Korean J Transplant.  2022 Nov;36(Supple 1):S205. 10.4285/ATW2022.F-3397.

Merkel cell carcinoma in young post-renal transplant male with atypical presentation

• Panjathia A
• Kanwar DB
• Sharma A
• Singh S
• Kumar S
• Sharma A

• KMID: 2535270
• DOI: http://doi.org/10.4285/ATW2022.F-3397

Abstract

Background
Merkel cell carcinoma (MCC) is a rare, aggressive neuroendocrine tumor of the skin which typically affects white men between 70 and 80 years, in sun-exposed areas.
Methods
A 39-year-old male from the north-eastern region of India with a history of renal transplant 8 years ago, on contin-uous immunosuppressive drugs developed a single painless, hard, hyperpigmented nodule over left the gluteal region on the posterolateral aspect of 3 months duration, 2×2 cm to start with. It further progressed to a nonhealing fungating mass with a necrotic surface and had grown in size since then. Dermis showed infiltration by lymphoid cells with large areas of coagulative necrosis of tumor cells described on excision biopsy by some pathologists as cutaneous lymphoma (NHL), and MCC by others. The lesion has increased to three times its original size over a span of 3 weeks. Surgical excision of mass done with sentinel lymph node biopsy of inguinal lymph nodes. Histopathology shows a tumor in the upper dermis extending up to muscle. IHC is positive for CD99, and CK20 and weak for synaptophysin, CK7 negative.
Results
In the span of 1-month post-excision, recurrence is seen even with continuous cycles of chemotherapy and distant metastasis to the meninges and brain. The patient had stable renal graft function in spite of ongoing tumor growth and continuous chemotherapy.
Conclusions
MCC is a rare and aggressive tumor. It can spread to local lymph nodes early, and surgeons should consider MCC as a differential diagnosis in case of rapidly growing painless lesion. Due to the rarity of MCC, further studies are needed to develop treatment protocols for dealing with immunosuppression in transplant patients. A multidisciplinary approach is required with the involvement of nuclear medicine and radiotherapists for early diagnosis, and treatment. and follow-up management.