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Age / Sex : 69 / F
Chief complaint : a nodule in the left cheek, growing gradually over several months
What is your diagnosis?
Two weeks later, you can see the final diagonosis with a brief discussion of this case (Please submit only one answer).
Courtesy : 박세경, Sekyoung Park, 고신대병원, Kosin University Gospel Hospital
Diagnosis: Merkel cell carcinoma
Discussion
Findings: 7x5x5 mm sized well-circumscribed hypoechoic nodule with marked vascularity of the dermis and hypodermis
Differential Diagnosis: glomus tumor
Discussion:
- Aggressive primary cutaneous neuroendocrine tumor
- The incidence of this rare tumor is increasing rapidly; the American Cancer Society estimates for 2008 almost 1500 new cases in the USA. Thus, the incidence of MCC will exceed the incidence of cutaneous T-cell lymphoma. The 5-year survival rate of 30–64% for MCC is much worse than that of melanoma
- Seventh and eighth decades of life
- M> F
- Head and neck (m/c), extremities, and the trunk
- A high incidence of local recurrence and distant metastasis
- Staging is an important determinant of survival.
- Definitive diagnosis of Merkel cell carcinoma requires biopsy.
- Because of the rarity of MCC and the resulting insufficient awareness of this neoplasm, imaging findings have been reported only in a few series.
- Color Doppler sonographic findings in primary cutaneous Merkel cell carcinoma: prominent and chaotic hypervascularity with arterial vessels .
- Imaging plays an important role in staging and follow-up of MCC patients.
- Standard management
- Wide local excision.
- Regional nodes are managed by surgery or radiotherapy.
References:
J Invest Dermatol. 2007 Sep;127(9):2100-3.
J Ultrasound Med. 2018 Jan;37(1):285-292. doi: 10.1002/jum.14329. Epub 2017 Jul 20.
RadioGraphics 2002; 22:367–376
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