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MRI of Merkel Cell Carcinoma: Histologic Correlation and Review of the Literature

¹ Department of Diagnostic, Interventional and Pediatric Radiology, University Hospital of Bern, Inselspital, Freiburg Strasse, CH-3010 Bern, Switzerland.
² Department of Radiation Oncology, University Hospital of Bern, Inselspital, Bern, Switzerland.
³ Department of Plastic and Reconstructive Surgery, University Hospital of Bern, Inselspital, Bern, Switzerland.
⁴ Department of Radiology, University of California, San Francisco, San Francisco, CA.
⁵ Department of Pathology, University Hospital of Bern, Inselspital, Bern, Switzerland.

OBJECTIVE. The objective of this study was to determine the MRI characteristics of Merkel cell carcinoma, with an emphasis on histologic correlation.

MATERIALS AND METHODS. The demographic information about 15 patients from our institution and their MRI examinations were retrospectively reviewed by three musculoskeletal radiologists by consensus for lesion location and intrinsic characteristics. The study group was composed of three women and 12 men who ranged in age from 48 to 87 years, with a mean age of 75 years. Histology results of resected specimens were reviewed in all cases and were correlated with imaging.

RESULTS. MRI showed skin thickening, subcutaneous reticular stranding (n = 9, 60%); multiple anatomically aligned subcutaneous soft-tissue masses, representing lymphatic tumor nodules (n = 5, 33%); lymph node enlargement with fine, compressed, retained fatty tissue (n = 5, 33%); nodal necrosis (n = 1); and perifascial and intramuscular metastases (n = 2). Histology confirmed the lymphatic nature of the soft-tissue Merkel cell tumors.

CONCLUSION. Patients with Merkel cell tumors may present at imaging with subcutaneous lymphatic reticular stranding, multiple subcutaneous masses, and lymph node metastases. Often there is massive lymph node enlargement with fine, compressed, retained fatty tissue.

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