Diagnostic Clue of Meningeal Melanocytoma: Case Report and Review of Literature

Abstract

In this report, the patient was pre-diagnosed as meningioma before surgery, which turned out to be meningeal melanocytoma. Hence, we will discuss the interpretation of imaging and neurological statuses that may help avoid this problem. A 45-year-old man had increasing pain around the neck 14 months prior to admission. His cervical spine MR imaging revealed a space-occupying, contrast-enhancing mass within the dura at the level of C1. The neurologic examination revealed that the patient had left-sided lower extremity weakness of 4+, decreased sensation on the right side, and hyperreflexia in both legs. Department of Neuroradiology interpreted CT and MR imaging as meningiom. The patient underwent decompression and removal of the mass. We confirmed diagnosis as meningeal melanocytoma through pathologic findings. Afterwards, we reviewed the patient's imaging work-up, which showed typical findings of meningeal melanocytoma. However, it was mistaken as meningioma, since the disease is rare.

A 82‐Year‐Old Man with an Extra‐Axial Frontal Mass

“…Indeed, the vast majority of meningiomas stain for EMA and vimentin, and progesterone receptor reactivity may also be of help . Besides, MRI data also suggested a meningioma .…”

Nivolumab as adjuvant treatment for a spinal melanocytoma

“…It is mainly located in the posterior fossa, but in the case in this clinical report the tumor was located at spinal level. [ 8 ] To diagnose such tumors, pathology examination that is to say microscopical examination, immunochemistry analysis and molecular study are gold standard tests. [ 9 ] This tumor mostly affects women, it is often diagnosed at the age of 50 years old [ 10 ] yet, rare cases affect kids.…”

Primary Meningeal Melanocytoma Located in the Craniovertebral Junction: A Case Report and Literature Review

“…Only 13 cases including the present case have been reported so far (Table 1). 2,4,[7][8][9][10][11][12][13][14] Most of the patients have been male and aged from 25 to 71 years with a mean age of 49.9 years. The duration of symptoms ranged from several weeks to 6 years, and the predominant symptom was headache induced by the mass effect.…”

“…Immunohistochemical staining showed meningeal melanocytomas are positive for HMB-45 and S-100 protein, but negative for keratin, epithelial membrane antigen, glial fibrillary acidic protein, and neuron-specific enolase. 2,4,7,9,15) MIB-1/Ki-67 labeling index helps to differentiate melanocytoma from malignant melanoma, as they are low in melanocytoma. 1,2,9) In our case, the tumor was composed of monomorphic spindle cells, which were arranged in fascicles and nests, and there was abundant melanin in the cytoplasm.…”

“…The most common location is the posterior fossa or upper spinal cord, [1][2][3] and a lesion located in the craniovertebral junction (CVJ) is rare. 4) As preoperative differential diagnosis of meningeal melanocytoma from meningioma can be difficult, [5][6][7] histopathologic and immunohistochemical examinations are necessary to make a definite diagnosis. 4,8) The optimal treatment of meningeal melanocytoma is complete surgical removal.…”