Primary Spinal Cord Melanoma in Thoracic Spine with Leptomeningeal Dissemination and Presenting Hydrocephalus

Abstract

Primary spinal cord melanoma is a rare central nervous system malignant tumor. Usually it resembles an intradural extramedullary (IDEM) nerve sheath tumor or melanoma. We experienced a patient with upper thoracic primary IDEM spinal cord melanoma who was diagnosed to be with hydrocephalus and without intracranial lesions. Initial symptoms of the patient were related to the hydrocephalus and the primary spinal cord melanoma was diagnosed eight months later. At the first operation, complete resection was impossible and the patient refused additional radiotherapy or chemotherapy. At 22 months after surgery, the patient revisited our institution with recurrent both leg weakness. Leptomeningeal dissemination was present in the whole spinal cord and only partial resection of tumor was performed. The symptoms slightly improved after surgery. Primary spinal cord melanoma is extremely rare but complete resection and additional radiotherapy or chemotherapy can prolong the disease free interval. Hydrocephalus or signs of increased intracranial pressure may be the diagnostic clue of spinal cord malignancy and progression.

Primary intramedullary malignant melanoma: can imaging lead to the correct diagnosis?

“…7,15,16 Lesions secondary to leptomeningeal dissemination also display hyperintense signals on T1-weighted imaging, with gadolinium enhancement and hypointense signals on T2-weighted imaging. 7,12 Similarly, in the present case, the primary lesion and leptomeningeal spread presented with a hyperintense signal on T1-weighted images and a hypointense signal on T2-weighted images owing to intratumoral pigment.…”

“…4,8,10 Hydrocephalus and/or signs of increased intracranial pressure, secondary to impaired cerebrospinal fluid circulation and absorption, may indicate leptomeningeal dissemination. 12 Radiological features of primary CNS melanoma depend on the degree of melanocytic content and the presence or absence of hemorrhage. 7 On computed tomography, the tumor appears as a hyperdense lesion enhanced by intravenous contrast.…”

“… 4 , 8 , 10 Hydrocephalus and/or signs of increased intracranial pressure, secondary to impaired cerebrospinal fluid circulation and absorption, may indicate leptomeningeal dissemination. 12 …”

Malignant Melanoma Presenting as Spinal Cord and Pleural Lesions

“…Multiple reports of CNS melanoma in the literature have shown different clinical presentations including symptoms of myelopathy, dysesthesia, weakness, pain, and fecal and urinary incontinence [ 13 , 15 – 17 ]. Hydrocephalus has also been reported as spinal cord lesions that can disturb the cerebrospinal fluid circulation [ 18 ]. In the case of pleural melanomas, the main symptoms include dyspnea, chest pain, and cough [ 3 ].…”

Primary malignant melanoma of the spinal cord: a case report

“…[8,9] OS in secondary CNS melanoma patients is less than one year, [1] although complete surgical resection followed by postoperative RT does increases OS in these patients. [10] However, lack of conclusive data renders the clinical outcome of spinal cord melanoma unpredictable. [2] Financial support and sponsorship Nil.…”