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Guo P, Wei X, Guo Z, Wu D. Clinicopathological features, current status, and progress of primary central nervous system melanoma diagnosis and treatment. Pigment Cell Melanoma Res 2024; 37:265-275. [PMID: 37886794 DOI: 10.1111/pcmr.13140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 09/10/2023] [Accepted: 09/23/2023] [Indexed: 10/28/2023]
Abstract
Primary central nervous system (CNS) melanoma is an extremely rare condition, with an incidence rate of 0.01 per 100,000 individuals per year. Despite its rarity, the etiology and pathogenesis of this disease are not yet fully understood. Primary CNS melanoma exhibits highly aggressive biological behavior and presents clinically in a distinct manner from other types of melanomas. It can develop at any age, predominantly affecting the meninges as the primary site, with clinical symptoms varying depending on the neoplasm's location. Due to the lack of specificity in its presentation and the challenging nature of imaging diagnosis, distinguishing primary CNS melanoma from other CNS diseases. The combination of challenges in early detection, heightened tumor aggressiveness, and the obscured location of its origin contribute to an unfavorable prognostic outcome. Furthermore, there has been currently no consensus on a standardized treatment approach for primary CNS melanoma. Despite recent advancements in targeted therapy and immunotherapy for CNS melanoma, patients with primary CNS melanoma have limited treatment options due to their inadequate response to these therapies. Here, we provided a comprehensive summary of the epidemiology, clinical features, molecular pathological manifestations, and available diagnostic and therapeutic approaches of primary CNS melanoma. Additionally, we proposed potential therapeutic strategies for it.
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Affiliation(s)
- Pengna Guo
- Cancer Center, The First Hospital Of Jilin University, Changchun, China
| | - Xiaoting Wei
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Melanoma and Sarcoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Zhen Guo
- Cancer Center, The First Hospital Of Jilin University, Changchun, China
| | - Di Wu
- Cancer Center, The First Hospital Of Jilin University, Changchun, China
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Zhang J, Wei Z, Chen J. The effectiveness of combined resection and radiotherapy for primary pineal malignant melanoma: a systematic review. Front Neurol 2024; 14:1344672. [PMID: 38375353 PMCID: PMC10875993 DOI: 10.3389/fneur.2023.1344672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 12/21/2023] [Indexed: 02/21/2024] Open
Abstract
Objective To evaluate the effectiveness of combined resection and radiotherapy (CRAR) for the treatment of primary pineal malignant melanoma (PPMM). Methods Relevant studies were identified through a literature search in PubMed, Embase, and Web of Science from 1899 to September 1, 2023. Then we further screened the literature according to the updated PRISMA 2020 guidelines. The article information, patient information, treatment, and survival rate were analyzed. The primary outcome measures the survival rate of CRAR compared with the overall patients and the patients without treatment. Secondary outcome measures operation methods, radiotherapy methods, and dose. Results In total, 28 published articles were recorded. Among them, 35.71% (10/28) articles were on CRAR. The median overall survival, CRAR, and no treatment survival were 65, 88, and 12 weeks, respectively. The median overall survival of CRAR was demonstrably better than that of no treatment (p < 0.0001) and overall survival, even with p = 0.1177. Most of the operations adopted a supracerebellar infratentorial approach, and stereotactic radiation to tumor bed usually ranged between 50 and 60 Gy. Small dose and multiple fractions was the most popular radiotherapy method. Conclusion Currently, CRAR, compared with other treatments, is more beneficial to prolonging the survival of PPMM patients. However, many more clinical cases are needed to verify it as the best treatment approach.
