An 86-year-old woman with a history of hypertension, hypercholesterolemia, depressive syndrome, tension-type headache, who had undergone surgery for left renal lithiasis and whose usual treatment was lorazepam, statin and hydrochlorothiazide.
The patient did not present pain, itching, functional impotence of the limb, or any other accompanying symptoms.
Physical examination revealed an excrecent, indurated and well-defined tumor measuring about 5 cm in diameter, red coloration, rough surface, non-friable, mobile and non-painful.
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hyperchromatosis was observed until tumor extirpation with wide margins, remitting to the Pathological Anatomy service for histological study, showing the following report: cellular proliferation with high tumor density and diffuse growth, with a very ulcercrovascular nucleus
Immunohistochemistry showed the following results: strongly positive chromogranin in almost 100% of cells.
CD38, CD45, myelooperoxidase and c-kit negative.
Chromogranin A, enolase A, CD 56, CD 138, EMA, CD 99, keratin CAM 5.2, Muc 31 slides.
Keratin 20 and TTF1 negative.
All of this was compatible with primary cutaneous neuroendocrine carcinoma or Merkel cell carcinoma (the negativity of keratin 20 did not guarantee that the tumor was primary skin tumor, but the age suggestive of primary tumor growth was TTF1.
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Computed tomography scan revealed tumoral adenopathies in the paraaortic spaces, left iliac and femoral chains, as well as edema in the left lower limb.
Having established the previously exposed results, it was decided to refer the patient to the Ongoing Therapy Service for pertinent treatment, without presenting a satisfactory evolution and with progressive deterioration of the general state, he died within the first year after diagnosis.
