Case Study C: Complete Spontaneous Regression of Merkel Cell Carcinoma Metastatic to the Liver
A 58-year-old Caucasian man noted a small lesion on the right side of his neck in August of 2006. The papule, resembled an ingrown hair, was relatively uncomfortable and slowly increased in size. Three months later a reddish-purple nodule had grown to a d
- PDF / 139,398 Bytes
- 3 Pages / 504.57 x 720 pts Page_size
- 98 Downloads / 148 Views
14
Natalie Vandeven and Paul Nghiem
Case History A 58-year-old Caucasian man noted a small lesion on the right side of his neck in August of 2006. The papule, resembled an ingrown hair, was relatively uncomfortable and slowly increased in size. Three months later a reddish-purple nodule had grown to a diameter of 2 cm and was narrowly excised. Pathology revealed a nodular proliferation of atypical round cells with hyperchromatic nuclei displaying “salt and pepper” chromatin. Numerous mitotic figures were observed and there were both individual cell and en masse necrosis. Immunohistological staining indicated positivity for cytokeratin 7, cytokeratin 20 (in a perinuclear dot-like pattern), neuron-specific enolase, and focal positivity for chromogranin and synaptophysin. The tumor cells were negative for TTF1 and S-100. On the basis of these results, a diagnosis of an unusual (cytokeratin 7 positive) Merkel cell carcinoma (MCC) was made. Full body CT and Octreotide scans were performed N. Vandeven Department of Medicine, University of Washington, 1850 Republican Street, Brotman Room 242, Seattle, WA 98109, USA e-mail: [email protected] P. Nghiem (*) Department of Dermatology Medicine, University of Washington School of Medicine & Fred Hutchinson Cancer Research Center, 815 Mercer Street, Box 358050, Seattle, WA 98109, USA e-mail: [email protected]
1 month later and showed no evidence of disease. The patient underwent a wide local re-excision and sentinel lymph node biopsy (SNLB) 1 month later. Two of three sentinel nodes were positive and the following month he underwent a lymphatic dissection of the neck. None of the 39 nodes removed were positive for MCC. Two months later, the patient began radiation treatment at the primary site and draining lymph node basin with a total of 5,000 rads in 25 fractions. A PET scan 2 months after the completion of radiation therapy showed no evidence of disease. During regular follow-up 6 months after completion of therapy, a PET scan revealed a 1.2 cm lesion in the liver, which was confirmed by MRI. Fine-needle aspiration cytology of the lesion indicated histological features consistent with his primary MCC tumor. It was determined that surgery and radiation were not possible given the location of the tumor. Because of the relatively poor outcomes and significant side effects associated with chemotherapy treatment of MCC, the patient refused this standard approach. The patient began exploring possible immune stimulating and alternative therapeutic options. These included seeing a medical intuitive at the Upledger Institute in Cumberland, Maine for “somato-emotional release” therapy. The patient began taking dietary supplements including vitamin C, a multivitamin, CoQ-10, turmeric, probiotics, and cod-liver oil. Twice daily he took 500 mg of a mushroom supplement (Stamets 7® mushroom formula produced by Fungi Perfecti). He also began using Flor Essence as a liver and
M. Alam et al. (eds.), Merkel Cell Carcinoma, DOI 10.1007/978-1-4614-6608-6_14, © Springer Science+Business Media New Y
Data Loading...
