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Rades D, Zemskova O, Gliemroth J, Yu NY. The Role of Radiotherapy for Meningeal Melanocytomas - A 20 Year Update. In Vivo 2024; 38:1220-1228. [PMID: 38688652 PMCID: PMC11059860 DOI: 10.21873/invivo.13558] [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: 12/21/2023] [Revised: 02/13/2024] [Accepted: 02/20/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND/AIM Meningeal melanocytomas are rare tumors of the central nervous system and optimal treatment needs further clarification. This study compared subtotal resection (STR), STR plus radiation therapy (RT), gross total resection (GTR), and GTR+RT to better define the role of postoperative RT. PATIENTS AND METHODS All cases reported in the literature were reviewed. Patients (n=184) with complete data were analyzed for local control (LC) and overall survival (OS). RESULTS On univariate analysis, GTR (vs. STR) was associated with improved LC (p=0.016). When comparing the treatment regimens, best and worst results were found after GTR+RT and STR alone, respectively (p<0.001). On univariate analysis, GTR resulted in better OS than STR (p=0.041). Moreover, the treatment regimen had a significant impact on OS (p=0.049). On multivariate analyses of LC and OS, extent of resection and treatment regimen were found to be significant factors. After STR, RT significantly improved LC but not OS. After GTR, RT did not significantly improve LC or OS. CONCLUSION GTR was significantly superior to STR regarding LC and OS. STR+RT resulted in significantly better LC when compared to STR alone.
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Affiliation(s)
- Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany;
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Oksana Zemskova
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
- Department of Radioneurosurgery, Romodanov Neurosurgery Institute, Kyiv, Ukraine
| | - Jan Gliemroth
- Department of Neurosurgery, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Nathan Y Yu
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, U.S.A
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Parwez R, Ahmed R, Baig A, Ruiz F, Baig Mirza A, Sadek AR, Arvin B, Qureshi A. Intradural extramedullary meningeal melanocytoma: a case report and literature review. J Surg Case Rep 2023; 2023:rjad002. [PMID: 36727122 PMCID: PMC9880139 DOI: 10.1093/jscr/rjad002] [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: 11/27/2022] [Accepted: 01/02/2023] [Indexed: 01/28/2023] Open
Abstract
Primary meningeal melanocytomas are extremely rare, benign tumours arising from the leptomeninges. While they are considered to be benign lesions, there is potential for their growth and transformation into malignant melanomas. They are commonly found in the cervical spine, with a decreased incidence in the thoracic and lumbar regions. We present a case report of a 56-year-old man who presented to our unit with a 4-month history of lower limb weakness and a sensory level at T6. Magnetic resonance imaging shows an intradural extramedullary tumour. The patient underwent a thoracic debulking of the lesion with neurophysiological monitoring. Histopathology confirmed the diagnosis of melanocytoma of meningeal origin, with a low mitotic count. Our patient recovered well post-operatively with no complications. Surgical resection is an effective method to manage this tumour; however, adjuvant radiotherapy is advised due to the risk of recurrence and malignant transformation.
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Affiliation(s)
| | - Razna Ahmed
- Correspondence address. GKT School of Medical Education, King’s College London, Great Maze Pond, London SE1 1UL, UK. E-mail:
| | - Arsalan Baig
- Department of Neurosurgery, Queens Hospital Romford, London, UK
| | - Fernanda Ruiz
- Department of Neuropathology, UCL Institute of Neurology, London, UK
| | | | | | - Babak Arvin
- Department of Neurosurgery, Queens Hospital Romford, London, UK
| | - Anjum Qureshi
- Department of Neurosurgery, Queens Hospital Romford, London, UK
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Filho PMM, Martini L, Saltiel R, Schwingel D, Pastorello J. Melanoma Originating from the Dura-Mater: A Case Report and Review of the Literature. CURRENT HEALTH SCIENCES JOURNAL 2023; 49:110-114. [PMID: 37786767 PMCID: PMC10541514 DOI: 10.12865/chsj.49.01.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 12/12/2022] [Indexed: 10/04/2023]
Abstract
Melanomas originating from the dura-mater are extremely rare tumors. The diagnosis is complex, and usually only made after excluding other entities. The prognosis is poor, with average free-disease survival of 20 months, after treatment with complete surgical excision and adjuvant therapy. We report the case of a 41-year-old asymptomatic patient, presenting with a subcutaneous mass in the left parieto-occipital region, later diagnosed as a primary dura mater melanoma. Treatment included complete microsurgical excision, radiotherapy and adjuvant immunotherapy. Therefore, due to the rare nature of the disease and its high lethality, correct diagnosis and treatment are medical challenges.