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Affiliation(s)
| | | | - Jincao Chen
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
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3
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Maiellaro A, Perna A, Giugliano P, Esposito M, Vacchiano G. Sudden Death from Primary Cerebral Melanoma: Clinical Signs and Pathological Observations. Healthcare (Basel) 2021; 9:healthcare9030341. [PMID: 33802952 PMCID: PMC8002833 DOI: 10.3390/healthcare9030341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/12/2021] [Accepted: 03/15/2021] [Indexed: 12/20/2022] Open
Abstract
Primary cerebral tumors rarely provoke sudden death. The incidence is often underestimated with reported frequencies in the range of 0.02 to 2.1% in medicolegal autopsy series. Furthermore, primary cerebral melanoma is an uncommon neoplasm. It represents approximately 1% of all melanoma cases and 0.07% of all brain tumors. This neoplasm is very aggressive, and its annual incidence is about 1 in 10 million people. In the present study, a 20-year-old male was admitted to hospital with vomiting, headache, paresthesia and aggressive behavior. A computed tomography (CT) scan of the head was performed showing a hyperdense nodule in the right parietal lobe with inflammation of the Silvian fissure. A complete autopsy was performed 48 h after death. A blackish material was displayed on the skull base, and posterior fossa. Microscopic examination diagnosed primary brain melanoma. A systematic review of the literature was also performed where no previous analogous cases were found. The forensic pathologist rarely encounters primary cerebral melanoma, and for these reasons, it seemed appropriate to describe this case as presenting aspecific clinical symptoms and leading to sudden unexpected death. Histopathological observations are reported and discussed to explain this surprising sudden death caused by a primary cerebral melanoma.
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Affiliation(s)
- Alfonso Maiellaro
- Legal Medicine Department, A. Cardarelli Hospital, 80131 Naples, Italy;
| | - Antonio Perna
- Pathology Unit, Mauro Scarlato Hospital, 84018 Scafati, Italy;
| | - Pasquale Giugliano
- AORN Sant’Anna e San Sebastiano di Caserta, 81100 San Sebastiano, Italy;
| | - Massimiliano Esposito
- Legal Medicine, Department of Medical, Surgical and Advanced Technologies, “G.F. Ingrassia”, University of Catania, 95123 Catania, Italy
- Correspondence: (M.E.); (G.V.); Tel.: +39-3409348781 (M.E.); +39-3475386107 (G.V.)
| | - Giuseppe Vacchiano
- Department of Law, University of Sannio, 82100 Benevento, Italy
- Correspondence: (M.E.); (G.V.); Tel.: +39-3409348781 (M.E.); +39-3475386107 (G.V.)
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Zhang J, Xiong Z, Chen J. Combined microscope and endoscopy total resection of primary pineal malignant melanoma: case report and literature review. J Cancer Res Clin Oncol 2020; 146:2589-2594. [PMID: 32700108 DOI: 10.1007/s00432-020-03328-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/18/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Primary pineal malignant melanoma (PPMM) is a rare entity of primary central nervous system melanomas, with only 26 cases reported in the literature to date. CASE PRESENTATION We report the case of a 65-year-old male with a PPMM who has prolonged survival of more than 104 weeks after combined microsurgical and endoscopic total resection. This is the first report: combined microscope and endoscopy total resection; PPMM in China; PPMM with total resection alone. CONCLUSION Combined microscope and endoscopy total resection is beneficial to prolong the survival of patients. But the best approach to treatment needs verification from more clinical cases in future.
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Affiliation(s)
- Jibo Zhang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Donghu Road 169, Wuhan, 430071, China.,Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, 55905, USA
| | - Zhongwei Xiong
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Donghu Road 169, Wuhan, 430071, China
| | - Jincao Chen
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Donghu Road 169, Wuhan, 430071, China.
