1. Count the letters in MEDITERRANEAN

   The word is: $\text{M E D I T E R R A N E A N}$

   Frequency of letters:

   • $E = 3$
   • $R = 2$
   • $A = 2$
   • $N = 2$
   • $M,D,I,T = 1$ each

2. Apply the position restrictions

   We need 4-letter words such that:

   • first letter is $R$
   • fourth letter is $E$

   So the form is: $R\_\_E$

   After fixing one $R$ and one $E$, the remaining available letters are:

   • $E = 2$
   • $R = 1$
   • $A = 2$
   • $N = 2$
   • $M,D,I,T = 1$ each

   Thus, for the 2nd and 3rd positions, we must choose an ordered pair from this remaining multiset.

3. Count all possible ordered pairs for positions 2 and 3

   Distinct available letter types are: $\{E,R,A,N,M,D,I,T\}$ i.e. $8$ types.

   We count ordered pairs in two cases.

   Case 1: Both letters different

   • Choose the 2nd letter in $8$ ways.
   • Choose the 3rd letter in $7$ ways.

   Total: $8 \times 7 = 56$

   Case 2: Both letters same

   This is possible only for letters having at least 2 copies left.

   Such letters are: $E, A, N$

   ($R$ has only 1 left, so $RR$ is not possible.)

   Hence same-letter pairs possible are: $EE, AA, NN$

   Total: $3$

4. Total number of words

   $56 + 3 = 59$

5. Check options

   • A: not equal to $59$
   • B: $110$ ❌
   • C: $56$ ❌
   • D: $59$ ✅

Therefore, the correct answer is: $\boxed{59}$