We describe a case of Merkel cell carcinoma which took an unusual pattern of metastasis. An 80-year-old man presented with a recurrent tumor on his pubic region accompanied with right inguinal lymph node swelling. In spite of wide local excision and bilateral inguinal lymph node dissection, he died of disseminated intravenous coagulation one month after the operation. Autopsy revealed marked enlargement of the liver Histologic examination revealed massive metastasis in multiple organs, including liver, lung, pancreas, spleen and bone marrow. In the liver, tumor cells diffusely infiltrated, forming extremely small nests. Such metastatic lesions could not be detected by CT scan performed a few days prior to death, while an ultrasound scan of the liver at that time disclosed numerous hyperechoic micronodules.
