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Haberfellner E, Elbaroody M, Alkhamees AF, Alaosta A, Eaton S, Quint E, Shahab S, O'Connor A, Im J, Khan A, El-Gohary Y, Lotfy M, Sawan M, Shamisa A, Soliman MAR. Primary Spinal Melanoma: Case Report and Systematic Review. Clin Neurol Neurosurg 2021; 205:106649. [PMID: 33932774 DOI: 10.1016/j.clineuro.2021.106649] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/15/2021] [Accepted: 04/10/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Primary malignant melanoma of the spinal cord (PSM) is a rare condition with limited evidence regarding its diagnosis (clinical and radiographic), management, and prognosis. Our aim was to report an extremely rare two cases of primary malignant melanoma of the spine one of them is sacral melanoma which represents the second reported case in the literature and to conduct a systematic review of the relevant literature. METHODS The diagnosis and management of these cases were retrospectively reviewed. Using the PRISMA guideline, we conducted a systematic review of the literature to analyze different management strategies and the prognosis of such pathology. RESULTS All two patients were operated on, and received gross total removal of their tumors, with extended follow up for tumor recurrences. One of the cases involved a sacral tumor, which was resected without adjuvant therapy. The other one was seen by oncology and received post-operative chemo- and radio- therapy. In addition to the aforementioned cases, we present a comprehensive review of the literature on PSM from 1950 to the present, demonstrating that PSM is a very rare tumor, with a limited counted number of cases reported worldwide. CONCLUSION In conclusion, we report an exceedingly rare two cases of primary malignant melanoma of the spine. Early surgical intervention is key to the management of these rare and aggressive tumors. GTR should be attempted if possible.
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Affiliation(s)
- Erika Haberfellner
- Schulich School of Medicine and Dentistry, Western University, Ontario, Canada
| | | | - Abdullah F Alkhamees
- Schulich School of Medicine and Dentistry, Western University, Ontario, Canada; Neurosurgery Department, Qassim University, Kingdom of Saudi Arabia
| | - Abdelfatah Alaosta
- Schulich School of Medicine and Dentistry, Western University, Ontario, Canada; Neurosurgery Department, Sirte University, Libya
| | - Sydney Eaton
- Schulich School of Medicine and Dentistry, Western University, Ontario, Canada
| | - Elise Quint
- Schulich School of Medicine and Dentistry, Western University, Ontario, Canada
| | - Saba Shahab
- Schulich School of Medicine and Dentistry, Western University, Ontario, Canada
| | - Avalon O'Connor
- Schulich School of Medicine and Dentistry, Western University, Ontario, Canada
| | - Jacob Im
- Schulich School of Medicine and Dentistry, Western University, Ontario, Canada
| | - Asham Khan
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, United States
| | - Yasser El-Gohary
- Pathology Department, Windsor Regional Hospital, Western University, Canada
| | | | | | - Abdalla Shamisa
- Neurosurgery Department, Windsor Regional Hospital, Western University, Canada
| | - Mohamed A R Soliman
- Schulich School of Medicine and Dentistry, Western University, Ontario, Canada; Neurosurgery Department, Cairo University, Egypt.
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Sharma A, Sinha VD. Primary Spinal Cord Melanoma of Intradural Extramedullary Origin. J Neurosci Rural Pract 2019; 10:522-525. [PMID: 31595127 PMCID: PMC6779565 DOI: 10.1055/s-0039-1697559] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Primary malignant melanoma is the very rare entity of the central nervous system. It accounts only 1% of all melanoma cases. A 67-year-old patient presented to us with lower back pain radiating to the left lower limb and progressive weakness of both lower limbs. She underwent magnetic resonance imaging scan of lumbosacral region that suggested T1 hyperintense, T2 hypointense, extramedullary altered signal intensity lesion at L1 and L2 vertebral level compressing terminal spinal cord, and cauda equine region. On histopathological examination, findings were suggestive of malignant melanoma that was confirmed with immunohistochemistry examination (positive for S-100, Melan-A, and HMB-45). Here, we are discussing an unusual case of primary malignant melanoma of conus and cauda equine region with comprehensive review regarding management and prognosis of the tumor.
