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Pellerino A, Verdijk RM, Nichelli L, Andratschke NH, Idbaih A, Goldbrunner R. Primary Meningeal Melanocytic Tumors of the Central Nervous System: A Review from the Ultra-Rare Brain Tumors Task Force of the European Network for Rare Cancers (EURACAN). Cancers (Basel) 2024; 16:2508. [PMID: 39061148 PMCID: PMC11274408 DOI: 10.3390/cancers16142508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Revised: 07/04/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Primary meningeal melanocytic tumors are ultra-rare entities with distinct histological and molecular features compared with other melanocytic or pigmented lesions, such as brain and leptomeningeal metastases from metastatic melanoma. METHODS The European Network for Rare Cancers (EURACAN) Task Force on Ultra-Rare Brain Tumors (domain 10, subdomain 10) performed a literature review from January 1985 to December 2023 regarding the epidemiologic and clinical characteristics, histological and molecular features, radiological findings, and efficacy of local treatments (surgery and radiotherapy) and systemic treatments for these entities. RESULTS Molecular analysis can detect specific mutations, including GNAQ, GNA11, SF3B1, EIF1AX, BAP1, that are typically found in circumscribed primary meningeal melanocytic tumors and not in other melanocytic lesions, whereas NRAS and BRAF mutations are typical for diffuse primary meningeal melanocytic tumors. The neuroimaging of the whole neuroaxis suggests a melanocytic nature of a lesion, depicts its circumscribed or diffuse nature, but cannot predict the tumor's aggressiveness. Gross-total resection is the first choice in the case of circumscribed meningeal melanocytoma and melanoma; conversely, meningeal biopsy may be reserved for patients with diffuse and multinodular leptomeningeal spread to achieve a definitive diagnosis. High-dose radiotherapy is rarely indicated in diffuse melanocytic tumors except as palliative treatment to alleviate symptoms. Last, a definitive advantage of a specific systemic treatment could not be concluded, as most of the data available derive from case reports or small cohorts. CONCLUSIONS As primary meningeal melanocytic tumors are extremely rare, the correlations between the clinical characteristics, molecular profile, radiological findings at diagnosis and progression are weak, and poor evidence on the best therapeutic approach is available. There is a need to develop shared platforms and registries to capture more knowledge regarding these ultra-rare entities.
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Affiliation(s)
- Alessia Pellerino
- Division of Neuro-Oncology, Department of Neuroscience “Rita Levi Montalcini”, University and City of Health and Science Hospital, 10126 Torino, Italy
| | - Robert M. Verdijk
- Department of Pathology, Section Ophthalmic Pathology, Erasmus MC University Medical Center, 3015 Rotterdam, The Netherlands;
- Department of Pathology, Leiden University Medical Center, 2333 Leiden, The Netherlands
| | - Lucia Nichelli
- Department of Neuroradiology, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, 75013 Paris, France;
| | - Nicolaus H. Andratschke
- Department of Radiation Oncology, University of Zurich, University Hospital Zurich, 8091 Zurich, Switzerland;
| | - Ahmed Idbaih
- CNRS, Inserm, DMU Neurosciences, Service de Neuro-Oncologie-Institut de Neurologie, Sorbonne Université, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, F-75013 Paris, France;
| | - Roland Goldbrunner
- Center for Neurosurgery, Department of General Neurosurgery, University of Cologne, 50923 Cologne, Germany;
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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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Shahab SW, Patil P, Fangusaro JR, Patteson B, Goldman-Yassen A, Eaton BR, Boydston W, Schniederjan M, Aguilera D. Primary Diffuse Leptomeningeal Melanomatosis in a Child with Extracranial Metastasis: Case Report. Curr Oncol 2024; 31:579-587. [PMID: 38275834 PMCID: PMC10814890 DOI: 10.3390/curroncol31010041] [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: 12/20/2023] [Revised: 01/14/2024] [Accepted: 01/19/2024] [Indexed: 01/27/2024] Open
Abstract
Primary meningeal melanomatosis is an extremely rare tumor with very few documented responses to treatment. A 3-year-old male with a complex past medical history, including prematurity and shunted hydrocephalus, was diagnosed with primary meningeal melanomatosis with peritoneal implants. Molecular testing revealed an NRAS Q61R mutation. The patient received proton craniospinal radiation followed by immunotherapy with nivolumab (1 mg/kg) and ipilimumab (3 mg/kg) IV every 3 weeks and, upon progression, he was switched to a higher dose of nivolumab (3 mg/kg IV every 2 weeks) and binimetinib (24 mg/m2/dose, twice a day). The patient had significant improvement of CNS disease with radiation therapy and initial immunotherapy but progression of extracranial metastatic peritoneal and abdominal disease. Radiation was not administered to the whole abdomen. After two cycles of nivolumab and treatment with the MEK inhibitor binimetinib, he had radiographic and clinical improvement in abdominal metastasis and ascitis. He ultimately died from RSV infection, Klebsiella sepsis, and subdural hemorrhage without evidence of tumor progression. This is the first report of a child with primary meningeal melanomatosis with extracranial metastatic disease with response to a combination of radiation, immunotherapy and MEK inhibitor therapy.
