PMC4896012_01
69-year-old man with Merkel cell carcinoma. CT of the face shows the tumor as a subcutaneous nodular lesion of the right cheek (arrow).
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CT demonstrated a right facial subcutaneous mass without musculoskeletal involvement and adenopathy (Fig. 1). Cross-sectional imaging of the chest, abdomen and pelvis was unremarkable.
71-year-old man with Merkel cell carcinoma metastasis. AP radiograph of the knees shows subtle lucent lesion at the medial aspect of the left proximal tibial metaphysis (arrows)
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Right knee radiographs raised the possibility of ill-defined lytic lesion involving the medial tibial plateau (Fig. 2).
71-year-old man with Merkel cell carcinoma metastasis. Anterior and posterior views of the technetium-99m MDP whole body bone scintigraphy show abnormal radiotracer uptake at the proximal right tibia predominantly at its medial aspect (arrows).
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Bone scintigraphy demonstrated an intense radiotracer uptake at the tibial epiphysis and metaphysis (Fig. 3).
71-year-old man with Merkel cell carcinoma metastasis. A, Coronal MR T1-weighted image shows the MCC metastasis within the medial meta-epiphysis of the right proximal tibia (arrows) with pathologic fracture (arrowheads).
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MR examination confirmed the pathologic fracture and showed an aggressively appearing and poorly defined mass of the medial tibial plateau extending to the tibial metaphysis with adjacent soft tissue involvement (Figure 4A, Figure 4B).
71-year-old man with Merkel cell carcinoma metastasis. B, Enhanced axial MR SPGR image with fat saturation shows the right proximal tibial MCC metastasis. There is soft tissue invasion with increased signal intensity extending beyond the proximal tibial cortex anteromedially and posterolaterally (arrows).
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Pathology confirmed the right knee lesion to be bone and soft tissue metastasis from MCC (Fig. 5).