title: Pancreatic metastasis of Merkel cell carcinoma and concomitant insulinoma: case report and literature review.
abstract: BACKGROUND
  Merkel cell carcinomas are rare neoplasm of neuroendocrine origin, usually observed in elderly people in areas with abundant sunlight, and predominantly located on the head and neck, extremities, and trunk. In many patients, a local recurrence after resection of the primary tumour and even distant metastases can be found.
  
  
  METHODS
  We report an unusual occurrence of pancreatic metastases from a previously diagnosed Merkel cell carcinoma with the discovery of a concomitant insulinoma. An 82-year old lady suffered from recurrent attacks of hypoglycemia and presented with an abdominal mass, 2 years prior she had an excision done on her eyebrow that was reported as Merkel cell carcinoma. An extended distal pancreatectomy and splenectomy along with resection of the left flexure of the colon for her abdominal mass was carried out. Final histopathology of the mass was a poorly differentiated endocrine carcinoma in the pancreatic tail, in the peripancreatic tissue and in the surrounding soft tissue consistent with metastatic Merkel cell carcinoma in addition to an insulinoma of the pancreatic body.
  
  
  CONCLUSIONS
  This is the first documented case of a metastatic Merkel cell carcinoma and a concomitant insulinoma, suggesting either a mere coincidence or an unknown neuroendocrine tumor syndrome.
authors.affiliation: Department of General Surgery, University of Heidelberg, Heidelberg, Germany. jeannine_bachmann@med.uni-heidelberg.de
authors.forename: Jeannine
authors.initials: J
authors.lastname: Bachmann
authors.forename: Jorg
authors.initials: J
authors.lastname: Kleeff
authors.forename: Frank
authors.initials: F
authors.lastname: Bergmann
authors.forename: Shailesh V
authors.initials: SV
authors.lastname: Shrikhande
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Hartschuh
authors.forename: Markus W
authors.initials: MW
authors.lastname: Büchler
authors.forename: Helmut
authors.initials: H
authors.lastname: Friess