Primary malignant melanoma of the cerebellum

Neurocutaneous melanosis: a case of primary intracranial melanoma with metastasis

Neurocutaneous melanosis is a rare disorder characterized by the presence of large or multiple congenital melanocytic naevi and benign or malignant pigment cell tumours of the leptomeninges. Distant metastasis is unusual in primary leptomeningeal/intracranial melanomas. We present the case history of an adult male who had multiple primary intracranial melanomas associated with neurocutaneous melanosis (naevus of Ota) in the ophthalmic division of the left trigeminal nerve. Excision of the intracranial tumours was carried out in two stages, but the patient died 2 days after the second operation. Autopsy showed multiple metastatic deposits in the liver. Symptoms and signs of raised intracranial pressure, the presence of Ota's naevus, and a dural-based mass or masses should alert the treating physician to suspect a primary leptomeningeal/intracranial melanoma.

Primary leptomeningeal melanoma simulating a meningioma

A surgically confirmed primary leptomeningeal malignant melanoma (PLMM) discovered at the parietal region is reported in a 72-year-old male. He developed progressive right hemiparesis and speech disorders caused by a parietal large mass that simulated a growing meningioma. A well-defined, dark-black tumor was removed completely and was histopathologically diagnosed as a malignant melanoma. No melanomas were detected by systemic clinical and radiological examination, including dermatological and ophthalmologic examinations. Follow-up examination 18 months postoperatively showed no evidence of recurrence of the tumor. The patient gradually became bedridden probably because of decreased general activity possibly due to brain atrophy and died of cardiac failure without any evidence of recurrence. Because of the absence of other systemic localizations, we consider this melanoma as primary. A favorable outcome was obtained by surgical treatment alone.

Primary leptomeningeal melanoma: an unusually aggressive tumor in childhood

Primary malignant melanoma of the leptomeninges of the central nervous system is a rare and aggressive tumor in children. We report our experience from 1964 to 1990 with this tumor in eight children. The mean age at diagnosis was 4.9 years (range, 1.3 to 13 yr). Five children presented with signs and symptoms of raised intracranial pressure from hydrocephalus secondary to tumoral obliteration of the basal cisterns, but the time from the initial symptomatology to diagnosis was frequently delayed. Three patients in this series had hairy nevi in association with their leptomeningeal melanoma. Cerebrospinal fluid (CSF) analysis typically showed raised opening pressures, decreased glucose, and increased protein concentrations. Malignant melanoma cells were found in the CSF in three patients. Confirmatory radiographic examinations included air encephalography, myelography, and computed tomographic and magnetic resonance scanning. Four patients were treated with lumboperitoneal shunts, and one patient was treated with a ventriculoperitoneal shunt for hydrocephalus. Two patients underwent craniotomies and subtotal excisions of their tumors. In seven patients, a definitive diagnosis of leptomeningeal melanoma was made by pathological examination of tissues sent at surgery or at post mortem. In one case, the diagnosis was established by a detailed cytological analysis of the CSF. Four children died of fulminant disease and tumor spread before treatment could be instituted. The four children who received treatment had a combination of radiation therapy and chemotherapy. One child received intrathecal methotrexate. The two children with the longest survivals (2 and 3 yr, respectively) received cisplatinum and dimethyltriazenoimidazole carboxamide in addition to craniospinal irradiation.(ABSTRACT TRUNCATED AT 250 WORDS)

Primary solitary intracranial melanoma: case report and review of the literature

Among CNS tumors, intracranial melanomas represent a subject of interest for neurooncologists and neurosurgeons because clinical and radiological patterns of these tumors can mimic the presence of meningiomas, and in spite of their malignant behavior they can be satisfactorily treated. In the present report we describe a new case of primary intracranial melanoma that displayed some radiological features of meningioma; we review the clinical features of 80 previously well-documented cases. The importance of neuroradiological and histochemical (S-100 protein, antimelanin antibodies, proliferating cell nuclear antigen staining) methods and of flow cytometry in helping with histopathological examination is stressed. Review of the clinical histories demonstrates that surgical excision is recommended in most cases, depending on tumor location, and that if total removal is performed, long-term disease-free periods can be attained.

Generalized melanosis in occult primary melanoma

Once encountered, generalized melanosis as a consequence of disseminated melanoma is not easily forgotten. Cases in the literature usually have resulted from primary cutaneous melanoma. A case of generalized melanosis caused by an occult primary melanoma is reported in a patient who originally complained of increased pigmentation. Findings of light microscopic studies of involved skin, pathogenesis of generalized melanosis, and possible sites of origin of the primary neoplasm are discussed.

