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Merkel Cell Carcinoma of Lower Extremity: A Case Report and Review of the Literatures

下肢默克細胞癌:病例報告及文獻回顧

摘要


默克細胞癌是罕見的,同時具有高度侵襲性及致命性的皮膚惡性腫瘤,通常以老年人及免疫功能缺損的患者較易發生。我們在此提出一位右大腿意外發現默克細胞癌之男性病患及其治療經驗。此病患接受腫瘤廣泛切除後,經由細胞角質蛋白20(CK 20)之免疫組織化學染色,證實為默克細胞癌。影像檢查包含:右腿、胸腔、腹腔及骨盆腔電腦斷層掃描,均顯示無區域淋巴節侵犯或遠端臟器轉移。因為臨床上無淋巴侵犯(cN0)證據且先前腫瘤廣泛切除顯示無殘存腫瘤,此病患並未接受哨兵淋巴結切片檢查。病患後續接受手術後放射治療,原發腫瘤部位及右鼠蹊淋巴引流區域分別接受59.4及54格雷之光子照射。在放射治療即將結束前僅出現乾性皮膚脫屑之急性反應,並於後續門診追蹤期間逐漸復原。病患在放射治療結束後半年內,每月回診接受理學檢查及定期影像追蹤,隨後改為每季定期回診追蹤。追蹤至今已達34個月且無復發跡象。由於默克細胞癌缺乏前瞻性之隨機臨床試驗資料,因此最理想的治療方式仍無定論。NCCN指引建議所有病患皆需接受哨兵淋巴結切片檢查,以求得正確之癌症分期,過去整合分析也證實術後局部放射治療可降低局部及區域腫瘤復發。

並列摘要


Merkel cell carcinoma (MCC) is a rare, aggressive neuroendocrine carcinoma of the skin, and most commonly seen in the elderly and immunocompromised patients. This is a case report describing our experience with MCC in a male patient who incidentally found a nodule over his right lower thigh. MCC was confirmed by positive cytokeratin 20 expressions in immunohistochemical staining after tumor wide excision. Image studies, including right leg CT, chest mediastinum CT and abdomen to pelvis CT, showed neither regional lymph node involvement nor visceral organ metastases. Due to clinical N0 and prior local excision with free margin, sentinel lymph node biopsy is not performed. The patient received postoperative photon beam RT with 59.4 Gy and 54 Gy to primary tumor bed with 5 cm margin and regional inguinal lymphatic area, respectively. Dry skin desquamation was noted near completion of adjuvant radiotherapy but recovered during follow-up. The patient underwent regular OPD follow-up monthly in the first six months after adjuvant RT and quarterly thereafter. The patient kept disease-free 34 months postoperatively. As no prospective randomized studies exist, the optimum treatment of this disease is limited. Sentinel lymph node biopsy was recommended by NCCN for accurate staging, previous meta-analysis demonstrates local adjuvant RT after complete excision reduced local and regional recurrence.

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