Intramedullary spinal cord metastasis of malignant melanoma:Two cases with rim signs in contrast‑enhanced magnetic resonance imaging: A case report

Mizuta, Haruki; Namikawa, Kenjiro; Nakama, Kenta; Yamazaki, Naoya

doi:10.3892/mco.2021.2209

Cited by 6 publications

(6 citation statements)

References 11 publications

(11 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Rim sign indicate a more intense thin rim with peripheral enhancement than other tumor areas and flame signs indicate flame-shaped enhancements at the edge of the lesion. Depending upon the variable degree of tumour melanin content, the signal characteristics on MRI are biased [8,[10][11][12]. Flame and rim sign, two unique characteristics of ISCM on contrast, are present in a much lower percentage in ISCM of other cancers [8].…”

Section: Discussionmentioning

confidence: 99%

“…Depending upon the variable degree of tumour melanin content, the signal characteristics on MRI are biased [8,[10][11][12]. Flame and rim sign, two unique characteristics of ISCM on contrast, are present in a much lower percentage in ISCM of other cancers [8]. Considering the above facts, it is diagnostically challenging to detect ISCM of melanoma.…”

Section: Discussionmentioning

confidence: 99%

“…In the literature, ISCM of malignant melanoma is described as a small percentage of the ISCMs of all cancer types; thus, it is sometimes not reported in detail. Twenty-seven cases of ISCM of malignant melanoma have been reported so far in a recent study [ 8 ]. On review of literature, we could not find any reported case with ISCM secondary to malignant melanoma as initial presentation.…”

Section: Discussionmentioning

confidence: 99%

“…It has been suggested that MRI is the most effective imaging technique for revealing spinal cord melanoma. According to most authors, the MRI pattern of spinal cord melanoma includes signal hyperintensity on T1-weighted images and signal iso- or hypo-intensity on T2-weighted images [ 8 ]. With injection of an appropriate contrast medium, there should be a moderate enhancement of the lesion [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Intramedullary Spinal Cord Metastasis as Initial Presentation of Malignant Melanoma: A Unique Case Report and Role of Contrast vs Non-contrast MRI in Its Diagnosis

Manan¹,

Rizvi²,

Kondlapudi³

2021

Cureus

View full text Add to dashboard Cite

Intramedullary spinal cord metastasis (ISCM) is a diagnostically challenging and dreadful complication of cancer. Twenty-seven cases of ISCM exclusively related to malignant melanoma have been reported so far in a recent study.On review of literature, we could not find any reported case with ISCM secondary to malignant melanoma as initial presentation. To the best of our knowledge, we are reporting the first such case. We report a case of a 71-year-old lady presenting with gradual onset of bilateral leg weakness “off legs” and lower limb paresthesias. On examination she had an upper motor neuron pattern lower limb weakness with reduced sensations to all modalities and brisk reflexes with extensor plantar responses. She was evaluated with non-contrast MRI (magnetic resonance imaging) spine which showed focal myelopathic cord signal at the conus and at the level of T10 and T11 vertebrae (radiological differential diagnosis given on MRI were B12 deficiency/inflammatory/infection). Thorough radiological scans were ordered which revealed a disseminated malignancy. A biopsy sample from gastric lesion revealed diagnosis of malignant melanoma. A repeat MRI whole spine with gadolinium contrast was done later with suspicion of spinal metastasis which has led to lower limb weakness. MRI with contrast showed an enhancing soft tissue metastatic mass lesion within conus in comparison with plain MRI done one week earlier. At present, diagnostic modalities available for diagnosing ISCM particularly secondary to melanoma do not have high specificity. Contrast MRI is the diagnostic modality of choice at present. Non-contrast MRI has low sensitivity in diagnosis of ISCM compared to contrast MRI and could potentially delay the management, especially in highly aggressive malignancies like malignant melanoma where an early diagnosis and treatment is critical for better outcome.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Intramedullary Spinal Cord Metastasis as Initial Presentation of Malignant Melanoma: A Unique Case Report and Role of Contrast vs Non-contrast MRI in Its Diagnosis

