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Spontaneous regression of Markel cell carcinoma in anterior mediastinum without cutaneous involvement

Published online by Cambridge University Press:  09 November 2020

My-Lien Nguyen ,
M. Kole Melton ,
Salahuddin Ahmad Open the ORCID record for Salahuddin Ahmad [Opens in a new window]  and
Christina Henson
My-Lien Nguyen
Affiliation:
Department of Radiation Oncology, University of Oklahoma Health Sciences Center, and Stephenson Cancer Center, Oklahoma City, Oklahoma, USA
M. Kole Melton
Affiliation:
Department of Radiation Oncology, University of Oklahoma Health Sciences Center, and Stephenson Cancer Center, Oklahoma City, Oklahoma, USA
Salahuddin Ahmad*
Affiliation:
Department of Radiation Oncology, University of Oklahoma Health Sciences Center, and Stephenson Cancer Center, Oklahoma City, Oklahoma, USA
Christina Henson
Affiliation:
Department of Radiation Oncology, University of Oklahoma Health Sciences Center, and Stephenson Cancer Center, Oklahoma City, Oklahoma, USA
*
Author for correspondence: Salahuddin Ahmad, Department of Radiation Oncology, University of Oklahoma Health Sciences Center, and Stephenson Cancer Center, Oklahoma City, Oklahoma, USA. E-mail: [email protected]
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Abstract

Background:

Merkel cell carcinoma (MCC) is a rare and highly aggressive neuroendocrine malignancy typically involving the skin. The majority of MCC involves the head/neck region and the extremities. Despite the aggressive nature of the disease, there have been several case studies that report spontaneous regression. We report a unique case of spontaneous regression of an MCC in a peculiar region in the anterior mediastinum with no cutaneous involvement.

Methods:

A 50-year-old man who presented with a mobile low anterior neck mass, proven by biopsy, to be MCC. Subsequent PET/CT confirmed an FDG (Flurodeoxyglucose)-avid upper mediastinal mass. The mass gradually regressed over the course of 1 month subsequent to biopsy and was no longer palpable on exam or visible on subsequent CT scans. The patient was treated with intensity modulated radiation therapy with a total dose of 6,160 cGy in 28 fractions to the site of previously visible primary disease. At-risk nodal basins were also treated. On subsequent follow-up, the patient continued to have no clinical or radiographic signs of disease.

Discussion:

Spontaneous regression of an MCC is rare but has been reported mostly in the head/neck region following biopsy. It is unknown why spontaneous regression occurs. There is a possibility that biopsy may stimulate T-lymphocytes resulting in spontaneous regression.

Conclusion:

This is the first case to our knowledge of spontaneous regression of an MCC in the anterior mediastinum with no cutaneous involvement. Most MCC are seen clinically due to skin changes with a majority of cases occurring in the head/neck region.

Keywords

cutaneous involvementintensity modulated radiation therapyMerkel cell carcinomaspontaneous regression
Type
Case Study
Information
Journal of Radiotherapy in Practice , Volume 21 , Issue 2 , June 2022 , pp. 287 - 288
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Copyright
© The Author(s), 2020. Published by Cambridge University Press

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