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Affiliation(s)
- Ashish Sharma
- Department of Neurosurgery, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| | - Virendra Deo Sinha
- Department of Neurosurgery, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
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Prognostic factors of patients with spinal malignant melanoma after surgical intervention: a case series of 21 patients and literature review. J Neurooncol 2019; 142:119-127. [PMID: 30607707 DOI: 10.1007/s11060-018-03071-1] [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: 09/19/2018] [Accepted: 12/03/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Spinal malignant melanoma (SMM) is a rare type of tumor that can cause nerve roots or spinal cord compression. Patients often suffer from fierce pain and paralyzation. And the estimated survival time were less than 6 months. Surgical interventions to remove the tumor and decompress the nearby nerve roots and spinal cord are effective management. Unfortunately, there lack a thorough and persuasive surgical guideline that specifically aims for this disease. It is necessary to obtain some clinical prognostic factors that predict the recurrence rate and overall survival (OS) of patients with SMM who underwent surgical interventions. METHODS 21 patients with SMM who underwent surgical intervention were retrospectively reviewed. Related patients factors, treatment factors and tumor factors were acquired and subjected into survive analyses using Kaplan-Meier method and the log-rank test. Further Cox proportional hazards model was used to identify independent prognostic factors. Literature regarding surgical interventions on SMM patients were reviewed and summarized as well. RESULTS Surgical approach total en-bloc spondylectomy (TES/Piecemeal) (p = 0.015, B 0.029, 95%CI 0.002-0.508), preoperative Frankel grade (A-C/D-E) (p = 0.021, B 15.041, 95%CI 1.492-151.669) and tumor metastases (Yes/No) (p = 0.013, B 16.667, 95%CI 1.805-153.897) are independent prognostic factors for recurrence free survival (RFS). Preoperative Frankel grade (A-C/D-E) (p = 0.031, B 10.676, 95%CI 1.241-91.877) is independent prognostic factors for OS. 12 literatures have been reviewed, including 11 case reports and one retrospective study. CONCLUSIONS Surgical interventions for patients with SMM are beneficial. Surgical approach (TES/piecemeal), tumor origin (primary/metastasis) and preoperative Frankel grade (A-C/D-E) are independent risk factors in predicting RFS. Preoperative Frankel grade (A-C/D-E) is independent prognostic factor in predicting OS.
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Wu L, Yao N, Fang J, Yang J, Xu Y. Clinical features and long-term outcomes of primary spinal malignant melanoma: a single center experience. J Neurooncol 2017; 135:513-519. [PMID: 28819705 DOI: 10.1007/s11060-017-2593-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 08/05/2017] [Indexed: 11/26/2022]
Abstract
Primary malignant melanomas are very rare tumors in the spinal canal. In this study, the authors review their experience in a series of seven patients with histologically proven primary spinal malignant melanoma (PSMM) and discuss the clinical features, treatment strategy, and long-term outcomes. Clinical data of seven patients with PSMM treated at a single institution were retrospectively analyzed. There were three male and four female patients, with a mean age of 44 years. The mean duration of illness was 5.4 months. The tumors showed hyperintensity in six cases on T1-weighted image (WI) and isointensity or hypointensity in five cases on T2WI. Gross total resection (GTR) of the tumor was achieved in two cases, and subtotal resection (STR) was achieved in five cases. Four STR patients underwent postoperative local radiation therapy. Postoperative MRI results showed no tumor recurrence in all four female patients after an average follow-up period of 64.5 months. Three male patients had tumor recurrence and dissemination after postoperative 14.7 months (8-24 months), and all died 16.3 months (10-25 months) after initial diagnosis. PSMM should be considered in the differential diagnosis of a middle-aged patient with spinal lesion if the tumor shows hyperintensity on T1WI and hypointensity or isointensity on T2WI on MRI. STR followed by radiotherapy is not excessively associated with deterioration of the final outcome compared to GTR. Our study suggests that PSMM might have female predominance in favorable outcome. Surgical resection followed by adjuvant radiotherapy and regular follow-up are recommended.
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Affiliation(s)
- Liang Wu
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing, 100050, China
| | - Ning Yao
- Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden
| | - Jingyi Fang
- Department of Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Jun Yang
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing, 100050, China
| | - Yulun Xu
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing, 100050, China.