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Affiliation(s)
| | - Laura Martini
- Neurosurgery Department, Hospital de Clínicas de Passo Fundo, Passo Fundo, Brazil
| | - Renan Saltiel
- Neurosurgery Department, Hospital de Clínicas de Passo Fundo, Passo Fundo, Brazil
| | - Daniela Schwingel
- Pathology Institute of Passo Fundo Department, Hospital de Clínicas de Passo Fundo, Brazil
| | - Júlia Pastorello
- Oncology Department, Hospital de Clínicas de Passo Fundo, Passo Fundo, Brazil
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How Should We Treat Meningeal Melanocytoma? A Retrospective Analysis of Potential Treatment Strategies. Cancers (Basel) 2022; 14:cancers14235851. [PMID: 36497333 PMCID: PMC9738837 DOI: 10.3390/cancers14235851] [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: 10/03/2022] [Revised: 11/11/2022] [Accepted: 11/20/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Meningeal melanocytomas (MM) are rare primary melanocytic tumors of the leptomeninges with an incidence of 1:10,000,000. Until now, there has been only sparse information about this tumor entity. Here, we provide a meta-analysis of all cases published in the English language since 1972. METHODS A literature review was performed using PubMed and Web of Science. All published cases were evaluated for location, sex, age, therapeutic approach, and outcome. In total, we included 201 patient cases in our meta-analysis. RESULTS The majority of MM was diagnosed more frequently in men between the third and fifth decade of life. Surgery is the preferred therapeutic approach, and total resection is associated with the best outcome. Patients with partial resection or tumor recurrence benefit from adjuvant radiotherapy, whereas chemo- or immunotherapies do not improve the disease course. Malignant transformation was described in 18 patients. Of these, 11 patients developed metastasis. CONCLUSIONS We present the first retrospective meta-analysis of all MM cases published in the English language, including an evaluation of different treatment strategies allowing us to suggest a novel treatment guideline highlighting the importance of total resection for recurrence-free survival and characterizing those cases which benefit from adjuvant radiotherapy.
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Akgun MY, Isler C, Ulu MO. C6-T1 Intradural Extramedullary Ventral Meningeal Melanocytoma Resected Via Anterior Corpectomy with Reconstruction. World Neurosurg 2020; 138:457-460. [PMID: 32251820 DOI: 10.1016/j.wneu.2020.03.122] [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: 01/25/2020] [Revised: 03/19/2020] [Accepted: 03/20/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Melanocytic lesions of the nervous system are thought to arise from leptomeningeal melanocytes, which are derived from neural crest and include diffuse melanocytosis, melanocytomas, and malignant melanomas. Meningeal melanocytomas are extremely rare benign lesions. The usual treatment of intradural extramedullary melanocytomas involves surgical removal through a posterior approach using a laminectomy or laminotomy. CASE DESCRIPTION We present a 30-year-old female harboring a C6-T1 ventrally located intradural extramedullary lesion compressing the cord anteriorly. The lesion was totally resected via an anterior approach with oblique corpectomy even if the usual treatment involves surgical removal through a posterior approach using a laminectomy or laminotomy. CONCLUSIONS There is no evidence of recurrence at 4-year follow-up records of the patient. We discuss the surgical approach of these rare lesions.