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Affiliation(s)
- Shubin W. Shahab
- Aflac Cancer and Blood Disorders Center, Atlanta, GA 30342, USA; (J.R.F.); (B.P.); (D.A.)
- Children’s Healthcare of Atlanta, Atlanta, GA 30322, USA; (P.P.); (A.G.-Y.); (B.R.E.); (W.B.); (M.S.)
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA
- Winship Cancer Institute, Atlanta, GA 30322, USA
| | - Prabhumallikarjun Patil
- Children’s Healthcare of Atlanta, Atlanta, GA 30322, USA; (P.P.); (A.G.-Y.); (B.R.E.); (W.B.); (M.S.)
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Jason R. Fangusaro
- Aflac Cancer and Blood Disorders Center, Atlanta, GA 30342, USA; (J.R.F.); (B.P.); (D.A.)
- Children’s Healthcare of Atlanta, Atlanta, GA 30322, USA; (P.P.); (A.G.-Y.); (B.R.E.); (W.B.); (M.S.)
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA
- Winship Cancer Institute, Atlanta, GA 30322, USA
| | - Brooke Patteson
- Aflac Cancer and Blood Disorders Center, Atlanta, GA 30342, USA; (J.R.F.); (B.P.); (D.A.)
- Children’s Healthcare of Atlanta, Atlanta, GA 30322, USA; (P.P.); (A.G.-Y.); (B.R.E.); (W.B.); (M.S.)
| | - Adam Goldman-Yassen
- Children’s Healthcare of Atlanta, Atlanta, GA 30322, USA; (P.P.); (A.G.-Y.); (B.R.E.); (W.B.); (M.S.)
- Department of Radiology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Bree R. Eaton
- Children’s Healthcare of Atlanta, Atlanta, GA 30322, USA; (P.P.); (A.G.-Y.); (B.R.E.); (W.B.); (M.S.)
- Winship Cancer Institute, Atlanta, GA 30322, USA
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - William Boydston
- Children’s Healthcare of Atlanta, Atlanta, GA 30322, USA; (P.P.); (A.G.-Y.); (B.R.E.); (W.B.); (M.S.)
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Matthew Schniederjan
- Children’s Healthcare of Atlanta, Atlanta, GA 30322, USA; (P.P.); (A.G.-Y.); (B.R.E.); (W.B.); (M.S.)
- Department of Pathology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Dolly Aguilera
- Aflac Cancer and Blood Disorders Center, Atlanta, GA 30342, USA; (J.R.F.); (B.P.); (D.A.)
- Children’s Healthcare of Atlanta, Atlanta, GA 30322, USA; (P.P.); (A.G.-Y.); (B.R.E.); (W.B.); (M.S.)
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA
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Zeng Y, Zhang Y, Zhang J, Jian W, Li R, Fu Q. Atypical primary malignant melanoma originating in the spinal canal: A case report and literature review. Oncol Lett 2023; 26:433. [PMID: 37664668 PMCID: PMC10472031 DOI: 10.3892/ol.2023.14020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/27/2023] [Indexed: 09/05/2023] Open
Abstract
Central nervous system (CNS) malignant melanomas are rare tumors of the CNS that are thought to arise from aberrant changes in melanocytes of the neural crest or melanocytic elements of the pia mater during early embryonic development. As a rare type of CNS malignant melanoma, only a few cases of primary malignant melanoma in the spinal canal have been reported thus far. The majority of these studies have reported on the diagnosis, radiographic features and gross total resection of primary spinal canal malignant melanoma; however, the prognosis and ideal treatment of patients with residual tumors remain elusive. The current study presented the rare case of a patient with primary malignant melanoma originating from the thoracic spinal canal, without any history of irradiation exposure and with an incompletely resected tumor. Disease-free survival of >2.5 years was observed in this patient who was treated with concurrent chemoradiotherapy followed by adjuvant chemotherapy with temozolomide and bevacizumab.
