ABSTRACT
BACKGROUND: Merkel cell carcinoma (MCC) is a rare, highly malignant, and aggressive dermal neuroendocrine neoplasm that rarely metastasizes to the central nervous system. OBJECTIVE: To review the current literature regarding treatment of neurometastatic MCC. METHODS: A case of a 78-year-old male with intracranial extra-axial metastatic MCC involving the left cerebellopontine angle is presented. RESULTS: A retrosigmoid craniectomy was performed with complete resection of the metastatic focus. Adjuvant treatment included whole-brain radiation therapy followed by etoposide and carboplatin chemotherapy. Seven months postoperatively, the patient was free of metastatic disease. CONCLUSION: Surgical resection should be performed when feasible to prevent local recurrence. This may be followed by early adjuvant fractionated whole-brain radiotherapy and systemic chemotherapy; however, no clinical trials have been performed to demonstrate a survival benefit.
Subject(s)
Carcinoma, Merkel Cell/secondary , Cerebellar Neoplasms/secondary , Cerebellopontine Angle/pathology , Skin Neoplasms/pathology , Aged , Antineoplastic Agents, Phytogenic/administration & dosage , Carboplatin/administration & dosage , Carcinoma, Merkel Cell/surgery , Cerebellopontine Angle/surgery , Chemotherapy, Adjuvant , Craniotomy , Etoposide/administration & dosage , Humans , Male , Radiotherapy Dosage , Radiotherapy, Adjuvant , Skin Neoplasms/surgeryABSTRACT
Helicobacter pylori has been linked to development of peptic ulcers and increases the risk of developing gastric carcinoma. Currently, about half of the world's population is infected with H. pylori, many of whom are older adults. Older adult populations often have multiple comorbidities that may mask dyspeptic signs and symptoms. The role of H. pylori and infective signs vary by age, and the confusing symptoms in older adult populations may delay detection and treatment of H. pylori. In addition, time of detection and appropriate treatment is paramount to prevent gastric pathology. Clinicians need to recognize and understand the importance of risk factors, screening, detection, and treatment of H. pylori, particularly in older adults. Earlier detection and more aggressive, proactive clinical recognition of dyspeptic signs and symptoms may lead to earlier screening and diagnosis of H. pylori in older adult populations and help decrease the frequency of gastric metaplasia.
