Sustained Remission of a Primary Nodal Merkel Cell Carcinoma in an HIV-Positive Patient

scan of the chest and abdomen did not show any pathological lesions at other sites. Wide surgical resection of the tumor with inguinal lymph node excision was performed, and the pathological examination with immunohistochemical studies (positive cytokeratin 20, neuron-specific enolase and synaptophysin staining; negative cytokeratin 7 and thyroidtranscription factor-1 staining) led to a confirmed diagnosis of MCC stage III, according to the system proposed by Allen et al. [2] (figs. 1–4). The patient underwent postoperative radiotherapy of the inguinal nodal disease for a total of 45 Gy administered over 25 treatment sessions. It was also decided to start adjuvant combination chemotherapy with carboplatin and etoposide, which the patient received for 6 rounds over a 3-month period. The treatment was well tolerated by the patient and HAART was not discontinued. At the end of the radiation and chemotherapy cycles, the absolute count of the patient’s CD4 T cells fell to 170/ml but the viral load still remained undetectable, and neither opportunistic diseases nor severe drug-related side effects were experienced. The patient is now 24 months since the initial diagnosis of MCC and 18 months since completion of oncological treatment, with no clinical evidence of disease relapse, and a total body PET-CT scan did not demonstrate any pathological findings.