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Affiliation(s)
- Ying Zeng
- Department of Radiation Oncology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China
| | - Yong Zhang
- Department of Radiation Oncology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China
| | - Jing Zhang
- Department of Radiation Oncology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China
| | - Wei Jian
- Department of Radiation Oncology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China
| | - Rongqing Li
- Department of Radiation Oncology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China
| | - Qiaofen Fu
- Department of Radiation Oncology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China
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Wong TF, Chen YS, Zhang XH, Hu WM, Zhang XS, Lv YC, Huang DC, Deng ML, Chen ZP. Longest survival with primary intracranial malignant melanoma: A case report and literature review. World J Clin Cases 2022; 10:11162-11171. [PMID: 36338197 PMCID: PMC9631140 DOI: 10.12998/wjcc.v10.i30.11162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 08/10/2022] [Accepted: 09/08/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Primary intracranial malignant melanoma (PIMM) is rare, and its prognosis is very poor. It is not clear what systematic treatment strategy can achieve long-term survival. This case study attempted to identify the optimal strategy for long-term survival outcomes by reviewing the PIMM patient with the longest survival following comprehensive treatment and by reviewing the related literature.
CASE SUMMARY The patient is a 47-year-old Chinese man who suffered from dizziness and gait disturbance. He underwent surgery for right cerebellum melanoma and was subsequently diagnosed by pathology in June 2000. After the surgery, the patient received three cycles of chemotherapy but relapsed locally within 4 mo. Following the second surgery for total tumor resection, the patient received an injection of Newcastle disease virus-modified tumor vaccine, interferon, and β-elemene treatment. The patient was tumor-free with a normal life for 21 years before the onset of the recurrence of melanoma without any symptoms in July 2021. A third gross-total resection with adjuvant radiotherapy and temozolomide therapy was performed. Brain magnetic resonance imaging showed no residual tumor or recurrence 3 mo after the 3rd operation, and the patient recovered well without neurological dysfunction until the last follow-up in June 2022, which was 22 years following the initial treatment.
CONCLUSION It is important for patients with PIMM to receive comprehensive treatment to enable the application of the most appropriate treatment strategies. Long-term survival is not impossible in patients with these malignancies.
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Affiliation(s)
- Tang-Fai Wong
- Department of Neurosurgery, Macao Kiang Wu Hospital, Macao 999078, Sichuan Province, China
- Department of Neurosurgery/Neuro-Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
| | - Yin-Sheng Chen
- Department of Neurosurgery/Neuro-Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
| | - Xiang-Heng Zhang
- Department of Neurosurgery/Neuro-Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
| | - Wan-Ming Hu
- Department of Pathology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
| | - Xiao-Shi Zhang
- Department of Biotherapy, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
| | - Yan-Chun Lv
- Department of Medical Imaging, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, Guangdong Province, China
| | - Dong-Cun Huang
- Department of Medical Imaging, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, Guangdong Province, China
| | - Mei-Ling Deng
- Department of Radiotherapy, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
| | - Zhong-Ping Chen
- Department of Neurosurgery/Neuro-Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
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Huang YM, Yeh KY, Chen PY, Hsieh TY, Hsu LS, Wu CE, Yang CH, Zheng YC. Primary intracranial malignant melanomas in solitary type: a tertiary center experience. J Clin Neurosci 2022; 101:37-46. [PMID: 35526362 DOI: 10.1016/j.jocn.2022.03.037] [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: 08/06/2021] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE Solitary type primary intracranial malignant melanoma (PIMM) is extremely rare but fatal. The optimal treatment algorithm according to clinical relevance of symptoms and outcomes is unclear. This series emphasized the prognostic factors of solitary PIMM and established the treatment algorithm for this rare disease. METHODS Patients with solitary PIMMs were pathologically verified and treated with neurosurgical tumor resection. All solitary PIMMs recruited at our institute received multidisciplinary team care. We analyzed the clinical findings and prognostic factors. RESULTS The study cohort included 10 patients. PIMMs in solitary type impacted middle-aged populations with male predominance in Taiwan. Most patients (80%) presented a single tumor initially. Six patients had progressed to multiplicity after the initial treatment. Rates of tumor bleeding and leptomeningeal metastasis seeding (LS) are high in solitary PIMMs. Patients who had gross-total resection (GTR) had better survival than those who had incomplete resection, with median overall survival (OS) rates of 170.4 months vs. 5.23 months (p = 0.004). Multiplicity, eloquent area involvement, initial tumor bleeding, LS, hydrocephalus, and Karnofsky Performance Score < 80 at diagnosis were associated with negative outcomes in progression-free survival and OS. Adjuvant radiotherapy for patients who had LS and for those who cannot undergo grossly total tumor removal resulted in a good outcome. CONCLUSIONS GTR demonstrated better outcomes for solitary PIMM. For recurrent tumors, aggressively repeated surgical resection remained beneficial for selected cases. Adjuvant radiotherapy was a treatment option for LS following operation. We proposed a possible treatment algorithm for solitary PIMM.