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Affiliation(s)
- Mehmet Yigit Akgun
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Neurosurgery, Istanbul, Turkey.
| | - Cihan Isler
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Neurosurgery, Istanbul, Turkey
| | - Mustafa Onur Ulu
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Neurosurgery, Istanbul, Turkey
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Salah El-Din AM, Aboul-Ela HM, Alsawy MF, Koheil A, Ashry AH. Spinal meningeal melanocytoma in a 5-year-old child: a case report and review of literature. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2018; 54:13. [PMID: 29780233 PMCID: PMC5956056 DOI: 10.1186/s41983-018-0017-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 04/17/2018] [Indexed: 12/12/2022] Open
Abstract
Background Meningeal melanocytoma is considered a rare lesion arising from leptomeningeal melanocytes. Nearly two thirds of meningeal melanocytomas were reported in the intracranial compartment and the remaining one third in the spine. Spinal melanocytomas can be extradural or intradural, with extradural variant being more common, and the majority of cases have been single reports. Methods A 5-year-old male presented with a 4-month history of non-radiating low back pain persistent at rest, with otherwise non-remarkable medical history. The patient was neurologically intact with no deficits. Preoperatively, routine laboratory investigations were non-remarkable. MRI imaging was done and showed a lesion at the level of T11 to L4, hyperintense on T1 and hypointense on T2 with homogenous contrast enhancement. Intraoperatively, the lesion was hemorrhagic, brownish, and rubbery in consistency attached to the ventral dura. Microscopic picture revealed dense cytoplasmic brown melanin pigments, with no significant mitoses or nuclear atypia. What is unique about our case is the age of the patient (5 years). Results To the best of our knowledge, after reviewing the literature, this is the youngest case to be reported. Conclusions SMM is an extremely rare tumor with a benign course. Complete surgical excision should be attempted. Age of presentation may be as young as in our case and the diagnosis of such a tumor should never be excluded in this early age group with persistent low back ache.
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Affiliation(s)
| | - Hashem M Aboul-Ela
- 1Neurosurgery Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed F Alsawy
- 1Neurosurgery Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Koheil
- 2Neurosurgery Department, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Ahmed H Ashry
- 1Neurosurgery Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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Intermediate-grade meningeal melanocytoma associated with nevus of Ota: a case report and review of the literature. Melanoma Res 2015; 25:273-8. [PMID: 25933209 DOI: 10.1097/cmr.0000000000000163] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Meningeal melanocytomas are rare melanin-producing tumors that are often found to be benign. However, a small subset of these tumors can present as intermediate-grade melanocytomas (IGMs) that have histopathological features that are between those of benign melanocytomas and malignant melanomas. IGMs have the potential to recur and metastasize or progress to a more histologically high grade melanoma. Melanocytomas appear to differ from primary and metastatic melanoma by their prolonged clinical course and they appear to have different driver mutations (i.e. mutation of GNAQ gene). The association of a meningeal melanocytoma with nevus of Ota is extremely rare. To our knowledge, there have been only 10 reported cases of synchronous occurrence and only one of the cases involved an IGM. We report the second case of intermediate-grade meningeal melanocytoma that is associated with congenital nevus of Ota. Histopathological work-up confirmed the intermediate grade of the lesion and a driver GNAQ mutation was identified consistent with previous reports.
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Coulibaly B, Bouvier C, Paula AMD, Fernandez C, Dufour H, Figarella-Branger D. [Pituitary melanocytoma mimicking an adenoma]. Ann Pathol 2011; 31:50-2. [PMID: 21349390 DOI: 10.1016/j.annpat.2010.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2009] [Indexed: 11/16/2022]
Abstract
A 62-year-old woman was referred for a pituitary tumour diagnosed because of a chronic asthenia and visual disorders. Cerebral MRI showed a pituitary tumour compressing the optic chiasm and enhanced after gadolinium injection. Biological findings showed panhypopituitarism and hyperprolactinemia. The diagnostic of pituitary macro-adenoma was performed and the patient was treated with hormone replacement therapy and dopaminergic agonist. Six months later, she presented visual disorders worsening leading to surgical excision. The diagnosis of pituitary melanocytoma was performed after anatomo-clinical confrontation. Post-operative radiation was done.
