Merkel Cell Carcinoma of Anal Canal: Case Report and Literature Review


Merkel Cell Carcinoma of Anal Canal: Case Report and Literature Review


Zahrh F Abualsaud1, Zahra F Alkhunaizi2, Mohammed Somali2, Amani Joudeh2, Mohammed Tahtouh1

1Dept of General Surgery, King Fahad Specialist Hospital Dammam, Saudi Arabia;
2Dept of Pathology, King Fahad Specialist Hospital Dammam, Saudi Arabia


Few cases of anal canal Merkel cell Carcinoma have been reported in the literature. Merkel Cell Carcinoma is rare neuroendocrine tumor which commonly found in sun-exposed areas such as extremities. We describe a case of 74-year-old male with anal canal Merkel Cell Carcinoma. He presented with peri-anal pain, tenesmus and itching. Besides, he was found to have chronic anemia. An anal nodule was found during per-rectum physical examination that was excised during endoscopy. Histological examination of the nodule confirmed the diagnosis of Merkel Cell Carcinoma. Thenceforward, patient died 7 months after diagnosis with marked metastatic disease despite initiation of Pembrolizumab therapy.


Keywords: Anal canal; Merkel cell carcinoma; Neuroendocrine tumors; MCC

Free Full-text PDF


How to cite this article:

Zahrh F Abualsaud, Zahra F Alkhunaizi, Mohammed Somali, Amani Joudeh, Mohammed Tahtouh.Merkel Cell Carcinoma of Anal Canal: Case Report and Literature Review. International Journal of Case Reports, 2021,5:245. DOI: 10.28933/ijcr-2021-08-2905


References:

