Case Report

Acute Anemia from Fungating Axillary Merkel Cell Carcinoma

by Krishna Sheth1*, Cody Lee2, Maha Jangda1, Ajith Saju1, Yaw Baah1

1Garnet Health Medical Center, New York, USA

2Touro College of Osteopathic Medicine, New York, USA

*Corresponding author: Krishna Sheth, Garnet Health Medical Center, New York, USA.

Received Date: 17 May, 2024

Accepted Date: 22 May, 2024

Published Date: 24 May, 2024

Citation: Sheth K, Lee C, Jangda M, Saju A, Baah Y (2024) Acute Anemia from Fungating Axillary Merkel Cell Carcinoma. Ann med clin Oncol 7: 163. https://doi.org/10.29011/2833-3497.000163

Abstract

Merkel cell carcinoma is a rare form of skin cancer. It is usually very aggressive and metastasizes rapidly with a high mortality rate. This type of carcinoma is often diagnosed when metastatic spread has already occurred in addition to local invasion. Common sites of metastasis include the brain, liver, lungs, and bones. We discuss an unusual presentation of 65-year-old female who presented with anemia secondary to blood loss from an exceptionally large fungating axillary mass due to metastatic Merkel cell carcinoma requiring multiple transfusions.

Keywords:Merkel cell carcinoma; Fungating axillary mass; Polyomavirus; Anemia; Blood transfusion; Nivolumab; Ipilimumab.

Introduction

Merkel cell carcinoma, also known as neuroendocrine carcinoma of the skin, most commonly occurs on the head, neck, and sun-exposed regions of the body. About 65% of cases present with local disease [1]. Merkel cells are specialized cells that lie in the basal layer of the epidermis and are responsible for tactile and light touch sensation. Merkel cell carcinoma, albeit the name, has been theorized to originate in epidermal or dermal stem cells as opposed to differentiated Merkel cells. Known risk factors for development of this carcinoma include advanced age, ultraviolet exposure, and immunosuppression. Evidence has also shown the presence of the Merkel cell polyomavirus in majority of Merkel cell carcinoma cases highlighting its association [1]. Merkel cell polyomavirus is ubiquitous and usually asymptomatic in healthy individuals, however, risk factors such as immunosuppression can lead to carcinogenic qualities. While skin biopsy confirms the diagnosis, additional sentinel lymph node biopsy is recommended due to the aggressiveness of spread. Complications include end organ dysfunction of metastatic sites. Merkel cell carcinoma is a rare and rapidly progressing cancer; therefore, prognosis is usually poor.

Case Presentation

A 65-year-old female with a history of metastatic Merkel cell carcinoma, gastrointestinal bleed, NSTEMI, diabetes mellitus, hyperlipidemia, hypertension, deep venous thrombosis status post IVC filter presented to the emergency department with complaints of fatigue and lightheadedness. Two months prior to arrival patient underwent a laparoscopic small bowel resection due gastrointestinal bleeding secondary to a metastatic mass and small bowel intussusception within the jejunum. Furthermore, four months prior to the current visit, patient suffered from an NSTEMI and had a drug-eluting stent placed.

Routine complete blood count (CBC) performed one day prior to arrival to the emergency department showed a hemoglobin of 7.6 g/dL, however repeat CBC upon arrival showed a downtrending hemoglobin measured at 7.1 g/dL. Upon physical examination, a fungating mass of the left axillary region was noted with active bleeding. Recent CT Chest showed large heterogenous enhancing, necrotic left axillary mass involving the overlying skin, seen in Figure 1.

Gross images of the axillary mass were unable to be obtained, however the Chest X-ray, shown in Figure 2, illustrates the extent of the mass.

 

Figure 1: A) illustrates CT thorax with contrast, with measured left axillary mass; B)illustrates a PET scan showing hypermetabolic region (yellow arrow).