{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T09:21:33Z","timestamp":1763716893080,"version":"3.45.0"},"reference-count":30,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T00:00:00Z","timestamp":1763683200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background and Clinical Significance: Merkel cell carcinoma (MCC) is a rare, aggressive neuroendocrine cutaneous malignancy with increasing incidence among elderly, immunocompromised patients or individuals exposed to ultraviolet radiation. Case Presentation: We present the case of an 84-year-old Caucasian male with no history of immunosuppression, who was admitted for asthenia, dysphagia, weight loss, and generalized weakness. Clinical and imaging investigations revealed a violaceous tumor on the right arm and disseminated metastases affecting the liver, spleen, bones and lymph nodes. A liver biopsy confirmed a small round blue cell neoplasm suggestive for MCC, although immunohistochemistry could not be performed due to the patient\u2019s fulminant deterioration and death within 12 days of admission. Conclusions: This case is notable for its exceptionally rapid progression, particularly splenic involvement, and absence of known immunosuppressive factors. It highlights the existence of highly proliferative MCC subtypes with potential for bypassing classical metastatic pathways. Early clinical suspicion and prompt histological evaluation are essential for diagnosis, although the prognosis remains poor in advanced stages. Due to fulminant deterioration, immunohistochemistry could not be performed; therefore, the diagnosis is highly suggestive based on clinical, imaging, and morphological correlation.<\/jats:p>","DOI":"10.3390\/diagnostics15232941","type":"journal-article","created":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T08:59:46Z","timestamp":1763715586000},"page":"2941","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Rapidly Progressive Merkel Cell Carcinoma with Atypical Metastatic Pattern\u2014A Case Report and Brief Literature Review"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2756-5784","authenticated-orcid":false,"given":"Teodora Gabriela","family":"Alexescu","sequence":"first","affiliation":[{"name":"4th Medical Discipline, Department of Internal Medicine, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, Republicii Street, No. 18, 400015 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-1711-8005","authenticated-orcid":false,"given":"Denisa","family":"Lungu","sequence":"additional","affiliation":[{"name":"Department of Neurology, County Emergency Hospital Cluj, Victor Babes Street, No. 43, 400012 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-3147-3145","authenticated-orcid":false,"given":"Tania","family":"Popescu","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Regional Institute of Gastroenetrology and Hepatology \u201cProf. Dr. Octavian Fodor\u201d, Croitorilor Street, No. 19, 400394 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8327-2444","authenticated-orcid":false,"given":"Mirela Georgiana","family":"Perne","sequence":"additional","affiliation":[{"name":"4th Medical Discipline, Department of Internal Medicine, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, Republicii Street, No. 18, 400015 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-4090-0164","authenticated-orcid":false,"given":"Cezara Andreea","family":"Gerdanovics","sequence":"additional","affiliation":[{"name":"4th Medical Discipline, Department of Internal Medicine, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, Republicii Street, No. 18, 400015 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4435-142X","authenticated-orcid":false,"given":"Olga Hilda","family":"Or\u0103\u0219an","sequence":"additional","affiliation":[{"name":"4th Medical Discipline, Department of Internal Medicine, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, Republicii Street, No. 18, 400015 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3989-2291","authenticated-orcid":false,"given":"Angela","family":"Cozma","sequence":"additional","affiliation":[{"name":"4th Medical Discipline, Department of Internal Medicine, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, Republicii Street, No. 18, 400015 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ioana Raluca","family":"Dobrot\u0103","sequence":"additional","affiliation":[{"name":"4th Medical Discipline, Department of Internal Medicine, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, Republicii Street, No. 18, 400015 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R\u0103zvan Dan","family":"Tog\u0103nel","sequence":"additional","affiliation":[{"name":"4th Medical Discipline, Department of Internal Medicine, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, Republicii Street, No. 18, 400015 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mircea Vasile","family":"Milaciu","sequence":"additional","affiliation":[{"name":"4th Medical Discipline, Department of Internal Medicine, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, Republicii Street, No. 18, 400015 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lorena","family":"Cium\u0103rnean","sequence":"additional","affiliation":[{"name":"Department 2, Faculty of Nursing and Health Sciences, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, Republicii Street, No. 18, 400015 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicoleta Valentina","family":"Leach","sequence":"additional","affiliation":[{"name":"Department 2, Faculty of Nursing and Health Sciences, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, Republicii Street, No. 18, 400015 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C\u0103lin Vasile","family":"Vlad","sequence":"additional","affiliation":[{"name":"4th Medical Discipline, Department of Internal Medicine, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, Republicii Street, No. 18, 400015 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vlad Alexandru","family":"Zolog","sequence":"additional","affiliation":[{"name":"4th Medical Discipline, Department of Internal Medicine, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, Republicii Street, No. 18, 400015 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cornel Drago\u0219","family":"Cheregi","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Medicine and Pharmacy Oradea, 1 Decembrie Plaza, No. 10, 410073 Oradea, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Uchi, H. 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