smt Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India
| | - Siddhi G S Khandeparkar
- Department of Pathology, Smt Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India
| | - Sanjay D Deshmukh
- Department of Pathology, Smt Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India
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Bombelli F, Lispi L, Calabrò F, Corsi FM, Petrucci A. Lambert–Eaton myasthenic syndrome associated to Merkel cell carcinoma: report of a case. Neurol Sci 2015; 36:1491-2. [DOI: 10.1007/s10072-015-2107-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 02/10/2015] [Indexed: 11/24/2022]
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18
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Zhang C, Emery L, Lancaster E. Paraneoplastic cerebellar degeneration associated with noncutaneous Merkel cell carcinoma. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2014; 1:e17. [PMID: 25340069 PMCID: PMC4202670 DOI: 10.1212/nxi.0000000000000017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 05/26/2014] [Indexed: 01/10/2023]
Affiliation(s)
- Cen Zhang
- Department of Neurology (C.Z., E.L.) and Department of Pathology and Laboratory Medicine (L.E.), Hospital of the University of Pennsylvania, Philadelphia
| | - Lyndsey Emery
- Department of Neurology (C.Z., E.L.) and Department of Pathology and Laboratory Medicine (L.E.), Hospital of the University of Pennsylvania, Philadelphia
| | - Eric Lancaster
- Department of Neurology (C.Z., E.L.) and Department of Pathology and Laboratory Medicine (L.E.), Hospital of the University of Pennsylvania, Philadelphia
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19
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Siau RT, Morris A, Karoo RO. Surgery results in complete cure of Lambert–Eaton myasthenic syndrome in a patient with metastatic Merkel cell carcinoma. J Plast Reconstr Aesthet Surg 2014; 67:e162-4. [DOI: 10.1016/j.bjps.2014.03.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 03/08/2014] [Indexed: 10/25/2022]
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20
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Triozzi PL, Fernandez AP. The role of the immune response in merkel cell carcinoma. Cancers (Basel) 2013; 5:234-54. [PMID: 24216706 PMCID: PMC3730301 DOI: 10.3390/cancers5010234] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 01/30/2013] [Accepted: 02/06/2013] [Indexed: 12/31/2022] Open
Abstract
Merkel cell carcinoma (MCC) is an aggressive neuroendocrine skin cancer. The Merkel cell polyomavirus (MCPyV) is implicated in its pathogenesis. Immune mechanisms are also implicated. Patients who are immunosuppressed have an increased risk. There is evidence that high intratumoral T-cell counts and immune transcripts are associated with favorable survival. Spontaneous regressions implicate immune effector mechanisms. Immunogenicity is also supported by observation of autoimmune paraneoplastic syndromes. Case reports suggest that immune modulation, including reduction of immune suppression, can result in tumor regression. The relationships between MCPyV infection, the immune response, and clinical outcome, however, remain poorly understood. Circulating antibodies against MCPyV antigens are present in most individuals. MCPyV-reactive T cells have been detected in both MCC patients and control subjects. High intratumoral T-cell counts are also associated with favorable survival in MCPyV-negative MCC. That the immune system plays a central role in preventing and controlling MCC is supported by several observations. MCCs often develop, however, despite the presence of humoral and cellular immune responses. A better understanding on how MCPyV and MCC evade the immune response will be necessary to develop effective immunotherapies.
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Affiliation(s)
- Pierre L. Triozzi
- Taussig Cancer Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +1-216-445-5141; Fax: +1-216-636-2498
| | - Anthony P. Fernandez
- Departments of Dermatology and Anatomic Pathology, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA; E-Mail:
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21
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Seaman B, Brem S, Fromm A, Staller A, McCardle T, Jain S. Intracranial spread of Merkel cell carcinoma to the cerebellopontine angle. J Cutan Med Surg 2012; 16:54-60. [PMID: 22417997 DOI: 10.1177/120347541201600111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Merkel cell carcinoma (MCC) is a rare, highly malignant, and aggressive dermal neuroendocrine neoplasm that rarely metastasizes to the central nervous system. OBJECTIVE To review the current literature regarding treatment of neurometastatic MCC. METHODS A case of a 78-year-old male with intracranial extra-axial metastatic MCC involving the left cerebellopontine angle is presented. RESULTS A retrosigmoid craniectomy was performed with complete resection of the metastatic focus. Adjuvant treatment included whole-brain radiation therapy followed by etoposide and carboplatin chemotherapy. Seven months postoperatively, the patient was free of metastatic disease. CONCLUSION Surgical resection should be performed when feasible to prevent local recurrence. This may be followed by early adjuvant fractionated whole-brain radiotherapy and systemic chemotherapy; however, no clinical trials have been performed to demonstrate a survival benefit.