1. Fitzgerald TL, Dennis S, Kachare SD, Vohra NA, Wong JH, Zervos EE. Dramatic increase in the incidence and mortality from Merkel cell carcinoma in the United States. Am Surg. 2015;81:802-806.
2. 24. Toker C. Trabecular carcinoma of the skin. Arch Der- matol 1972;105:107–10.
3. Rockville Merkel Cell Carcinoma Group. Merkel Cell Carcinoma: recent progress and current priorities on etiology, pathogenesis, and clinical management. J Clin Oncol. 2009 Aug 20;27(24):4021–6.
4. Paterson C, Musselman L, Chorneyko K, Reid S, Rawlinson J. Merkel cell (neuroendocrine) carcinoma of the anal canal: report of a case. Dis Colon Rectum. 2003;46(5):676-678. doi:10.1007/s10350-004-6630-1
5. Feng H, Shuda M, Chang Y, Moore PS. Clonal integration of a polyomavirus in human Merkel cell carcinoma. Science. 2008;319 (5866):1096–100.
6. Emma Ramahi, B.A., Jehee Choi, B.S., Clifton D. Fuller, M.D., Ph.D., Tony Y. Eng, M.D. Merkel Cell Carcinoma. Am J Clin Oncol. 2013 June ; 36(3): 299–309. doi:10.1097/COC.0b013e318210f83c.
7. Poulsen M. Merkel cell carcinoma of the skin. Lancet Oncol 2004;5:593 – 9
8. Jankowski M, Kopinski P, Schwartz R, Czajkowski R. Merkel cell carcinoma: is this a true carcinoma? Experimental Dermatology. 2014;23 (11):792–4.
9. Haley CT, Mui UN, Vangipuram R, Rady PL, Tyring SK. Human oncoviruses: Mucocutaneous manifestations, pathogenesis, therapeutics, and prevention: Papillomaviruses and Merkel cell polyomavirus. J Am Acad Dermatol. 2019 Jul;81(1):1-21. doi: 10.1016/j.jaad.2018.09.062. Epub 2018 Nov 28. PMID: 30502418.
10. Schrama D, Ugurel S, Becker JC. Merkel cell carcinoma: recent insights and new treatment options. Curr Opin Oncol. 2012; 24:141-149.
11. Huang WS, Lin PY, Lee IL, Chin CC, Wang JY, Yang WG. Metastatic Merkel cell carcinoma in the rectum: report of a case. Dis Colon Rectum. 2007 Nov;50(11):1992-5. doi: 10.1007/s10350-006-0879-5. PMID: 17713819.
12. Sidhu GS, Chandra P, Cassai ND. Merkel cells, normal and neoplastic: An update. Ultrastruct Pathol. 2005;29:287–294.
13. Han SY, North JP, Canavan T, Kim N, Yu SS. Merkel cell carcinoma. Hematol Oncol Clin North Am. 2012;26:1351-1374.
14. Paulson KG, Lemos BD, Feng B, et al. Array-CGH reveals recurrent genomic changes in Merkel cell carcinoma including amplification of L-Myc. J Invest Dermatol. 2009;129:1547–1555.
15. Gupta SG, Want LC, Penas PF, et al. Sentinel lymph node biopsy for evaluation and treatment of patients with Merkel cell carcinoma. Arch Dermatol. 2006;142:685–690.
16. Coquard R. Merkel cell carcinoma of the anal canal: importance of radiotherapy. Dis Colon Rectum. 2004 Feb;47(2):256-7; author reply 257. doi: 10.1007/s10350-003-0022-9. PMID: 15043301.
17. KouzminaM,KoljonenV,LeikolaJ,Bo€hlingT,LanttoE. Frequency and locations of systemic metastases in Merkel cell carcinoma by imaging. Acta Radiol Open. 2017;6, 2058460117700449.
18. Lemos BD, Storer BE, Iyer JG, et al. Pathologic nodal evaluation improves prognostic accuracy in Merkel cell carcinoma: analysis of 5823 cases as the basis of the first consensus staging system. J Am Acad Dermatol. 2010;63:751-761.
19. Harms KL, Healy MA, Nghiem P, et al. Analysis of prognostic factors from 9387 Merkel cell carcinoma cases forms the basis for the new 8th edition AJCC Staging System. Ann Surg Oncol. 2016;23:3564-3571.
20. 7. Limei Guo, Naoto Kuroda, Eriko Miyazaki, Yulan Jin, Makoto Toi, Tadashi Hamauzu, Makoto Hiroi, Takeshi Inoue, Atsushi Inoue, and Hideaki Enzan. Anal canal neuroendocrine carcinoma with Pagetoid extension. Pathology International 2004;54: 630–635
21. E. J. S. Ong, L. M. Wang, J. Darby. Synchronous Merkel cell and squamous cell carcinoma of the anal canal in an HIV‐positive patient: a case report. Colorectal Disease 2012, The Association of Coloproctology of Great Britain and Ireland. , 819–820 doi:10.1111/j.1463-1318.2012.02983.x
22. Ohtomo R, Sekine S, Taniguchi H, Tsuda H, Moriya Y, Kushima R. Anal canal neuroendocrine carcinoma associated with squamous intraepithelial neoplasia: a human papillomavirus 18-related lesion. Pathol Int. 2012;62(5):356-359. doi:10.1111/j.1440-1827.2012.02800.x
23. 10. Allen PJ, Bowne WB, Jaques DP, Brennan MF, Busam K, Coit DG. Merkel cell carcinoma: prognosis and treatment of patients from a single in stitution. J Cl in On col 2005; 23: 2300-9.
24. Tai PT, Yu E, Winquist E, Hammond A, Stitt L, Tonita J, et al. Chemotherapy in neuroendocrine/Merkel cell carcinoma of the skin: case series and review of 204 cases. J Clin Oncol 2000; 18: 2493-9.
25. Jouary T, Leyral C, Dreno B, Doussau A, Sassolas B, Beylot-Barry M, et al. Adjuvant prophylactic regional radiotherapy versus observation in stage I Merkel cell carcinoma: a multicentric prospective randomized study. Ann Oncol 2012; 23: 1074-80.
26. National Comprehensive Cancer N. NCCN Guidelines Version 1.2018 Merkel Cell Carcinoma: National comprehensive cancer, network; 2017. [Online] [Cited 2017 December 12]. Available from: URL:https://www.nccn.org/professionals/physician_gls/pdf/mcc.pdf.
27. Amin MB, Greene FL, Edge SB, Compton CC, Gershenwald JE, Brookland RK, et al. The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging. CA Cancer J Clin 2017; 67: 93-9.
28. Patnaik A, Kang SP, Rasco D, Papadopoulos KP, Elassaiss-Schaap J, Beeram M, et al. Phase I study of pembrolizumab (MK-3475; anti-PD-1 monoclonal antibody) in patients with advanced solid tumors. Clin Cancer Res. 2015; 21(19):4286–93. DOI: 10.1158/1078-0432.CCR-14-2607 [PubMed: 25977344]
29. Nghiem, P., Bhatia, S., Daud, A., Friedlander, P., Kluger, H., Kohrt, H., et al. Activity of PD-1 blockade with pembrolizumab as first systemic therapy in patients with advanced Merkel cell carcinoma [abstract]. The European Cancer Congress; September 27; Vienna, Austria. 2015. This early study demonstrated exceptionally high initial response rates
30. Pembrolizumab in treating patients with advanced Merkel cell cancer. National Institutes of Health; https://clinicaltrials.gov/show/NCT02267603 [Accessed Jan 2016]


Terms of Use/Privacy Policy/ Disclaimer/ Other Policies:
You agree that by using our site, you have read, understood, and agreed to be bound by all of our terms of use/privacy policy/ disclaimer/ other policies (click here for details).



This work and its PDF file(s) are licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.