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Affiliation(s)
- Yen-Min Huang
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.
| | - Kun-Yun Yeh
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan.
| | - Pin-Yuan Chen
- Departments of Neurosurgery, Chang Gung Memorial Hospital, Keelung and Linkou & Chang Gung University, Taiwan.
| | - Tsan-Yu Hsieh
- Department of Pathology, Chang Gung Memorial Hospital, Keelung, Taiwan.
| | - Li-Sung Hsu
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.
| | - Chiao-En Wu
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan.
| | - Cheng-Han Yang
- Departments of Anatomic Pathology, Chang Gung Memorial Hospital at Linkou.
| | - Yun-Cong Zheng
- Departments of Neurosurgery, Chang Gung Memorial Hospital, Keelung and Linkou & Chang Gung University, Taiwan.
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Shi YF, Chen YQ, Chen HF, Hu X. An atypical primary malignant melanoma arising from the cervical nerve root: A case report and review of literture. World J Clin Cases 2022; 10:381-387. [PMID: 35071542 PMCID: PMC8727269 DOI: 10.12998/wjcc.v10.i1.381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 10/29/2021] [Accepted: 11/30/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Primary melanomas affecting the central nervous system are very rare, and melanomas originating in the spinal canal or origin of the spinal nerve root are even rarer. As a consequence, not much is known about this.
CASE SUMMARY Here we report a case of primary malignant melanoma originating in the cervical spinal cord nerve root. A 64-year-old woman presented with symptoms of numbness in the right side of the neck, pain, and hypoesthesia in the right upper limb which persisted for 1 year. Neurological examination showed that the superficial sensation in the right upper limb had decreased with muscle strength of grade 4. Magnetic resonance imaging examination revealed a mass (approximately 2.5 cm × 1.4 cm × 1 cm) in the right side of the spinal canal in the C-2 plane. Based on findings obtained during operation, perioperative examination, pathological diagnosis, and the diagnostic criteria of primary central melanoma proposed by Hayward, the mass was confirmed to be a melanoma of intraspinal nerve root origin.
CONCLUSION This is the first case of primary malignant melanoma originating from cervical spinal cord nerve roots and spread along the inside and outside of the spinal canal. The clinical relevance of this case is discussed to provide new insights into the differential diagnosis of intraspinal tumours. Further studies are needed to better understand the mechanisms driving the growth pattern and development of this type of tumour.