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Affiliation(s)
- Brian Seaman
- Department of Neuro-oncology and Pathology, Moffitt Cancer Research Center, Tampa, FL, USA
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22
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Prommer E. Neuromuscular paraneoplastic syndromes: the Lambert-Eaton myasthenic syndrome. J Palliat Med 2011; 13:1159-62. [PMID: 20836646 DOI: 10.1089/jpm.2009.0418] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Disorders in which the effects of cancer occur at a site remote from the primary tumor are termed paraneoplastic disorders. The most well- known paraneoplastic disorder affecting the neuromuscular junction is the Lambert-Eaton myasthenic syndrome (LEMS). DISCUSSION We describe a case of the Lambert-Eaton myasthenic syndrome diagnosed in a patient with small cell lung cancer presenting with profound weakness. The discussion that follows the case describes the pathophysiology of the disorder, clinical characteristics and therapies that have been used. The role of the palliative care team in the case is described.
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Affiliation(s)
- Eric Prommer
- Department of Hematology/Oncology/Palliative Care, Mayo Clinic Arizona, Phoenix, Arizona 85054, USA.
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23
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Hocar O, Poszepczynska-Guigné E, Faye O, Wechsler J, Bagot M, Buffard V. [Severe necrotizing myopathy subsequent to Merkel cell carcinoma]. Ann Dermatol Venereol 2010; 138:130-4. [PMID: 21333825 DOI: 10.1016/j.annder.2010.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Revised: 09/22/2010] [Accepted: 11/17/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Merkel cell carcinoma (MCC) is a rare tumour with a poor prognosis. Rare cases of paraneoplastic neurological syndrome have been associated with this type of tumour, namely myasthenic syndrome of Lambert-Eaton and encephalomyelitis. We report the first case of severe necrotizing myopathy with anti-Hu antibodies complicating MCC. CASE REPORT We describe the case of a 58-year-old woman with Merkel cell carcinoma (MCC) of the forearm complicated by severe necrotizing myopathy associated with the presence of anti-Hu antibodies. This myopathy occurred 3 months after complete remission of MCC. The patient was treated with high-dose corticosteroids combined with two intravenous infusions of immunoglobulins. Her neurological status deteriorated despite this treatment. Pararaneoplastic syndrome (anti-Hu antibodies, necrotizing myopathy) complicating MCC was suspected. There was no visible tumour relapse. After multidisciplinary discussion, it was decided to supplement treatment with chemotherapy (carboplatin and VP-16). The patient died 20 days after the first course of chemotherapy. DISCUSSION Severe necrotizing myopathy with anti-Hu antibodies may be added to the list of possible paraneoplastic syndromes associated with Merkel cell carcinoma.
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Affiliation(s)
- O Hocar
- Service de dermatologie, hôpital Henri-Mondor, 51, avenue du Maréchal-De-Lattre-De-Tassigny, 94010 Créteil cedex, France.
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24
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Bailey TL, Fung MA, Gandour-Edwards R, Ellis WG, Schrot RJ. Clinical emergence of neurometastatic merkel cell carcinoma: a surgical case series and literature review. J Neurooncol 2010; 102:147-55. [PMID: 20668913 PMCID: PMC3041920 DOI: 10.1007/s11060-010-0304-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Accepted: 07/05/2010] [Indexed: 11/27/2022]
Abstract
Merkel cell carcinoma (MCC) is a rare cutaneous neuroendocrine neoplasm of possible viral origin and is known for its aggressive behavior. The incidence of MCC has increased in the last 15 years. Merkel cell carcinoma has the potential to metastasize, but rarely involves the central nervous system. Herein, we report three consecutive surgical cases of MCC presenting at a single institution within 1 year. We used intracavitary BCNU wafers (Gliadel®) in two cases. Pathological features, including CK20 positivity, consistent with MCC, were present in all cases. We found 33 published cases of MCC with CNS involvement. We suggest that the incidence of neurometastatic MCC may be increasing, parallel to the increasing incidence of primary MCC. We propose a role for intracavitary BCNU wafers in the treatment of intra-axial neurometastatic MCC.
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Affiliation(s)
- Thomasina L Bailey
- Department of Pathology, UC Davis Medical Center, 4400V Street, Sacramento, CA 95817, USA
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25
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Pituitary metastasis of Merkel cell carcinoma. J Neurooncol 2009; 97:295-9. [DOI: 10.1007/s11060-009-0025-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Accepted: 09/21/2009] [Indexed: 11/26/2022]
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26
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Pardo P, Agustín F, Miranda C. [Merkel cell carcinoma: a report of two cases]. RADIOLOGIA 2007; 49:366-8. [PMID: 17910878 DOI: 10.1016/s0033-8338(07)73796-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We present two cases of Merkel cell carcinoma (also called cutaneous neuroendocrine carcinoma) and review the relevant literature. This is a rare skin tumor that is very aggressive, with a great tendency to local recurrence and rapid metastatic spread to regional lymph nodes as well as hematogeneous dissemination. We discuss the usefulness of different imaging modalities in determining the extension of disease and in patient follow-up.
