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Gastroenterology Review/Przegląd Gastroenterologiczny
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4/2015
vol. 10
 
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Anaemia due to gastric haemorrhage by a metastatic Merkel cell carcinoma

Jorge Santos-Juanes
,
Carmen Palomo
,
Luis Rodrigo
,
Iván Fernández-Vega

Data publikacji online: 2015/04/28
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Merkel cell carcinoma (MCC) is an aggressive uncommon neuroendocrine tumour of the skin, probably originating from Merkel cells, and described by Toker in 1972 as Trabecular carcinoma [1]. Subsequently, electron-dense neurosecretory granules were demonstrated in the tumour cells and it was classified as definite neuroendocrine tumour. Merkel cell carcinoma is characterised by a high incidence of local recurrences, regional local metastases, distant metastasis, and high mortality rate [2]. Merkel cell carcinoma occurs predominantly in elderly white males (61% male vs. 39% female), with a mean age of 69 years at diagnosis [3]. Lately, reports on MCC have increased, probable due to the higher incidence of damaging sun exposure, the advancing age of the population, and the increasing numbers of immunocompromised individuals [3]. In fact, it has been described that MCC is strongly associated with a polyomavirus [4], which might explain why MCC appears more frequently in immunocompromised patients such as solid-organ transplant recipients and HIV/AIDS infected people, and is associated with other malignancies [5]. Taking all of the data together, MCC could sometimes appear as a metastatic tumour in many different organs such as liver, bone, lung, and brain [6]. In light of this we report herein a patient who developed anaemia due to gastric haemorrhage as the first sign of gastric metastasis by MCC, which has rarely been reported [7].
A 52-year-old man with a previous diagnosis of type 2 diabetes mellitus and mild retinopathy was referred to our hospital due to severe asthaenia and dizziness. Almost 2 years previously, a cutaneous surgical excision was performed removing a 2 cm well-delimitated solid nodule on his right thigh, diagnosed as a Merkel cell carcinoma after a battery of immunohistochemical tests (Figures 1 A, B). Moreover, ipsilateral inguinal lymphadenectomy was done revealing one infiltrated lymph node. The patient underwent local radiotherapy (5000 RADs) in combination with chemotherapy (carboplatin and etopoxide) with a very good clinical tolerance. So far, the patient has been asymptomatic.
The current physical examination of the patient pointed out a paleness of the skin and mucous membranes. An extensive workup was performed showing intense anaemia with haemoglobin level of 8.4 g/dl. Abdominal computed tomography (CT) highlighted a gastric wall thickening with associated regional lymphadenopathy. Subsequently, gastroscopy showed...


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