Primary leptomeningeal melanoma. Diagnosis by ultrastructural cytology of cerebrospinal fluid and cranial computed tomography

A case of primary leptomeningeal melanoma is presented in which the diagnosis was made by ultrastructural demonstration of melanoma cells from the cerebrospinal fluid (CSF) at a time when cranial computed tomography (CT) still gave negative results. Later CT examinations documented the emergence of a tumor mass of the left temporoparietal lobe. This case clearly illustrates the complementary role of these investigational procedures for the diagnosis of cerebrospinal melanoma: leptomeningeal involvement, characterized by two-dimensional diffuse spread of melanoma tissue ("leptomeningeal melanomatosis"), is invisible with CT, but easily recognisable by CSF cytology; in contrast, nodular parenchymal tumor deposits can be readily detected by CT. Identification of pigmented cells recovered from the CSF requires ultrastructural confirmation.

Malignant melanoma of the gallbladder: a case report

A 47-year-old woman with malignant melanoma in the gallbladder and brain is described. Evidence is offered that the tumor arose in the gallbladder, the main factor being the presence of "junctional change" and isolated melanocytes in the adjacent mucosa.

Amelanotic melanoma of the lung and brain with fenestrated intrinsic tumor capillaries

Tissue from an amelanotic melanoma which involved the lung and brain was studied by electron microscopy. Endothelial fenestrae were found in the intrinsic tumor capillaries at both locations, a finding which does not appear to have been previously reported for amelanotic melanoma. Pitfalls in the diagnosis of this rare tumor are discussed.

[Neurocutaneous melanosis. Report of a case]

The clinical, laboratorial and radiological features of a 3-month-old child with neurocutaneous melanosis are described. The patient was born with multiple disseminated benign cutaneous nevi, proven by skin-biopsy, and presented with drug-resistant seizures and psycho-motor retardation. Serial cerebrospinal fluid studies showed high protein and low glucose levels, with pleocytosis and malignant cells in the fluid. Pneumoencephalogram showed mild non-obstructive hydrocephalus. Immunological studies showed normal immunological activity at three months of age and very poor activity at one year. The patient died at 16 months of age, after the sudden onset of intracranial hypertension and meningeal signs. Immunotherapy and chemotherapy were suggested but not accepted by the family. Some comments are made based on this and other 43 cases described in the literature; the value of laboratory studies in detecting malignant transformaiton in the meninges in patients with benign skin nevi is stressed.

Primary malignant melanoma of the cerebellum: a case with metastases outside the nervous system

A case of primary intracranial melanoma in a 65-year-old female is described. A complete postmortem examination revealed multiple metastases in the liver, and eliminated the possibility of an extraneural primary melanoma. A review of the literature confirmed that such cases are highly exceptional, and that an exhaustive autopsy including particularly the eyes is indispensable to substantiate the diagnosis. When these conditions are fulfilled, there is no reason not to consider the eventuality of visceral deposits from a primary melanoma of the central nervous system.

Primary pigmented carcinoma of the choroid plexus. A light and electron microscopic study

Pigmented carcinoma of the choroid plexus was found in a 33-year-old man. Autopsy revealed no primary tumor in the skin or eyes. A slightly cystic pigmented tumor was present in the right lateral ventricle infiltrating the thalamus and striatum. Metastatic implants were found in both temporal lobes and the cerebellum. The spinal cord was covered by black meningeal nodules, and the cauda equina was completely encased by the tumor. Metastases were found in the liver, pancreas, and kidney. Microscopically the mass contained normal choroid plexus with psammoma bodies adjacent to carcinomatous epithelium forming prominent papillae and tubules. Melanin granules were found within the neoplastic cells and in the stroma. Electron microscopy demonstrated melanin granules in various stages of development in the cells, which were joined one to another by desmosome-like structures. This is the second reported case of pigmented carcinoma of the choroid plexus and the first with metastases outside the central nervous system.

Neurocutaneous melanosis. Report of a case and review of the literature

A case of neurocutaneous melanosis in a 15 year old male is described. A primary malignant meningeal melanoma caused the death of the patient in six months. The skin lesions were benign. The literature is reviewed, and the nature of the disease and its relationship with other phakomatoses is discussed.

Malignant melanoma and the central nervous system. A guide for classification based on the clinical findings

Twenty-seven cases diagnosed as having malignant melanoma affecting the central nervous system have been studied. In 20 patients the tumours represented secondary spread from elsewhere, but there were six who had a primary melanoma either of the spinal cord, leptomeninges, or brain. Confusion exists in the literature about how to differentiate primary from secondary tumours but this suggests several clinical factors which may indicate that the lesion is probably a primary one. This method of categorizing the cases is supported by the differences in duration of symptoms and survival times for each group and a simple classification can therefore be proposed.

Melanoma and pigmentation of the leptomeninges in Ugandan Africans

A case of leptomeningeal melanoma in an African child of 7 years is presented together with a survey of pigmentation in the normal African brain. There is a direct relationship between the depth of pigment of the leptomeninges and the skin in Ugandan Africans, suggesting that similar factors operate in the control of melanocytes in these two sites.