PMC6388979_01
Location of facial malignant tumor and histopathological findings of Merkel cell carcinoma.. Notes: (A) Merkel cell carcinoma was excised from the right preauricular area. (B) H&E staining revealed diffuse proliferation of atypical and pleomorphic tumor cells; small, round basophilic cells are arranged in cordlike structures (original magnification x200). Histology of the tumor. (C-G) Immunohistochemical analysis found that the tumor cells were positive for (C) CK20, (D) Syn, (E) CgA, (F) CD56 and (G) Ki67 (original magnification x400). (H, I) Excisional biopsy revealed Merkel cell carcinoma with negative margins (original magnification: H x40; I x200).. Abbreviations: CT, Computed tomography; PET, positron emission tomography.
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The patient underwent surgical treatment on the 26 August 2017) (Figure 1). I) with negative margins (Figure 1). Immunohistochemical staining showed that tumor cells were positive for CK20, CD56, chromogranin A (CgA) and Syn (Figure 1). The proliferative activity (Ki-67) reached ~ 80% (Figure 1).
Images of the whole-body PET/CT scan 2 weeks post-surgical excision showing a nodule (red arrow) (0.3*0.8 cm) in the post-operative site with maxSUV values of 1.7 (A). No distant metastases were detected (B, C).. Abbreviations: CT, computed tomography; PET, positron emission tomography.
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At the 2-week post operation follow-up, whole body examination with 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT was performed (Figure 2).
Computed tomography scan (A, B) neck demonstrating a mass (red arrow) in relation to the (C) cervical lymph node mass (red arrow).
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The scan demonstrated a right cervical lymph node mass at the C2 level (Figure 3).
Histology of the resected cervical lymph node biopsy mass.. Notes: (A, B) H&E staining found diffuse proliferation of atypical and pleomorphic cells (original magnification: A x40; B x200). (C-G) Immunohistochemical analysis found that the resected mass was positive for (C) CK20, (D) Syn, (E) CgA, (F) CD56 and (G) Ki67 (original magnification x400).
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Then, the patient underwent cervical lymph node biopsy (March 05, 2018) and pathological diagnosis confirmed metastatic MCC (Figure 4).
The various treatments the patient received and the duration of each treatment.. Abbreviations: FDG, 18F-fluorodeoxyglucose; IMRT, intensity modulated radiation therapy; PET-CT, positron emission tomography-computed tomography.
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The treatment timeline is presented in Figure 5.