Primary extramedullary spinal melanoma mimicking spinal meningioma: A case report and literature review

Abstract

Primary spinal melanoma is a rare lesion, which occurs throughout the cranial and spinal regions, however, is primarily observed in the middle or lower thoracic spine. The clinical features of primary spinal melanoma are complex and unspecific, resulting in a high misdiagnosis rate. In the present case report, a rare case of spinal melanoma exhibiting the dural tail sign and mimicking spinal meningioma is reported. The initial diagnosis, using magnetic resonance imaging (MRI), was unclear. Thus, melanin-containing tumors and spinal meningioma should have been considered in the differential diagnosis. The tumor was completely resected using a standard posterior midline approach, which was followed by chemotherapy. Subsequent to the surgery, the patient was discharged with improved motor capacity and a follow-up MRI scan showed no recurrence after six months. The present study demonstrates that it is critical for neurosurgeons to focus on increasing the accuracy of initial diagnoses in order to make informed decisions regarding the requirement for surgical resection. The present case report presents the clinical, radiological and pathological features of primary extramedullary spinal melanoma mimicking spinal meningioma to emphasize the importance of early identification and diagnosis.

Meningiomas em cães: aspectos clínicos, histopatológicos e imuno-histoquímicos

“…Meningiomas císticos com localização ventricular apresentam aspectos de imagem semelhantes ao ependimoma, papiloma de plexo coroide e neurocitoma (Qiu et al 2014). Além disso, outras neoplasias podem ter características macroscópicas e de localização semelhantes (melanoma espinhal mimetizando meningioma) (Li et al 2014). Portanto, o diagnóstico definitivo é estabelecido por meio de exame histopatológico e classificação histoló-gica.…”

Malignant Melanoma Presenting as Spinal Cord and Pleural Lesions

“…PSM are located either intradurally or extradurally and may possess intra- or extramural components [ 11 ]. A review of 60 cases of PSM by Li et al [ 12 ] showed that 62.4% were extramedullary while 37.7% were intramedullary. There are also reports of multifocal primary cervical spinal cord melanomas.…”

“…It is difficult to differentiate between various melanin-containing tumors intraoperatively; however, features such as dural mater attachment and a distinct dark black color may indicate that the tumor originates from leptomeningeal melanocytes [ 12 ]. However, surgeons need to keep in mind that spinal meningiomas may mimic this appearance when complicated by hemorrhage [ 12 ].…”

Genomic analysis reveals low tumor mutation burden which may be associated with GNAQ/11 alteration in a series of primary leptomeningeal melanomas

“…Diagnosis of LMNs is challenging due to rarity of the disease and non‐specific imaging findings, and is complicated by the situations in which primary cutaneous melanoma may display spontaneous regression or may have been misdiagnosed as benign, or in cases where melanoma may arise from an extracutaneous site (Kanatas, Bullock, Pal, Chakrabarty, & Chumas, ; Kusters‐Vandevelde, Kusters, et al, ; Li et al, ; Wadasadawala, Trivedi, Gupta, Epari, & Jalali, ). Reports from other small case series of LMN tumors have revealed similar genomic profiling to the tumors in our study.…”