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Man W, Wang G. Incidence, Outcomes and Predictors of Primary Central Nervous System Melanoma: A SEER-Based Study. World Neurosurg 2019; 129:e782-e790. [DOI: 10.1016/j.wneu.2019.06.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 06/03/2019] [Accepted: 06/04/2019] [Indexed: 11/25/2022]
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Hajhouji F, Ganau M, Helene C, Romano A, Gubian A, Proust F, Chibbaro S. Rare encounters: Primary pineal malignant melanoma with lepto-meningeal spread. Case report and literature review on management challenges and outcomes. J Clin Neurosci 2019; 65:161-165. [DOI: 10.1016/j.jocn.2019.03.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 03/22/2019] [Indexed: 12/24/2022]
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Arai N, Kagami H, Mine Y, Ishii T, Inaba M. Primary Solitary Intracranial Malignant Melanoma: A Systematic Review of Literature. World Neurosurg 2018; 117:386-393. [PMID: 29959081 DOI: 10.1016/j.wneu.2018.06.138] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 06/15/2018] [Accepted: 06/16/2018] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Primary solitary intracranial malignant melanoma (PIMM) is extremely rare. In 1992, an extensive review of 81 patients with PIMM was undertaken. Imaging studies, microsurgery, and adjuvant therapy have developed considerably over the last 25 years, and targeted therapy recently has been proven successful for metastatic melanoma. These factors could influence current and future clinical PIMM results. METHODS We undertook a literature search of PIMM patients since 1992. RESULTS We reviewed 49 cases of PIMM. The mean age was 45.8 years. No significant sex difference was found. Intracranial hypertension and focal neurologic deficits were commonly observed around 70% and 40%, respectively. There were no significant differences of survival period according to tumor sites. Surgeries were performed in 42 of 49 patients with PIMM reviewed (92%). The mean survival of the gross total removal group was significantly longer than that of surgical results (>22 months vs. 12 months (interquartile range: 5-22 months; P = 0.026). For adjuvant therapy, 9 patients underwent chemotherapy and 18 patients underwent radiotherapy postoperatively There was no significant difference in survival period between with and without adjuvant therapies. Leptomeningeal enhancement diagnosed in the initial MRI, was the worst prognostic factor. CONCLUSIONS Gross total removal of the PIMM was the most promising treatment. Currently adjuvant therapy has not been associated with the survival period. To improve clinical outcome, immunotherapy and targeted therapies are likely to become more important.
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Affiliation(s)
- Nobuhiko Arai
- Department of Neurosurgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Kanagawa, Japan.
| | - Hiroshi Kagami
- Department of Neurosurgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Kanagawa, Japan
| | - Yutaka Mine
- Department of Neurosurgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Kanagawa, Japan
| | - Toshiharu Ishii
- Department of Pathology, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Kanagawa, Japan
| | - Makoto Inaba
- Department of Neurosurgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Kanagawa, Japan
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Ma Y, Gui Q, Lang S. Intracranial malignant melanoma: A report of 7 cases. Oncol Lett 2015; 10:2171-2175. [PMID: 26622814 PMCID: PMC4579826 DOI: 10.3892/ol.2015.3537] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 06/11/2015] [Indexed: 12/13/2022] Open
Abstract
The aim of the present study was to investigate the clinical diagnosis and treatment of intracranial malignant melanoma. For this purpose, the clinical manifestation, signs, cerebrospinal fluid (CSF) contents, imageology, pathological features, treatment and prognosis of 7 cases of intracranial malignant melanoma were analyzed in The Chinese PLA General Hospital (Beijing, China) from 1996 to 2013. All the melanoma cases were confirmed by histopathology, and CSF cytopathology demonstrated that there were 5 cases of primary malignant melanoma and 2 cases of secondary malignant melanoma. Among the patients, 4 presented with >1 pigmented nevus in the skin, and 1 presented with skin melanoma. Intracranial malignant melanoma mostly affects middle-aged males. CSF cytopathology and imageology (particularly enhanced magnetic resonance), are important tools in the diagnosis of the disease. Particularly, when a patient presents with a pigmented nevus in the skin and an abnormal lesion in the brain, a diagnosis of intracranial malignant melanoma should be considered.
