Totalendoprothetischer Hüftgelenkersatz bei metastasiertem Merkel-Zellkarzinom

Merkel cell carcinoma is an extremely rare malignant tumor which derives from the neuroendocrine cell system with features of epithelial differentiation. It belongs to the APUD-system (amine and precursor uptake and decarboxylation) and is characterized by highly aggressive spread with a predisposition for local recurrence and local regional and distant metastases. Metastatic spread to the hip has not been described in the literature before. We report on a 76-year old male patient with metastases of the left femoral head and greater trochanter 3 1/2 years after excision of a Merkel cell carcinoma of the left thigh with consecutive radical lymph node dissection of the left inguinal area and radiation therapy. Although microscopic, immunohistological and ultrastructural characteristics of the carcinoma have been well defined, there are no established treatment guidelines and prognostic factors that may predict the behaviour of the tumor due to the limited number of cases. Elective lymph node dissection decreases the rate of local recurrence but is not associated with improved overall survival. At the time of establishing the diagnosis, about half of the patients has positive lymph nodes with a 3-year-survival rate of 60%.