Manan¹,

Rizvi²,

Kondlapudi³

2021

Cureus

View full text Add to dashboard Cite

show abstract

“…tumors of the central nervous system. In contrast, extradural metastases with potential spinal cord compression (MSCC) possess the lion share of spinal tumors (60%) ( 4 ) and affect about 5% of all cancer patients ( 5 ), with intramedullary metastases known to be rare ( 6 , 7 ).…”

Section: Introductionmentioning

confidence: 99%

Spinal oncologic paraparesis: Analysis of neurological and surgical outcomes in patients with intramedullary, extramedullary, and extradural tumors

et al. 2023

View full text Add to dashboard Cite

ObjectivesParaparesis due to oncologic lesions of the spine warrants swift neurosurgical intervention to prevent permanent disability and hence maintain independence of affected patients. Clinical parameters that predict a favorable outcome after surgical intervention could aid decision-making in emergency situations.MethodsPatients who underwent surgical intervention for paraparesis (grade of muscle strength <5 according to the British Medical Research Council grading system) secondary to spinal neoplasms between 2006 and 2020 were included in a single-center retrospective analysis. Pre- and postoperative clinical data were collected. The neurological status was assessed using the modified McCormick Disability Scale (mMcC) Score. In a univariate analysis, patients with favorable (discharge mMcC improved or stable at <3) and non-favorable outcome (discharge mMcC deteriorated or stable at >2) and different tumor anatomical compartments were statistically compared.Results117 patients with oncologic paraparesis pertaining to intramedullary lesions (n=17, 15%), intradural extramedullary (n=24, 21%) and extradural lesions (n=76, 65%) with a mean age of 65.3 ± 14.6 years were included in the analysis. Thoracic tumors were the most common (77%), followed by lumbar and cervical tumors (13% and 12%, respectively). Surgery was performed within a mean of 36±60 hours of admission across all tumors and included decompression over a median of 2 segments (IQR:1-3) and mostly subtotal tumor resection (n=83, 71%). Surgical and medical complications were documented in 9% (n=11) and 7% (n=8) of cases, respectively. The median hospital length-of-stay was 9 (7-13) days. Upon discharge, the median mMcC score had improved from 3 to 2 (p<0.0001). At last follow-up (median 180; IQR 51-1080 days), patients showed an improvement in their mean Karnofsky Performance Score (KPS) from 51.7±18.8% to 65.3±20.4% (p<0.001). Localization in the intramedullary compartment, a high preoperative mMcC score, in addition to bladder and bowel dysfunction were associated with a non-favorable outcome (p<0.001).ConclusionThe data presented on patients with spinal oncologic paraparesis provide a risk-benefit narrative that favors surgical intervention across all etiologies. At the same time, they outline clinical factors that confer a less-favorable outcome like intramedullary tumor localization, a high McCormick score and/or bladder and bowel abnormalities at admission.

show abstract

Spinal Oncology: Intradural Tumors

Delawan,

AlDallal,

Al-Badri

et al. 2024

Neuroradiology Board's Favorites

View full text Add to dashboard Cite

Intramedullary spinal cord metastasis of malignant melanoma:Two cases with rim signs in contrast‑enhanced magnetic resonance imaging: A case report

Cited by 6 publications

References 11 publications

Intramedullary Spinal Cord Metastasis as Initial Presentation of Malignant Melanoma: A Unique Case Report and Role of Contrast vs Non-contrast MRI in Its Diagnosis

Intramedullary Spinal Cord Metastasis as Initial Presentation of Malignant Melanoma: A Unique Case Report and Role of Contrast vs Non-contrast MRI in Its Diagnosis

Spinal oncologic paraparesis: Analysis of neurological and surgical outcomes in patients with intramedullary, extramedullary, and extradural tumors

Spinal Oncology: Intradural Tumors

Contact Info

Product

Resources

About