Primary leptomeningeal melanoma simulating a meningioma

Primary leptomeningeal melanoma of the cervical spine mimicking a meningioma-a case report

Background and Importance Primary leptomeningeal melanoma (PLM) is highly malignant and exceedingly rare. Due to its rarity, diagnostic and treatment paradigms have been slow to evolve. We report the first case of a PLM that mimics a cervical spine meningioma and then discuss the current clinical, radiologic, and pathologic diagnostic methodologies as well as expected outcomes related to this disease. Clinical Presentation A 54-year-old woman presented a dural-based extramedullary solid mass ventral to the C2-C3 spinal cord causing spinal cord compression without cord signal changes, characteristic of meningioma. Intraoperative microscopic inspection revealed numerous black spots littering the surface of the dura; the tumor itself was yellow in appearance and had a soft consistency. Pathologic analysis of the specimen revealed a malignant melanin-containing tumor. No primary site was found, so a diagnosis of primary leptomeningeal melanoma was made, and the patient subsequently received interferon therapy. To date (2 years postoperatively), no local or systemic recurrence of the tumor has been identified. Conclusion As with most rare tumors, case reports constitute the vast majority of references to PLM. Only an increased awareness and an extensive report of each individual case can help diagnose and clarify the nature of PLM. Clinicians need to be aware of such malignant conditions when diagnosing benign tumoral lesions of the spine such as meningiomas.

Cutaneous malignant melanoma "recurred as" or "in coexistence" with meningioma?

Background:

The authors report a rare case of a patient with previously treated cutaneous malignant melanoma that recurred 1 year later as an intracranial meningioma.

Case Description:

A 20-year-old woman presented with exophthalmos, diplopia and a mass in the left supraorbital area. Imaging study revealed an enhanced intracranial extradural mass with bone destruction. The patient had a history of cutaneous malignant melanoma surgery on the same location 1 year before. The patient underwent left frontotemporal craniotomy for total resection of the mass. Histological study revealed the intracranial mass to be an atypical meningioma.

Conclusion:

To our knowledge, this is a rare report of a patient with this tumor occurrence. This case serves to remind neurosurgeons of the potential existence of benign and/ or malignant tumors of neural crest origin.

Second primary tumors following a diagnosis of meningioma in Sweden, 1958-1997

This study quantifies the risk of second primary tumors following a diagnosis of meningioma. 12,012 meningiomas and 926 second primary cancers were identified (ICD7, path code 461) between 1958 and 1997 using Swedish Cancer Registry data. Standardized incidence ratios (SIRs) and exact 95% confidence intervals (CIs) were calculated. An elevated risk of any second primary cancer diagnosis (SIR = 1.2, 95% CI = 1.1-1.3) was observed. Elevated and statistically significant SIRs were observed for renal cancer (SIR = 1.6), melanoma (SIR = 1.7), thyroid cancer (SIR = 2.6) and brain tumors (SIR = 2.6). A consistent pattern of risk over time supports the evaluation of common risk factor profiles for renal, melanoma and thyroid cancers. Radiation exposures increase the risk of these rare tumors, so quantifying the cumulative and shared effects of environmental and treatment exposures is of further interest.