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Affiliation(s)
- Yi-Feng Shi
- Department of Neurosurgery, West China Hospital, Chengdu 610041, Sichuan Province, China
| | - Yu-Qi Chen
- Department of Neurosurgery, West China Hospital, Chengdu 610041, Sichuan Province, China
| | - Hai-Feng Chen
- Department of Neurosurgery, West China Hospital, Chengdu 610041, Sichuan Province, China
| | - Xin Hu
- Department of Neurosurgery, West China Hospital, Chengdu 610041, Sichuan Province, China
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Jitpakdee K, Kotheeranurak V, Lim WJ, Kim JS. Anterior Transcorporeal Approach for Cervical Metastatic Melanoma Resection Guided by O-Arm-Navigated Intraoperative Computed Tomography. Oper Neurosurg (Hagerstown) 2022; 22:e7-e11. [PMID: 34982904 DOI: 10.1227/ons.0000000000000014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/24/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Surgical resection of the ventrally located tumor in the cervical spinal region is technically challenging and usually requires a traditional extensive approach. To reduce collateral injury and preserve cervical stability, the anterior transcorporeal approach under navigated guidance is an alternative minimally invasive technique. OBJECTIVE To describe a minimally invasive transcorporeal approach for cervical intradural extramedullary tumor resection and spinal cord decompression. Previous literature regarding available treatment options was reviewed. METHODS A patient with known intracranial malignant melanoma presented with severe myelopathy from metastatic melanoma compressing the cervical cord. The anterior transcorporeal approach for total tumor resection and spinal cord decompression under a microscope was planned. Under spinal navigation, small bone tunneling was performed to expose and remove the tumor without compromising cervical stability. RESULTS The melanoma resection was successfully performed without complications. Myelopathic symptoms were significantly improved with the absence of instability or local recurrence at the long-term follow-up. CONCLUSION We present the anterior transcorporeal approach that can be used to resect the tumor in the ventral cervical region and effectively decompress the cervical cord without complications. Moreover, this approach is the minimally invasive surgical technique that preserves spinal stability, minimizes bleeding, and shortens the hospital stay.
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Affiliation(s)
- Khanathip Jitpakdee
- Department of Orthopedics, Queen Savang Vadhana Memorial Hospital, Si Racha, Thailand
| | - Vit Kotheeranurak
- Department of Orthopedics, Queen Savang Vadhana Memorial Hospital, Si Racha, Thailand
| | - Woo Jung Lim
- Spine Center, Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jin-Sung Kim
- Spine Center, Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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Intracranial malignant melanoma: An egyptian institute experience. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Tuz Zahra F, Ajmal Z, Qian J, Wrzesinski S. Primary Intramedullary Spinal Melanoma: A Rare Disease of the Spinal Cord. Cureus 2021; 13:e16194. [PMID: 34367798 PMCID: PMC8336382 DOI: 10.7759/cureus.16194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2021] [Indexed: 01/18/2023] Open
Abstract
Primary malignant melanoma of the intramedullary region of the spinal cord has rarely been reported in the literature. These tumors can have variable appearance on magnetic resonance imaging (MRI) due to different extents of melanin and hemorrhage. Histopathologic confirmation and a comprehensive workup to rule out extra-spinal melanoma are required to make definitive diagnosis. We present a case of a patient diagnosed with primary intramedullary spinal melanoma in his lower thoracic spinal cord who was effectively treated with surgical resection, adjuvant radiation, and adjuvant immunotherapy. Gross total resection (GTR) is most vital in the management of this spinal tumor. Although several studies have established the efficacy of immunotherapy agents in advanced malignant melanoma, the use of these agents has not been studied in primary central nervous system melanomas. This case provides insight into the diagnostic approach and treatment options for this unique malignancy.
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Affiliation(s)
| | - Zainub Ajmal
- Internal Medicine, Albany Medical Center, Albany, USA
| | - Jiang Qian
- Pathology, Albany Medical Center, Albany, USA
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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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Wang Y, Ren S, Gong X, Wang J, Zhu N, Cai D, Ruan J. Prognostic factors for postoperative survival in melanoma patients with bone metastasis. Medicine (Baltimore) 2021; 100:e24558. [PMID: 33530285 PMCID: PMC7850704 DOI: 10.1097/md.0000000000024558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 01/12/2021] [Indexed: 01/05/2023] Open
Abstract
Melanoma can spread to the bone by metastasis and is relevant to a poor outcome. However, because of the rarity of melanoma patients with bone metastasis, the prognostic postoperative survival factors of them have not been elucidated. The aim of this special population-based cohort was to elucidate the prognostic factors associated with postoperative survival. The Surveillance, Epidemiology, and End Results database was used to extract postoperative survival data relating to patients with melanoma and bone metastasis at diagnosis between 2010 and 2016, along with data on a range of potential postoperative prognostic factors. We then investigated the potential postoperative prognostic roles of these factors using a Cox regression model and the Kaplan-Meier analysis. In all, the Surveillance, Epidemiology, and End Results database included 186 cases. Regarding overall survival, the 1-, 3-, and 5-year overall survival rates for the entire cohort were 36.2%, 15.4%, and 9.5%, respectively. Regarding cancer-specific survival, the 1-, 3-, and 5-year cancer-specific survival rates were 42.0%, 23.2%, and 16.6%, respectively. Within a cohort of melanoma patients with bone metastasis after surgery, our analysis showed that a smaller tumor size and the lack of metastases at other sites were predictors of survival.
