Differential Diagnosis between Primary Intracranial Melanoma and Cerebral Cavernoma in Crohn’s Disease: A Case Report and Literature Review

Abstract

Primary intracranial melanomas are rare, with a challenging diagnosis based only on clinical and imaging features. The authors described the case of an intracerebral right parieto-temporal melanoma mimicking a cavernoma in a patient affected by Crohn's disease. A 67-year-old female patient with Crohn's disease and small bowel stenosis was hospitalized for surgical removal of the terminal ileum and latero-lateral ileo-colic anastomosis. During postoperative week 1, the patient developed psychomotor agitation followed by altered consciousness. An urgent brain CT showed a right intracerebral parieto-temporal hemorrhage with intralesional calcifications. The patient underwent a decompressive craniectomy with hematoma drainage and a complete resection of the lesion. Histologic examination showed characteristics consistent with malignant melanoma. In patients with inflammatory bowel disease (IBD), the differential diagnosis between intracerebral melanoma and cavernoma may be challenging, considering the similar clinical and radiological findings. Thus, a comprehensive multidisciplinary approach is required to exclude the possible coexistence of such intracranial lesions.