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Affiliation(s)
- Béma Coulibaly
- Service d'anatomie pathologique et de neuropathologie, CHU de Timone, Marseille, France.
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Eskandari R, Schmidt MH. Intramedullary spinal melanocytoma. Rare Tumors 2010; 2:e24. [PMID: 21139826 DOI: 10.4081/rt.2010.e24] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2009] [Revised: 03/24/2010] [Accepted: 03/25/2010] [Indexed: 02/07/2023] Open
Abstract
Meningeal melanocytoma is a benign lesion arising from leptomeningeal melanocytes that at times can mimic its malignant counterpart, melanoma. Lesions of the spine usually occur in extramedullary locations and present with spinal cord compression symptoms. Because most reported spinal cases occur in the thoracic region, these symptoms usually include lower extremity weakness or numbness. The authors present a case of primary intramedullary spinal meningeal melanocytoma presenting with bilateral lower extremity symptoms in which the patient had no known supratentorial primary lesions. Gross total surgical resection allowed for full recovery, but early recurrence of tumor was detected on close follow-up monitoring, allowing for elective local radiation without loss of neurological function. Case reports of such tumors discuss different treatment strategies, but just as important is the close follow-up monitoring in these patients even after gross total surgical resection, since these tumors can recur.
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Affiliation(s)
- Ramin Eskandari
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA
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Kanatas AN, Bullock MD, Pal D, Chakrabarty A, Chumas P. Intradural extramedullary primary malignant melanoma radiographically mimicking a neurofibroma. Br J Neurosurg 2009; 21:39-40. [PMID: 17453774 DOI: 10.1080/02688690701242235] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
A case of intradural extramedullary primary malignant melanoma mimicking the presentation of a neurofibroma is described. We emphasise the fact that surgeons should be aware of unexpected malignant lesions involving spinal nerve roots.
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Affiliation(s)
- A N Kanatas
- Department of Neurosurgery, Leeds General Infirmary, UK.
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11
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Kini JR, Jeyraj V, Jayaprakash CS, Indira S, Naik CNR, Rao D. Intraoperative smear cytology of meningeal melanocytoma of the posterior fossa. Cytopathology 2009; 20:59-62. [PMID: 18093219 DOI: 10.1111/j.1365-2303.2007.00536.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- J R Kini
- Department of Pathology, Fr Muller Medical College, Mangalore, Karnataka, India.
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12
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Horn EM, Nakaji P, Coons SW, Dickman CA. Surgical treatment for intramedullary spinal cord melanocytomas. J Neurosurg Spine 2008; 9:48-54. [PMID: 18590410 DOI: 10.3171/spi/2008/9/7/048] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Spinal meningeal melanocytomas are rare lesions that are histologically benign and can behave aggressively, with local infiltration. The authors present their experience with intramedullary spinal cord melanocytomas consisting of 3 cases, which represents the second largest series in the literature. A retrospective chart review was performed following identification of all spinal melanocytomas treated at the author's institution, based on information obtained from a neuropathology database. The charts were reviewed for patient demographics, surgical procedure, clinical outcome, and long-term tumor progression. Three patients were identified in whom spinal melanocytoma had been diagnosed between 1989 and 2006. The patients' ages were 37, 37, and 48 years, and the location of their tumor was C1-3, T9-10, and T-12, respectively. All 3 had complete resection with no adjuvant radiotherapy during follow-up periods of 16, 38, and 185 months, respectively. One patient demonstrated a recurrence 29 months after resection and the other 2 patients have demonstrated asymptomatic recurrences on imaging studies obtained at 16 and 38 months following resection. With these cases added to the available literature, the evidence strongly suggests that complete resection is the treatment of choice for spinal melanocytomas. Even with complete resection, recurrences are common and close follow-up is needed for the long term in these patients. Radiation therapy should be reserved for those cases in which complete resection is not possible or in which there is recurrence.
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Affiliation(s)
- Eric M Horn
- Department of Neurological Surgery, Indiana University College of Medicine, Indianapolis, Indiana 46202-5124, USA.
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