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Affiliation(s)
- Yucheng Wang
- Department of Orthopedics, Taizhou University Affiliated Municipal Hospital, Taizhou, Zhejiang
- Hebei North University, Zhangjiakou, Hebei
| | - Shihong Ren
- Department of Orthopedics, The First People's Hospital of Wenling, Taizhou, Zhejiang, China
| | - Xiaokang Gong
- Department of Orthopedics, Taizhou University Affiliated Municipal Hospital, Taizhou, Zhejiang
| | - Jiacheng Wang
- Department of Orthopedics, Taizhou University Affiliated Municipal Hospital, Taizhou, Zhejiang
| | - Ning Zhu
- Department of Orthopedics, Taizhou University Affiliated Municipal Hospital, Taizhou, Zhejiang
| | | | - Jianwei Ruan
- Department of Orthopedics, Taizhou University Affiliated Municipal Hospital, Taizhou, Zhejiang
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Lyu L, Zou L, Jiang Y, Ding H, Chen C, Ye F, Hu Y, Yin S, Zhou P, Jiang S. Clinical characteristics and treatment outcomes of pigmented tumors in central nervous system: Focusing on melanocytic tumors. J Clin Neurosci 2020; 81:83-89. [PMID: 33222976 DOI: 10.1016/j.jocn.2020.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/05/2020] [Accepted: 09/06/2020] [Indexed: 02/08/2023]
Abstract
Pigmented tumors are rare neoplasm of central nervous system. Melanocytic tumor, including primary and metastatic lesions, is the most common type. Owing to the rarity, the differential diagnosis of pigmented tumors and clinical management of melanocytic tumor remain challenge. Therefore, focusing on melanocytic tumors, the clinical, radiological, histopathological features and treatment outcomes were presented and analyzed in this study. We identified 22 melanocytic tumors, 2 melanotic medulloblastomas, 2 melanotic ependymomas and 1 melanotic schwannoma. Compared with metastatic melanocytic tumors (MMTs), primary melanocytic tumors (PMTs) were characterized by younger age (36.11 ± 17.96 vs. 51.69 ± 12.58 years, p = 0.0262), lower possibility to be multiple lesions (11.1%vs. 61.5%, p = 0.0306), higher proportion of hypointensity on T2-weighted images (66.7% vs. 15.4%, p = 0.0260) and higher frequency in black appearance (77.8% vs. 23.1%, p = 0.0247). During the follow-up, 4 PMTs and 11 MMTs (71.4%) experienced tumor progression. PMTs had better prognosis than MMTs that progression-free survival (PFS) rate of PMT was 50.0% but decreased to 23.1% for MMTs at 12 months (p = 0.0123). Cox proportional hazards regression revealed that multiplicity of tumor was an independent predictor for PFS. None of patient with multiple tumors was in PFS after 12 months' follow-up whereas PFS rate was 40.5% for single tumor (p = 0.0002). In conclusion, radiological appearances, especially hypointensity on T2-weighted images, might be an indication for PMT. MMTs are more likely to be multiple intraparenchymal masses in elder patients located in supratentorial region. Current treatments included operation, radiotherapy and chemotherapy are not competent to control tumor progression and other therapeutic modalities are urgently needed.
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Affiliation(s)
- Liang Lyu
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, China
| | - Linbo Zou
- Department of Neurosurgery, People's Hospital of Deyang City, Deyang, China
| | - Yong Jiang
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, China
| | - Hao Ding
- Department of Neurosurgery, Fourth People's Hospital of Zigong, Zigong, China
| | - Cheng Chen
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, China
| | - Feng Ye
- Department of Neurosurgery, People's Hospital of Deyang City, Deyang, China
| | - Yu Hu
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, China
| | - Senlin Yin
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, China
| | - Peizhi Zhou
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, China.
| | - Shu Jiang
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, China.
