Nemoto I, Sato-Matsumura K C, Fujita Y, Natsuga K, Ujiie H, Tomita Y, Kato N, Kondo M, Ohnishi K
Department of Dermatology, Sapporo Social Insurance General Hospital, Sapporo, Japan.
Clin Exp Dermatol. 2008 May;33(3):270-2. doi: 10.1111/j.1365-2230.2007.02618.x. Epub 2007 Dec 18.
We describe an unusual bone-marrow metastasis of Merkel cell carcinoma (MCC) arising in the right cheek of a 73-year-old woman with systemic lupus erythematosus (SLE) and Sjögren's syndrome, who had been treated with oral prednisolone and methotrexate for 10 years. Seven months after wide local excision followed by local irradiation, the patient presented with thrombocytopaenia. Her bone marrow had been completely replaced by metastatic MCC cells, and metastatic cytokeratin 20-positive cells were also identified in the peripheral blood. To our knowledge, in the English literature, only six cases have been described previously of MCC bone-marrow involvement. Of these six cases, four were immunosuppressed, similar to our case. The high incidence of MCC in immunosuppressed patients such as those with SLE has been discussed previously. We consider that immunosuppression might be associated with bone-marrow metastasis, which is a rare form of MCC.
我们描述了一例罕见的默克尔细胞癌（MCC）骨髓转移病例，该病例发生在一名73岁患有系统性红斑狼疮（SLE）和干燥综合征的女性右侧脸颊，她接受口服泼尼松龙和甲氨蝶呤治疗已达10年。在进行广泛局部切除并局部放疗7个月后，患者出现血小板减少症。其骨髓已完全被转移性MCC细胞取代，在外周血中也发现了转移性细胞角蛋白20阳性细胞。据我们所知，在英文文献中，此前仅描述过6例MCC累及骨髓的病例。在这6例病例中，有4例存在免疫抑制，与我们的病例相似。此前曾讨论过免疫抑制患者（如SLE患者）中MCC的高发病率。我们认为免疫抑制可能与骨髓转移有关，而骨髓转移是MCC的一种罕见形式。