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Affiliation(s)
- Yunfeng Ma
- Department of Neurology, Chinese PLA General Hospital, Beijing 100853, P.R. China
| | - Qiuping Gui
- Department of Pathology, Chinese PLA General Hospital, Beijing 100853, P.R. China
| | - Senyang Lang
- Department of Psychology, Chinese PLA General Hospital, Beijing 100853, P.R. China
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Primary pineal malignant melanoma with B-Raf V600E mutation: a case report and brief review of the literature. Acta Neurochir (Wien) 2015; 157:1267-70. [PMID: 25976339 DOI: 10.1007/s00701-015-2427-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 04/14/2015] [Indexed: 10/23/2022]
Abstract
Primary pineal melanoma is exceedingly rare, and sufficient treatment options have not been established. Here we describe a 57-year-old male patient who presented with short-term memory disturbance and ataxia. Magnetic resonance imaging of the brain showed a tumor mass in the pineal gland. Biopsy revealed a malignant melanocytic tumor. No primary malignant melanoma was known, and extensive imaging studies including PET-CT excluded other sites affected by a malignant melanoma. The demonstration of the BRAF V600E mutation in the pineal tumor made the patient eligible for intrathecal treatment with vemurafenib. Unfortunately, the patient died 26 days after surgery due to tumor hemorrhage. This is the first report of V600E in primary pineal melanoma, suggesting that a fraction of these rare tumors might additionally benefit from vemurafenib treatment.
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10
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Quillo-Olvera J, Uribe-Olalde JS, Alcántara-Gómez LA, Rejón-Pérez JD, Palomera-Gómez HG. [Primary malignant melanoma of the central nervous system: A diagnostic challenge]. CIR CIR 2015; 83:129-34. [PMID: 25986983 DOI: 10.1016/j.circir.2015.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 02/18/2014] [Indexed: 10/23/2022]
Abstract
BACKGROUND The rare incidence of primary malignant melanoma of the central nervous system and its ability to mimic other melanocytic tumors on images makes it a diagnostic challenge for the neurosurgeon. CLINICAL CASE A 51-year-old patient, with a tumor located in the right forniceal callosum area. Total surgical excision was performed. Histopathological result was consistent with the diagnosis of primary malignant melanoma of the central nervous system, after ruling out extra cranial and extra spinal melanocytic lesions. CONCLUSIONS The primary malignant melanoma of the central nervous system is extremely rare. There are features in magnetic resonance imaging that increase the diagnostic suspicion; nevertheless there are other tumors with more prevalence that share some of these features through image. Since there is not an established therapeutic standard its prognosis is discouraging.
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Affiliation(s)
- Javier Quillo-Olvera
- Servicio de Neurocirugía, Hospital Regional Valentín Gómez Farías ISSSTE, Zapopan, Jalisco, México.
| | | | | | - Jorge Dax Rejón-Pérez
- Servicio de Neurocirugía, Hospital Regional Valentín Gómez Farías ISSSTE, Zapopan, Jalisco, México
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Park JH, Hong YK. Primary malignant melanoma in the pineal region. J Korean Neurosurg Soc 2014; 56:504-8. [PMID: 25628812 PMCID: PMC4303728 DOI: 10.3340/jkns.2014.56.6.504] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 09/01/2014] [Accepted: 09/28/2014] [Indexed: 11/27/2022] Open
Abstract
A 59-year-old male patient had 5-month history of gait disturbance and memory impairment. His initial brain computed tomography scan showed 3.5×2.8 cm sized mass with high density in the pineal region. The tumor was hypointense on T2 weighted magnetic resonance images and hyperintense on T1 weighted magnetic resonance images with heterogenous enhancement of central portion. The tumor was totally removed via the occipital transtentorial approach. Black mass was observed in the operation field, and after surgery, histopathological examination confirmed the diagnosis of malignant melanoma. Whole spine magnetic resonance images and whole body 18-fluoro-deoxyglucose positron emission tomography could not demonstrate the primary site of this melanoma. Scrupulous physical examination of his skin and mucosa was done and dark pigmented lesion on his left leg was found, but additional studies including magnetic resonance images and skin biopsy showed negative finding. As a result, final diagnosis of primary pineal malignant melanoma was made. He underwent treatment with the whole brain radiotherapy and extended local boost irradiation without chemotherapy. His preoperative symptoms were disappeared, and no other specific neurological deficits were founded. His follow-up image studies showed no recurrence or distant metastasis until 26 weeks after surgery. Primary pineal malignant melanomas are extremely rare intracranial tumors, and only 17 cases have been reported since 1899. The most recent case report showed favorable outcome by subtotal tumor resection followed by whole brain and extended local irradiation without chemotherapy. Our case is another result to prove that total tumor resection with radiotherapy can be the current optimal treatment for primary malignant melanoma in the pineal region.
