ABSTRACT
Merkel cell carcinoma (MCC) is a rare and aggressive neuroendocrine neoplasm of the skin that has a high propensity to metastasize. Abdominal metastases of MCC have been described previously though these are typically regional with nodal spread. We report the case of a 60-year-old man with a history of left upper extremity MCC who had resection, radiation therapy, and immunotherapy. He ultimately developed large bowel obstruction from metastatic intraperitoneal implants. A 6 cm mass at the descending colon was biopsied and proven to be metastatic MCC. The tumor eroded through the wall of the colon and perforated, requiring emergent colectomy for septic shock. Herein, we describe the first case of colonic perforation secondary to metastatic MCC. This case illustrates the importance of expedient and multifactorial management of patients with rapidly growing metastatic colonic tumors that are at risk for perforation.
ABSTRACT
Pseudovascular squamous cell carcinoma (SCC) is a rare variant of SCC characterized by acantholysis and necrosis with preservation of vascular-like cords and spaces mimicking glands or vascular differentiation. Only three cases of this variant in the oral cavity have been reported in the literature. However, none of these cases were eosinophil-rich, which is considered to be a good prognostic indicator for conventional SCC. We report one case of an eosinophil-rich pseudovascular adenoid SCC in the oral cavity. A 38-year-old previously healthy African-American female presented with an enlarging inner left cheek mass with overlying ulcer of 2 months duration. A computed tomography scan with contrast demonstrated a large irregularly outlined peripherally enhancing mass located between the anterior margin of the ramus of the left mandible and maxilla protruding outward. An incisional biopsy was performed followed by a wide local excision 3 weeks later. She recovered well postoperatively but refused to follow-up chemoradiation therapy. Six months later, she presented with altered mental status secondary to hypercalcemia from bony metastases. She was discharged to a hospice facility as per her family's request. Histologic sections of the specimens revealed a diffuse hypercellular pleomorphic ill-circumscribed lesion with extensive necrosis. The viable areas exhibited slit vascular-like spaces and micropapillary architectural patterns with stromal eosinophilia. Focal small cellular nests with features of SCC were present. Immunohistochemistry displayed positivity for vimentin, p53, AE1/AE3 and CAM 5.2 (focally positive). All tumor cells were negative for desmin and CD34.