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Affiliation(s)
- P Pardo
- Servicio de Radiodiagnóstico. Complejo Hospitalario de Ourense. España.
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27
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Abstract
Merkel cell carcinoma (MCC) is a rare and extremely aggressive skin cancer that arises from primary neural cells. It presents most commonly in the elderly and immunocompromised patients. Pathologically, MCC should be distinguished from extrapulmonary small cell lung cancer or metastatic small cell lung cancer or a small cell variant of melanoma. The prognosis is based largely on the stage of disease at the time of presentation. Therapeutic options for MCC include wide resection with or without adjuvant radiotherapy or chemotherapy. Novel therapies based on the understanding of the molecular aspects of MCC are currently being explored.
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Affiliation(s)
- Vy Dinh
- Department of Internal Medicine, University of Miami School of Medicine, Miami, FL 33136, USA
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28
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Abstract
Paraneoplastic neurologic disorders (PND) are remote medical complications of cancer that cannot be attributed to direct effects of the neoplasm or its metastases. PND are uncommon, disabling syndromes that have been recognized for more than 50 years. Despite their rarity, these diseases are the subject of intensive research and clinical fascination. This review highlights notable recent publications related to PND. In recent years, the broad clinical spectrum of PND has become even more apparent. PND can affect any part of the central or peripheral nervous system and often affect multiple areas simultaneously. These disorders are often associated with neuron-specific autoantibodies in the serum and cerebrospinal fluid. In clinical practice, detection of these antibodies is crucial for the diagnosis because the neurologic symptoms usually precede the diagnosis of cancer. Recent publications have described new antibody specificities associated with PND and expand our ability to identify patients serologically. Once diagnosed, detection of cancer can be difficult, but the use of positron emission tomography has been shown to be a useful supplement to standard imaging procedures. PND are thought to be autoimmune disorders precipitated by the immune response to cancer. Observations and laboratory studies in PND patients have shown that activation of cytotoxic T cells is an important component of the disease. These studies not only shed light on the pathogenesis of PND and the mechanisms of effective antitumor immunity but may eventually lead to improved treatment.
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Affiliation(s)
- Steven Vernino
- Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9036, USA.
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29
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P129 - Myopathie paranéoplasique sévère associée à un carcinome de Merkel. Ann Dermatol Venereol 2005. [DOI: 10.1016/s0151-9638(05)79858-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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30
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Abstract
Leptomeningeal metastases (LM) are increasingly recognized as a devastating complication of solid tumors. Improved treatment of primary malignancy and advances in diagnostic imaging have led to an apparent increase in the number of patients diagnosed with LM. Unfortunately, therapeutic options remain limited. Radiotherapy is used to treat bulky tumor and provide symptomatic relief. Intrathecal chemotherapy benefits a selected subset of patients. The challenge to the future is to delineate the molecular mechanisms underlying LM and to develop novel therapeutic or prophylactic modalities to combat LM.
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31
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Bickle K, Glass LF, Messina JL, Fenske NA, Siegrist K. Merkel cell carcinoma: a clinical, histopathologic, and immunohistochemical review. ACTA ACUST UNITED AC 2003; 23:46-53. [PMID: 15095915 DOI: 10.1016/s1085-5629(03)00087-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Merkel cell carcinoma is a rare aggressive neoplasm, with about 400 cases diagnosed in the United States each year. Among the cutaneous-derived neoplasms, it is the most deadliest, with a higher mortality rate than melanoma. Although the classic clinical presentation as a rapidly growing papule in a sun-exposed site of an elderly patient is not specific, certain histopathologic and ancillary pathologic features allow for its discrimination in most cases. Herein, we review the etiology, pathogenesis, clinical, and pathologic attributes as well as the staging treatment and prognosis of this important public health menace.
