Hostname: page-component-848d4c4894-nmvwc Total loading time: 0 Render date: 2024-06-21T16:09:56.414Z Has data issue: false hasContentIssue false
  • English
  • Français

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: salahuddin-ahmad@ouhsc.edu
Get access Rights & Permissions [Opens in a new window]

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
Check for updates
Copyright
© The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Toker, C. Trabecular carcinoma of the skin. Arch Dermatol 1972; 105: 107–110.CrossRefGoogle ScholarPubMed
Vesely, MJJ, Murray, DJ, Neligan, PC. Complete spontaneous regression in Merkel cell carcinoma. J Plastic Reconstr Aesthetic Surg 2008; 61: 165–171.CrossRefGoogle ScholarPubMed
Tothill, R, Estall, V, Rischin, D. Merkel cell carcinoma: emerging biology, current approaches, and future directions. Am Soc Clin Oncol Educ Book 2015; 35: e519–e526.CrossRefGoogle Scholar
Schrama, D, Ugurel, S, Becker, J. Merkel cell carcinoma: recent insights and new treatment options. Curr Opin Oncol 2012; 24(2): 141–149.CrossRefGoogle ScholarPubMed
Paulson, KG, Park, SY, Vandeven, NA et al. Merkel cell carcinoma: current US incidence and projected increases based on changing demographics. J Am Acad Dermatol 2018; 78: 457.CrossRefGoogle ScholarPubMed
Ciudad, C, Aviles, A, Alfageme, F, Lecona, M, Suarez, R, Lazaro, P. Spontaneous regression in Merkel cell carcinoma: report of two cases with a description of dermoscopic features and review of the literature. Dermatol Surg 2010; 36: 687–693.CrossRefGoogle ScholarPubMed
Sais, G, Admella, C, Soler, T. Spontaneous regression in primary cutaneous neuroendocrine (Merkel cell) carcinoma: a rare immune phenomenon? J Eur Acad Dermatol Venereol 2002; 16: 82–83.CrossRefGoogle ScholarPubMed
Walsh, NM. Complete spontaneous regression of Merkel cell carcinoma (1986–2016): a 30 year perspective. J Cutan Pathol 2016; 43: 1150–1154.CrossRefGoogle ScholarPubMed
Takenaka, H, Kishimoto, S, Shibagaki, R. Merkel cell carcinoma with partial spontaneous regression: an immunohisto-chemical, ultrastructural and TUNEL labeling study. Am J Dermatopathol 1997; 19: 614–618.CrossRefGoogle Scholar
Baker, M, Roman, J, Reuben, A et al. Spontaneous regression of Merkel cell carcinoma is driven by adaptive immune activation and clonal T cell expansion [abstract]. Proceedings of the American Association for Cancer Research Annual Meeting 2018, 14th–18th, Chicago, IL: Cancer Res 2018; 78 (13 Suppl): Abstract - 4676.CrossRefGoogle Scholar