Case 134: Primary Leptomeningeal Melanomatosis

Demir, Mustafa Kemal; Aker, Fügen; Akıncı, Okan; Özgültekin, Asu

doi:10.1148/radiol.2473050507

Cited by 17 publications

(10 citation statements)

References 13 publications

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“…2,18 Communicating hydrocephalus with associated intracranial hypertension seem to be common clinical features of melanocytic lesions in the CNS. 2,3,9,15,[19][20][21][22] Although the cause remains unclear, intracranial hypertension with communicating hydrocephalus can be the first and only clinical sign of PLM. 15,23 Communicating hydrocephalus in the setting of diffuse leptomeningeal melanosis can be explained by features of poor CSF resorption.…”

Section: Clinical Evaluationmentioning

confidence: 99%

“…2,3,9,15,[19][20][21][22] Although the cause remains unclear, intracranial hypertension with communicating hydrocephalus can be the first and only clinical sign of PLM. 15,23 Communicating hydrocephalus in the setting of diffuse leptomeningeal melanosis can be explained by features of poor CSF resorption. [24][25][26][27] However, there is little evidence to explain the observed communicating hydrocephalus in solid leptomeningeal melanocytic lesions, apart perhaps from locally disrupted CSF circulation.…”

Section: Clinical Evaluationmentioning

confidence: 99%

“…9,14,17,18,27,33,36,37 The paramagnetic properties of melanin create hyperintense signal on T1-weighted images and isointense signal on T2-weighted images, which can be interpreted as intratumoral hemorrhage. 2,3,15,17,27 PLM and other melanocytic lesions tend to enhance avidly with gadolinium. 27 The present case is radiographically atypical for PLM in that its MRI characteristics more resemble the appearance of amelanotic melanoma without a hemorrhagic component (T1 isointense and T2 hyperintense), which is similar to the appearance of meningioma.…”

Section: Radiologymentioning

confidence: 99%

“…6 Spinal PLM represents both diagnostic and management challenges. 14,15 We present the rare case of PLM in the ventral cervical spine, and then discuss the diagnosis and management of this lesion as a mimicker of meningioma.…”

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confidence: 99%

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Primary Leptomeningeal Melanoma of the Cervical Spine Mimicking a Meningioma—A Case Report

et al. 2014

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Background and Importance Primary leptomeningeal melanoma (PLM) is highly malignant and exceedingly rare. Due to its rarity, diagnostic and treatment paradigms have been slow to evolve. We report the first case of a PLM that mimics a cervical spine meningioma and then discuss the current clinical, radiologic, and pathologic diagnostic methodologies as well as expected outcomes related to this disease. Clinical Presentation A 54-year-old woman presented a dural-based extramedullary solid mass ventral to the C2–C3 spinal cord causing spinal cord compression without cord signal changes, characteristic of meningioma. Intraoperative microscopic inspection revealed numerous black spots littering the surface of the dura; the tumor itself was yellow in appearance and had a soft consistency. Pathologic analysis of the specimen revealed a malignant melanin-containing tumor. No primary site was found, so a diagnosis of primary leptomeningeal melanoma was made, and the patient subsequently received interferon therapy. To date (2 years postoperatively), no local or systemic recurrence of the tumor has been identified. Conclusion As with most rare tumors, case reports constitute the vast majority of references to PLM. Only an increased awareness and an extensive report of each individual case can help diagnose and clarify the nature of PLM. Clinicians need to be aware of such malignant conditions when diagnosing benign tumoral lesions of the spine such as meningiomas.

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Section: Clinical Evaluationmentioning

confidence: 99%

Section: Clinical Evaluationmentioning

confidence: 99%

Section: Radiologymentioning

confidence: 99%

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confidence: 99%

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Primary Leptomeningeal Melanoma of the Cervical Spine Mimicking a Meningioma—A Case Report

et al. 2014

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“…Hence, the surgeon should be advised of this possible diagnosis in suspected cases of meningioma. Notions that can make the surgeon accomplish maximal effort at tumor resection and eliminate the risk of recurrence (1, 2). …”

Section: Introductionmentioning

confidence: 99%

Unusual Tonsillar Herniation in Meningeal Melanocytoma: A Case Report

et al. 2012

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Meningeal melanocytoma is a primary melanocytic neoplasm with certain MR and immunohistochemical characteristics worthy to note. In a 38-year-old man with a complaint of headache for a couple of years and recently added nausea, vomiting, diplopia, progressive visual blurring and hearing loss, magnetic resonance imaging (MRI) was remarkable for T1 shortening of leptomeninges and certain nodules in precontrast study. Subsequent contrast-enhanced MR imaging of the brain and spine revealed enhancement in the basal cisterns extending throughout the spinal canal. Contrast-enhanced MRI revealed diffuse enhancement in the basal cisterns extending throughout the spinal canal. Immunohistochemical analysis on one of the intraspinal nodules proposed leptomeningeal melanocytoma. The characteristic shortening of T1 and T2 relaxation times in MRI as a result of the paramagnetic stable free radicals that exist within melanin, often suggests a diagnosis of a melanocytic leptomeningeal process. Moreover, there are unique immunohistochemical characteristics for these varied lesions. In appropriate clinical settings, certain radiologic findings, especially both T1 and T2 shortening in nodular CNS lesions should propose meningeal melanocytoma.

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