Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2025 Mar 1;17(3):e79903.
doi: 10.7759/cureus.79903. eCollection 2025 Mar.

Pericardial Oligometastasis From Merkel Cell Carcinoma Treated With Stereotactic Ablative Radiotherapy

Jose Miguel C Callueng  1 , Islam Mohamed  1 , Dante D'Urbano  2 , Benjamin Mou  1
Affiliations
Case Reports

Pericardial Oligometastasis From Merkel Cell Carcinoma Treated With Stereotactic Ablative Radiotherapy

Jose Miguel C Callueng et al. Cureus. .

Abstract

Merkel cell carcinoma (MCC) is a rare and aggressive neuroendocrine skin cancer that often has a poor prognosis due to its propensity for distant metastases. A 74-year-old man with a history of MCC of the left forearm, previously treated with surgery and adjuvant radiotherapy, was found to have an asymptomatic pericardial nodule associated with pericardial effusion on routine follow-up imaging. Subsequent biopsy confirmed metastatic MCC. Restaging demonstrated no other sites of metastases. The pericardial metastasis was treated with stereotactic ablative radiotherapy (SABR) to a dose of 40 Gray (Gy) in five daily fractions. A significant decrease in the size of the pericardial nodule was observed 2.3 months post-SABR, and a clinical complete response was achieved 8.9 months post-SABR. Apart from an asymptomatic mildly increased pericardial effusion, no other acute or late adverse effects were observed. At 40.1 months post-SABR, the patient continued to show a durable response to treatment with no evidence of recurrence. To the best of our knowledge, this case of pericardial oligometastases from MCC treated with SABR is the longest reported duration of response.

Keywords: isolated cardiac metastasis; merkel cell carcinoma; oligometastasis; sbrt (stereotactic body radiotherapy); stereotactic ablative radiation.

PubMed Disclaimer

Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: Benjamin Mou declare(s) personal fees from Amgen. Benjamin Mou declare(s) personal fees from Bristol-Myers Squibb. Benjamin Mou and Dante D'Urbano declare(s) personal fees from Astra Zeneca. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Diagnostic imaging. (A) Chest CT scan and (B) PET CT showing the asymptomatic pericardial nodule (yellow arrows).
CT = computed tomography, PET = positron emission tomography
Figure 2
Figure 2. Representative microscopic images. (A) Cell block section and (B) Cytologic smear showing small round blue tumor cells with high nuclear to cytoplasmic ratio, fine nuclear chromatin and conspicuous mitotic activity. Positive immunohistochemical staining for both (C) CK20 and (D) Synaptophysin.
CK20 = cytokeratin 20
Figure 3
Figure 3. Radiation plan showing dose coverage of the IGTV (cyan) and PTV (red) near the adjacent heart.
IGTV = internal gross target volume, PTV = planning target volume
Figure 4
Figure 4. Follow-up chest CT imaging post-SABR at (A) 2.3 months, (B) 8.9 months, and (C) 40.1 months.
CT = computed tomography, SABR = stereotactic ablative radiotherapy
See this image and copyright information in PMC

References

    1. Merkel cell carcinoma: report of 10 cases and review of the literature. Akhtar S, Oza KK, Wright J. J Am Acad Dermatol. 2000;43:755–767. - PubMed
    1. The role of radiotherapy alone in patients with merkel cell carcinoma: reporting the Australian experience of 43 patients. Veness M, Foote M, Gebski V, Poulsen M. Int J Radiat Oncol Biol Phys. 2010;78:703–709. - PubMed
    1. Merkel cell carcinoma: critical review with guidelines for multidisciplinary management. Bichakjian CK, Lowe L, Lao CD, Sandler HM, Bradford CR, Johnson TM, Wong SL. Cancer. 2007;110:1–12. - PubMed
    1. Definitive radiotherapy or chemoradiotherapy in the treatment of Merkel cell carcinoma. Sundaresan P, Hruby G, Hamilton A, Hong A, Boyer M, Chatfield M, Thompson JF. Clin Oncol (R Coll Radiol) 2012;24:0–6. - PubMed
    1. Management and prognosis of cardiac metastatic Merkel cell carcinoma: a case-control study and literature review. Akaike T, Cahill K, Akaike G, et al. Cancers (Basel) 2022;14 - PMC - PubMed

Publication types

LinkOut - more resources