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Grosshans HK, Huttner AJ, Piepmeier JM, Kaulen LD, Fulbright RK, Baehring JM, Karschnia P. Primary melanotic tumors of the nervous system: a consecutive case series. Eur J Neurol 2020; 27:2303-2307. [PMID: 32654331 DOI: 10.1111/ene.14437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/07/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Primary melanotic tumors of the nervous system (PMTNS) are thought to be an exceedingly rare group of tumors not captured by tumor registries. We aimed to determine relative incidence, clinical presentation, diagnostic findings, patient management, and outcome. METHODS We retrospectively searched the database of the Section of Neuro-Oncology at the Yale Cancer Center for patients with primary or metastatic melanotic lesions of the nervous system. For patients with PMTNS, we recorded demographic data, clinical presentation, histopathological and imaging findings, therapy, and outcome. RESULTS A total of 116 patients with melanotic lesions were identified, including four patients with PMTNS. The relative incidence of PMTNS was therefore calculated as 3.4%. Histology of PMTNS patients revealed melanocytoma in three patients and psammomatous melanotic schwannoma in one patient. Symptoms were non-specific and attributed to tumor mass effect. Magnetic resonance imaging showed hyperintensity on pre-contrast T1-weighted imaging, hypointensity on T2-weighted imaging, and homogenous contrast enhancement in all PMTNS patients. Definitive diagnosis was based on tissue analysis, with detection of melanin-containing cells on conventional histology and S100-positivity on immunohistochemistry. Molecular analysis for GNAQQ209L mutation assisted in establishing diagnosis when only small amounts of tissue were available. Aggressive surgical treatment showed favorable outcomes in all cases; radiation therapy was used for residual or relapsed disease. The median follow-up was 7.5 ± 5 years, and all patients were alive on the day of database closure. CONCLUSION Primary melanotic tumors of the nervous system are rare nervous system tumors. Outcome appears excellent, and complete surgical resection may form the basis for favorable outcome. Radiation therapy may represent a therapeutic approach for residual or relapsed disease.
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Affiliation(s)
- H K Grosshans
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - A J Huttner
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - J M Piepmeier
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
| | - L D Kaulen
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA.,Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - R K Fulbright
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - J M Baehring
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA.,Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
| | - P Karschnia
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA.,Department of Neurosurgery, Ludwig-Maximilians-University (LMU), Munich, Germany
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Zhu L, Wang Y, Yang C, Li Y, Zheng Z, Wu L, Zhou H. Long non-coding RNA MIAT promotes the growth of melanoma via targeting miR-150. Hum Cell 2020; 33:819-829. [PMID: 32300960 DOI: 10.1007/s13577-020-00340-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 02/26/2020] [Indexed: 02/06/2023]
Abstract
Melanoma is a common skin cancer and it can lead to high mortality probably by early invasion and metastasis. LncRNA MIAT is involved in tumor proliferation, invasion and epithelial-to-mesenchymal transition (EMT). However, the roles of MIAT in melanoma still require further investigation. Thus, the aim of the study is to investigate the roles of MIAT in melanoma, especially the effects of MIAT on EMT of melanoma cancer cells. The results showed that the expression of MIAT was significantly upregulated in melanoma tissue and cells compared with the normal skin and normal melanocytes; moreover, miR-150 was confirmed as a target of MIAT. Furthermore, knockdown of MIAT inhibited cell proliferation and invasion in melanoma cancer cells and transfection of miR-150 inhibitors partial abrogated the anti-tumor effects of MIAT siRNA. In addition, MIAT siRNA also inhibited the EMT of melanoma cells, while miR-150 inhibitors can reverse the effects of MIAT siRNA. Finally, knockdown of MIAT also inhibited the carcinogenic effects of melanoma in vivo by targeting miR-150. In conclusion, we reported that MIAT promotes the proliferation, invasion and EMT of melanoma cells via targeting miR-150, which suggested that MIAT might be a therapeutic target for the treatment of melanoma.
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Affiliation(s)
- Lifei Zhu
- Department of Dermatology, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510655, China
| | - Yexiao Wang
- Department of Dermatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China
| | - Chaoying Yang
- Department of Dermatology, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510655, China
| | - Yanchang Li
- Department of Dermatology, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510655, China
| | - Zhixin Zheng
- Department of Dermatology, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510655, China
| | - Liangcai Wu
- Department of Dermatology, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510655, China.
| | - Hui Zhou
- Department of Dermatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China.
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