MRI of Merkel Cell Carcinoma: Histologic Correlation and Review of the Literature
Suzanne E. Anderson1,
Karl T. Beer2,
Andrej Banic3,
Lynne S. Steinbach4,
Matthias Martin1,
Esther E. Friedrich2,
Edouard Stauffer5,
Peter Vock1 and
Richard H. Greiner2
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.
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Fig. 1A —MR images of typical patient with Merkel cell carcinoma show
one unique imaging finding of Merkel cell carcinoma: positive anatomic
alignment of subcutaneous lymphatic tumor nodules. Patient is 63-year-old man
with primary tumor in skin of right popliteal fossa. Axial T1-weighted image
(TR/TE, 480/14) shows multiple skin and subcutaneous metastases in anterior
proximal thigh (black arrows). Because these are lymphatic metastases
and are small, small regions of fat remain between tumor nodules (white
arrow).
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Fig. 1B —MR images of typical patient with Merkel cell carcinoma show
one unique imaging finding of Merkel cell carcinoma: positive anatomic
alignment of subcutaneous lymphatic tumor nodules. Patient is 63-year-old man
with primary tumor in skin of right popliteal fossa. Corresponding axial STIR
image (4,800/60; inversion time, 180 msec) shows high signal intensity of skin
and subcutaneous lymphatic metastases (small arrows), an example of
positive anatomic alignment of subcutaneous lymphatic tumor nodules. Marked
reticular stranding in subcutaneous fat is also seen. Histologically these two
findings were shown to represent lymphangitis carcinomatosa. Lymph node
metastases (large arrow) are seen adjacent to proximal superficial
femoral artery.
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Fig. 1C —MR images of typical patient with Merkel cell carcinoma show
one unique imaging finding of Merkel cell carcinoma: positive anatomic
alignment of subcutaneous lymphatic tumor nodules. Patient is 63-year-old man
with primary tumor in skin of right popliteal fossa. Axial STIR image
(4,800/60; inversion time, 180 msec), obtained inferior in relation to
A and B, shows perifascial intramuscular metastasis
(arrow) and extensive reticular stranding in anterior and medial
subcutaneous fat of thigh.
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Fig. 1D —MR images of typical patient with Merkel cell carcinoma show
one unique imaging finding of Merkel cell carcinoma: positive anatomic
alignment of subcutaneous lymphatic tumor nodules. Patient is 63-year-old man
with primary tumor in skin of right popliteal fossa. Contrast-enhanced
T1-weighted fat-saturated image (684/14) shows diffuse contrast enhancement
within subcutaneous and intramuscular metastases (arrow).
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Fig. 1E —MR images of typical patient with Merkel cell carcinoma show
one unique imaging finding of Merkel cell carcinoma: positive anatomic
alignment of subcutaneous lymphatic tumor nodules. Patient is 63-year-old man
with primary tumor in skin of right popliteal fossa. Photomicrograph of
histology section shows skin surface (small arrow) and tumor mass
(large arrow) within subcutaneous fat. (H and E, x2.5)
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Fig. 1F —MR images of typical patient with Merkel cell carcinoma show
one unique imaging finding of Merkel cell carcinoma: positive anatomic
alignment of subcutaneous lymphatic tumor nodules. Patient is 63-year-old man
with primary tumor in skin of right popliteal fossa. Enlargement of
photomicrograph shown in E reveals subcutaneous tumor mass is composed
of dense small blue cells with hyperchromatic nuclei, minimal cytoplasm, and
frequent mitoses. These histologic features may account for slight increased
signal intensity on T1 weighting within small subcutaneous nodules. (H and E,
x10)
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Fig. 1G —MR images of typical patient with Merkel cell carcinoma show
one unique imaging finding of Merkel cell carcinoma: positive anatomic
alignment of subcutaneous lymphatic tumor nodules. Patient is 63-year-old man
with primary tumor in skin of right popliteal fossa. Photomicrograph of
histology section shows lymphatic tumor invasion (arrows) and dilated
lymphatic vessels (arrowhead), which correspond to reticular
stranding and subcutaneous nodules on MRI. (H and E, x5)
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Fig. 2A —Example of large lymph node metastases with compressed
retained fatty tissue in 86-year-old man with primary tumor site in skin of
axilla. Axial T1-weighted image (TR/TE, 534/12) of right axilla shows large
lymph node metastatic mass with fine, compressed, retained fatty tissue
(arrows).
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Fig. 2B —Example of large lymph node metastases with compressed
retained fatty tissue in 86-year-old man with primary tumor site in skin of
axilla. Sagittal T1-weighted image (534/12) of axillary lymph nodal
metastases, measuring 20 x 7 x 12 cm, shows subtle fine,
compressed, retained fatty tissue of fat signal intensity
(arrows).
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Fig. 2C —Example of large lymph node metastases with compressed
retained fatty tissue in 86-year-old man with primary tumor site in skin of
axilla. Axial T1-weighted contrast-enhanced fat-saturated image (524/12) shows
evidence of tumor necrosis (arrow).
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Fig. 2D —Example of large lymph node metastases with compressed
retained fatty tissue in 86-year-old man with primary tumor site in skin of
axilla. Photomicrograph of histology section of tumor mass with central
necrosis (asterisk) corresponding to tumor necrosis shown in
C. Infiltration of adjacent fat tissue (arrow) is noted. (H
and E, x2.5)
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Fig. 3A —77-year-old man with primary tumor site in periorbital
region. Axial T1-weighted image (TR/TE, 750/25) before radiation therapy shows
sternum (arrow).
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Fig. 3B —77-year-old man with primary tumor site in periorbital
region. Corresponding axial T1-weighted contrast-enhanced fat-saturated image
(601/12) shows large exophytic soft-tissue component (arrows).
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Fig. 3C —77-year-old man with primary tumor site in periorbital
region. Axial T1-weighted image (750/25) 1 month after radiation therapy
(total dose, 45 Gy) shows excellent response with marked reduction in tumor
bulk of sternal disease (arrow). In our series after local radiation
therapy, there was typically marked reduction of tumor bulk or excellent tumor
response.
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Fig. 3D —77-year-old man with primary tumor site in periorbital
region. Corresponding axial T1-weighted contrast-enhanced fat-saturated image
(159/48) shows excellent response to radiation therapy with marked reduction
of exophytic soft-tissue component of sternal tumor (arrow).
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Copyright © 2005 by the American Roentgen Ray Society.