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Affiliation(s)
- Jae-Hyun Park
- Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Yong-Kil Hong
- Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
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Lensing FD, Abele TA, Sivakumar W, Taussky P, Shah LM, Salzman KL. Pineal region masses--imaging findings and surgical approaches. Curr Probl Diagn Radiol 2014; 44:76-87. [PMID: 25027864 DOI: 10.1067/j.cpradiol.2014.05.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 05/19/2014] [Accepted: 05/19/2014] [Indexed: 11/22/2022]
Abstract
The anatomy of the pineal region is complex. Despite advances in surgical techniques since the first reported successful pineal region surgery in the early 20th century, pineal region surgery remains challenging owing to the proximity of deep cerebral veins and dorsal midbrain structures critical for vision. In this article, we review the relevant surgical anatomy of the pineal region and discuss historically important and current surgical approaches. We describe specific imaging features of pineal region masses that may affect surgical planning and review neoplastic and nonneoplastic masses that occur in the pineal region.
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Affiliation(s)
- Forrester D Lensing
- Neuroradiology Section, Department of Radiology, University of Utah Health Science Center, Salt Lake City, UT
| | - Travis A Abele
- Neuroradiology Section, Department of Radiology, University of Utah Health Science Center, Salt Lake City, UT
| | - Walavan Sivakumar
- Department of Neurosurgery, University of Utah Health Science Center, Salt Lake City, UT
| | - Philipp Taussky
- Department of Neurosurgery, University of Utah Health Science Center, Salt Lake City, UT
| | - Lubdha M Shah
- Neuroradiology Section, Department of Radiology, University of Utah Health Science Center, Salt Lake City, UT
| | - Karen L Salzman
- Neuroradiology Section, Department of Radiology, University of Utah Health Science Center, Salt Lake City, UT.
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Fang AS, Meyers SP. Magnetic resonance imaging of pineal region tumours. Insights Imaging 2013; 4:369-82. [PMID: 23640020 PMCID: PMC3675249 DOI: 10.1007/s13244-013-0248-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Revised: 03/19/2013] [Accepted: 03/28/2013] [Indexed: 12/23/2022] Open
Abstract
Objectives Pineal lesions can present as a heterogeneous collection of benign and malignant disease conditions. Pineal lesions include germ cell tumours, neoplasms arising from the pineal parenchyma, as well as other pineal region masses. Methods A variety of cases of pineal lesions are presented. The important clinical features and typical imaging findings of each pineal lesion are described with emphasis on their morphological appearance and signal intensity characteristics on magnetic resonance imaging (MRI). Conclusion Knowledge of the imaging characteristics and clinical features of varying pineal lesions can assist in narrowing the differential diagnosis for more accurate and rational therapeutic planning. Teaching Points • Pineal parenchymal tumours show an “explosion” of normal pineal calcifications towards the periphery. • Pineoblastomas often have restricted diffusion, with apparent diffusion coefficient (ADC) values lower than germinomas. • Pineal teratomas and pineal lipomas display fat signal characteristics and fat saturation on MRI. • Pineal lesions in patients with known malignancy should raise suspicion of metastatic involvement. • Pineal cysts and arachnoid cysts show MRI signal characteristics similar to cerebrospinal fluid (CSF).
