Merkel cell carcinoma, staging Innumerable subcutaneous nodules are identified along the left lower extremity. These lesions are slightly hyperintense to skeletal muscle on T1 sequences and hyperintense to skeletal muscle on T2 sequences. Following contrast administration, there is generally solid enhancement although some of the larger lesions demonstrates central areas of nonenhancement which likely the result of necrosis.Index lesions are as follows: -Medial soft tissues of the thigh, series 26 image 21/50. 4.9 x 3.9 x 2.7 cm in the greatest AP, transverse, and craniocaudal dimensions-Anterior thigh, series 26 image 8/50, 1.6 x 1.9 x 2.3 cm, -Medial to the patella, series 26 image 37/50, 1.3 x 2.1 x 2.1 cm The underlying marrow signal of the femur is normal. There is mild diffuse subcutaneous edema of the thigh particularly medially. A cystic lesion is identified within the medial subcutaneous tissues just the at the level of the distal metaphysis. This lesion demonstrates signal characteristics of a simple cyst with thin peripheral rim-like enhancement. Additionally, there are multiple enlarged inguinal and iliac chain lymph nodes. Index nodes are as follows:-Left iliac chain, series 25 image 8/51, 3 x 3 cm-Left iliac chain, series 25 image 10/51, 3.5 x 2.2 cm-Left inguinal canal, series 25 image 22/51, 3 x 2.6 cm
1. Innumerable subcutaneous nodules consistent with the known diagnosis of Merkel cell carcinoma.2. Multiple enlarged inguinal and pelvic lymph nodes reflecting metastatic disease.