Metastatic Merkel Cell Carcinoma Masquerading as Multiple Immune-Related Adverse Events

Figure 6

(a) Right upper quadrant ultrasound, hospital day 4, was notable for diffusely heterogeneous hepatic parenchyma with scattered hypoechoic lesions, suspicious for malignancy. No intrahepatic biliary ductal dilatation was observed. (b) Core liver biopsy revealed metastatic disease occupying roughly 60% of the total parenchyma. Background hepatic parenchyma was without signs of marked inflammation. (c) Gross inspection of the liver revealed replacement of the parenchyma by firm tan/yellow confluent nodules and punctate hemorrhagic areas. (d) Cross section of hepatic tissue recapitulated overwhelming tumor burden.