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Affiliation(s)
- Kelly Bickle
- Divison of Dermatology, Department of Internal Medicine, University of South Florida College of Medicine, 12901 Bruce D. Downs Blvd, MDC 19, Tampa, FL 33612-4799, USA
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32
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Greenlee JE, Steffens JD, Clawson SA, Hill K, Dalmau J. Anti-Hu antibodies in Merkel cell carcinoma. Ann Neurol 2002; 52:111-5. [PMID: 12112058 DOI: 10.1002/ana.10225] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Anti-Hu antibody is an antineuronal autoantibody found in a subset of patients with paraneoplastic neurological disease. The antibody was first associated with small cell carcinoma of the lung and is most often used as a marker for this neoplasm in patients presenting with suspected paraneoplastic syndromes. Here we report a patient with a multifaceted neurological disorder in the setting of Merkel cell carcinoma. The patient's serum contained antibodies against the Hu antigen, and the expression of the Hu antigen was demonstrated in the patient's tumor.
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Affiliation(s)
- John E Greenlee
- Neurology Service, Veterans Affairs Medical Center and Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT 84148, USA.
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33
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Calza L, Beltrami C, Manfredi R, Colangeli V, Freo E, Chiodo F. Merkel cell carcinoma in a human immunodeficiency virus-infected patient. Br J Dermatol 2002; 146:895-8. [PMID: 12000392 DOI: 10.1046/j.1365-2133.2002.04646.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In the general population, Merkel cell carcinoma (MCC) is a very rare neuroendocrine primary skin cancer, known for its high propensity for local recurrence and distant metastases. Treatment for this neoplasm is individualized on the grounds of clinical staging at presentation, and may include surgical excision, radiotherapy and chemotherapy. Several studies suggest that MCC occurs more frequently and with a more aggressive course in immunocompromised patients such as organ transplant recipients and those infected with human immunodeficiency virus (HIV). A case of this cutaneous malignancy, characterized by a short-term local recurrence and systemic fatal spread in spite of surgical treatment, radiotherapy and chemotherapy, is described in a patient with advanced HIV infection.
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Affiliation(s)
- L Calza
- Department of Clinical and Experimental Medicine, Division of Infectious Diseases, University of Bologna, S. Orsola Hospital, via Massarenti 11, 40138 Bologna, Italy.
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34
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Abstract
Merkel cell carcinoma (MCC) is a rare, highly malignant cutaneous tumor, primarily of the head and neck, that requires timely diagnosis, adequate staging, and aggressive therapy. MCC tends to be overlooked in the early stage, has a high propensity for invading local and regional nodal basins, and exhibits a high postoperative recurrence rate, with distant thoracic, abdominal, and central nervous system metastases. Conventional radiography and cross-sectional imaging show lesions similar to those originating from other small cell carcinomas. Nuclear medicine procedures such as sentinel node scintigraphy, somatostatin receptor scintigraphy, and positron emission tomography may be used to supplement judicious cross-sectional imaging evaluation, thereby adding diagnostic value in staging and providing therapeutic guidance. Ultimately, however, the diagnosis relies exclusively on pathologic findings at immunohistochemical staining and electron microscopy. The rarity of MCC and the resulting insufficient awareness of this neoplasm often delay correct identification and treatment, which essentially consists of wide-margin surgical excision of the primary tumor and local and regional radiation therapy. To date, clinical information is still insufficient to fully appreciate the role of imaging in MCC management. A better imaging algorithm is expected with increased awareness and improved clinical understanding of this uncommon skin neoplasm.
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Affiliation(s)
- Ba D Nguyen
- Department of Diagnostic Radiology, Mayo Clinic, Scottsdale, AZ 85259, USA
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35
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36
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Turgut M, Gökpinar D, Barutça S, Erkuş M. Lumbosacral metastatic extradural Merkel cell carcinoma causing nerve root compression--case report. Neurol Med Chir (Tokyo) 2002; 42:78-80. [PMID: 11944594 DOI: 10.2176/nmc.42.78] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
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 non-invasively 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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Affiliation(s)
- Mehmet Turgut
- Neurosurgery Department, Adnan Menderes University Hospital, Aydin, Turkey.
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Affiliation(s)
- Wolfram Goessling
- Department of Adult Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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38
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Plunkett TA, Subrumanian R, Leslie MD, Harper PG. Management of Merkel cell carcinoma. Expert Rev Anticancer Ther 2001; 1:441-5. [PMID: 12113110 DOI: 10.1586/14737140.1.3.441] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Merkel cell carcinoma is an uncommon cutaneous malignancy. Although it is rare, Merkel cell carcinoma has been described as the most malignant primary skin tumor. It is therefore important that once diagnosed, Merkel cell carcinoma is treated appropriately. The aim of this short review is to provide a summary of the available literature to guide clinicians in the future management of such patients. Inevitably in such a rare disease, there are no randomized trials of therapy. The treatment of individual patients will rely on opinion as much as the 'evidence'.
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Affiliation(s)
- T A Plunkett
- Guy's, King's and St Thomas' Cancer Centre, Guy's Hospital, London SE1 9RT, UK.
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