A thoracic vertebral localization of a metastasized cutaneous Merkel cell carcinoma: Case report and review of literature

Abstract

Background:Merkel cell carcinoma (MCC) is a rare neuroendocrine skin tumor, which may be related to sun exposure. It can metastasize to lungs, liver and bone, leading to severe morbidity and mortality. Vertebral metastases from MCC are rare. The authors report the tenth case in the literature, a 59-year-old patient with MCC, which was primarily localized in the scalp, and later provoked distant metastasis to the thoracic spinal column.Case Description:A 59-year-old woman was admitted at our Unit of Neurosurgery with a 4-month history of progressive and severe dorsal back pain, without neurological signs. The patient had been surgically treated for a recidivated MCC in the occipital region in 2007, 2011, and 2013. (In 2013, the surgical treatment also included lateral cervical lymph node dissection). Chemotherapy and radiotherapy had come after the treatments. Magnetic resonance imaging (MRI) of the dorsal spine showed metastatic vertebral involvement with cord impingement of the T7-T8 levels. A total body CT scan revealed lungs and liver metastases, besides vertebral district. After a multidisciplinary consult a palliative surgery was decided and a posterior dorsal approach was employed: Radiofrequency (RF) thermoablation was followed by the injection of cement of T7 and T8 and transpedicle fixation T5-T9. The postoperative course was uneventful and followed by a further adjuvant therapyConclusion:Spinal metastases from MCC are described in literature only exceptionally. The clinical course is presented, along with a review of literature.

Merkel cells: A collective review of current concepts

“…[ 2 ] MC carcinoma is a very rare, rapidly growing, cutaneous neuroendocrine malignancy encountered in head-and-neck region with propensity to recur and metastasize which is believed to be derived from MCs due to its similarity in histopathology. [ 59 60 61 ]…”

Management of Spinal Bone Metastases With Radiofrequency Ablation, Vertebral Reinforcement and Transpedicular Fixation: A Retrospective Single-Center Case Series

“…After surgery, a thin-slice CT scan was performed, in order to evaluate cement distribution. According to the previously described radiological evaluation, Saliou filling score was satisfactory (12)(13)(14)(15)(16)(17)(18) in 20 vertebrae (31,7%), mediocre (6-11) in 33 vertebrae (52,4%), inadequate (0-5) in 10 vertebrae (15,9%). (Figure 4)…”

“…After surgery, in order to evaluate if the procedure was performed correctly and with the proper amount of PMMA, a thin-slice CT scan was mandatory. Based on Saliou filling score was satisfactory (12)(13)(14)(15)(16)(17)(18) in 20 vertebrae (31,7%), mediocre (6)(7)(8)(9)(10)(11) in 33 vertebrae (52,4%), inadequate (0-5) in 10 vertebrae (15,9%).…”

“…Percutaneous techniques, such as vertebroplasty, kyphoplasty and RFA achieve a key role in management of vertebral metastatic lesions (16)(17)(18)(19)(20).…”

“…12 months. Based on Saliou filling score, filling was satisfactory (12)(13)(14)(15)(16)(17)(18) in 20 vertebrae (31,7%), mediocre (6)(7)(8)(9)(10)(11) in 33 vertebrae (52,4%), inadequate (0-5) in 10 vertebrae (15,9%). A consistent PMMA filling of vertebral bodies was successfully achieved with significant pain relief.…”