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Affiliation(s)
- Adam S Fang
- Department of Imaging Sciences, University of Rochester Medical Center School of Medicine and Dentistry, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA,
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Somers KE, Almast J, Biemiller RA, Silberstein HJ, Johnson MD, Mohile NA. Diagnosis of primary CNS melanoma with neuroimaging. J Clin Oncol 2012; 31:e9-11. [PMID: 23169522 DOI: 10.1200/jco.2012.41.6115] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Shinsato Y, Hanada T, Kisanuki T, Yonezawa H, Yunoue S, Yoshioka T, Hanaya R, Tokimura H, Hirano H, Arita K. Primary malignant melanoma in the pineal region treated without chemotherapy. Surg Neurol Int 2012; 3:123. [PMID: 23226609 PMCID: PMC3512338 DOI: 10.4103/2152-7806.102348] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 08/28/2012] [Indexed: 11/18/2022] Open
Abstract
Background: Primary pineal malignant melanomas are uncommon intracranial tumor. Here we discuss and review a case of primary pineal malignant melanoma over its feature of imaging studies, pathological findings, and management. Case Description: A 49-year-old woman receiving renal dialysis underwent computed tomography due to a 4-month history of tinnitus and hearing disturbance. A high-density 35-mm diameter tumor was detected in the pineal region; there was obstructive hydrocephalus. The tumor was heterogeneously hyperintense on T1-weighted magnetic resonance images, iso- and low-mixed intense on T2-weighted images with hemorrhagic components, and very low-intense on T2* images. A tumor was subtotally removed via the occipital transtentorial approach. Histologically, it consisted of densely proliferated spindle-shaped or polygonal cells with rich cytoplasmic melanin. The neoplastic cells manifested cellular pleomorphism, nuclear atypia, and mitosis (3/10 high-power fields) and were immunopositive for HMB45, Melan-A, and S100 protein. The MIB-1 index was 17.4%. Whole-body 18-fluoro-deoxyglucose positron emission tomography did not demonstrate any sites with hyper uptake. Examination of the skin and mucosa identified no lesions suggestive of melanoma. She underwent treatment with the whole brain and extended local boost irradiation. Chemotherapy was not delivered due to renal failure. Follow-up imaging studies showed no recurrence or distant lesions 56 weeks after surgery. Conclusion: We report a rare case of primary pineal malignant melanoma with prolonged survival of more than 56 weeks after subtotal tumor resection followed by whole-brain and extended local irradiation without chemotherapy. Radiotherapy without chemotherapy might be sufficient for the treatment of this tumor.
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Affiliation(s)
- Yoshinari Shinsato
- Department of Neurosurgery, Field of Oncology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
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Azimi P, Mohmmadi HR, Refiezadeh M. Primary pineal melanoma presenting with leptomeningeal spreading in a 22-year-old woman: a case report. J Med Case Rep 2012; 6:165. [PMID: 22738318 PMCID: PMC3423035 DOI: 10.1186/1752-1947-6-165] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Accepted: 02/23/2012] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Primary malignant melanoma of the pineal region is exceedingly rare. We report a case of primary pineal malignant melanoma and review the literature. CASE PRESENTATION Our patient was a 22-year-old Iranian woman without any significant past medical history, who was referred to our center with a four-week history of headache and gait disturbance. A magnetic resonance imaging study showed a solid mass in the pineal region causing obstructive hydrocephalus. A brain biopsy was performed and the histological examination indicated melanoma. No other additional melanocytic lesions were found elsewhere. Our patient underwent gross total resection. At the time of discharge she had fully recovered without any neurological deficits. Three weeks after discharge, she was readmitted to hospital with the diagnosis of distal deep vein thrombosis and pulmonary embolism; 12 weeks after the onset of her illness she died of cardiopulmonary arrest. CONCLUSION We have presented here a rare tumor, a primary malignant melanoma of the pineal region. To the best of our knowledge, this is the second-youngest patient with such a tumor reported in the literature.
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Affiliation(s)
- Parisa Azimi
- Department of Neurosurgery, University of Shahid Beheshti Medical Sciences, Imam Hossain Hospital, Shahid Madani Street, Tehran, PA 1617763141, Iran
| | - Hassan Reza Mohmmadi
- Department of Neurosurgery, University of Shahid Beheshti Medical Sciences, Imam Hossain Hospital, Shahid Madani Street, Tehran, PA 1617763141, Iran
| | - Mitra Refiezadeh
- Department of Pathology, University of Shahid Beheshti Medical Sciences, Imam Hossain Hospital, Shahid Madani Street, Tehran, PA 1617763141, Iran
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