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Liu QY, Liu AM, Li HG, Guan YB. Primary spinal melanoma of extramedullary origin: a report of three cases and systematic review of the literature. Spinal Cord Ser Cases 2015; 1:15003. [PMID: 28053708 DOI: 10.1038/scsandc.2015.3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 01/12/2015] [Accepted: 01/14/2015] [Indexed: 02/06/2023] Open
Abstract
STUDY DESIGN A review of the literature and three case reports. OBJECTIVES Primary spinal melanoma (PSM) of extramedullary origin is a rare malignant condition with limited current literature in regards to its clinical course, magnetic resonance imaging (MRI) findings, treatment strategies and prognosis. We reported here three cases of PSM of extramedullary origin. SETTING China, Guangzhou. METHODS We report three cases of PSM of extramedullary origin. The clinical and radiological findings of these cases were retrospectively analyzed. RESULTS The three cases were all of males aged 39, 47 and 76 years, respectively. The duration of their symptoms was 3 weeks, 2 months and 11 months respectively. The extramedullary tumors were all well-defined solitary tumors and were located at C4-5, L2-3 and T9-10, respectively. In one case, involvement of the intervertebral foramen was found. Preoperative MRI showed hyperintense T1W signals and hypointense T2W signals in all three cases and all tumors were clinically misdiagnosed as schwannomas. The patients received total or subtotal resection surgery without radiotherapy or chemotherapy. Patients were alive at 18 months, 27 months and 36 months postoperative follow-up, respectively. CONCLUSION PSM of extramedullary origin is a rare malignant tumor that shows characteristic findings on MRI. Surgical resection is the preferred treatment strategy.
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Affiliation(s)
- Q-Y Liu
- Department of Radiology, Zengcheng People's Hospital, Zengcheng, Guangdong Province, China; Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - A-M Liu
- Division of Neurosurgery, Department of Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University , Guangzhou, Guangdong Province, China
| | - H-G Li
- Department of Pathology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University , Guangzhou, Guangdong Province, China
| | - Y-B Guan
- Department of Radiology, First Affiliated Hospital of Guangzhou Medical University , Guangzhou City, Guangdong Province, China
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LI YUPING, ZHANG HENGZHU, SHE LEI, WANG XIAODONG, DONG LUN, XU ENXI, WANG XINGDONG. Primary extramedullary spinal melanoma mimicking spinal meningioma: A case report and literature review. Oncol Lett 2014; 8:339-344. [PMID: 24959273 PMCID: PMC4063659 DOI: 10.3892/ol.2014.2099] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 04/10/2014] [Indexed: 01/05/2023] Open
Abstract
Primary spinal melanoma is a rare lesion, which occurs throughout the cranial and spinal regions, however, is primarily observed in the middle or lower thoracic spine. The clinical features of primary spinal melanoma are complex and unspecific, resulting in a high misdiagnosis rate. In the present case report, a rare case of spinal melanoma exhibiting the dural tail sign and mimicking spinal meningioma is reported. The initial diagnosis, using magnetic resonance imaging (MRI), was unclear. Thus, melanin-containing tumors and spinal meningioma should have been considered in the differential diagnosis. The tumor was completely resected using a standard posterior midline approach, which was followed by chemotherapy. Subsequent to the surgery, the patient was discharged with improved motor capacity and a follow-up MRI scan showed no recurrence after six months. The present study demonstrates that it is critical for neurosurgeons to focus on increasing the accuracy of initial diagnoses in order to make informed decisions regarding the requirement for surgical resection. The present case report presents the clinical, radiological and pathological features of primary extramedullary spinal melanoma mimicking spinal meningioma to emphasize the importance of early identification and diagnosis.
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Affiliation(s)
- YU-PING LI
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu 225001, P.R. China
| | - HENG-ZHU ZHANG
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu 225001, P.R. China
| | - LEI SHE
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu 225001, P.R. China
| | - XIAO-DONG WANG
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu 225001, P.R. China
| | - LUN DONG
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu 225001, P.R. China
| | - ENXI XU
- Department of Neurosurgery, Zhenjiang First People’s Hospital, Zhenjiang, Jiangsu 212002, P.R. China
| | - XING-DONG WANG
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu 225001, P.R. China
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Ripamonti CI, Bossi P, Santini D, Fallon M. Pain related to cancer treatments and diagnostic procedures: a no man's land? Ann Oncol 2014; 25:1097-106. [PMID: 24625453 DOI: 10.1093/annonc/mdu011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND While guidelines are available for the management of cancer-related pain, little attention is given to the assessment and treatment of pain caused by treatments and diagnostic procedures in cancer patients. METHODS We evaluated the literature on pain related to cancer treatment and diagnostic procedures within a critical analysis. RESULTS The data available are sparse, suggesting that little attention has been directed at this important aspect of oncology. This points to potentially suboptimal patient management. CONCLUSIONS Appropriate studies are necessary in order to understand the incidence and appropriate management of pain, both during and/or after oncological treatments and diagnostic procedures. At the same time, Health Care Professionals should have heightened awareness of the causes and treatment of pain with the aim of anticipating and managing pain most appropriately for each individual patient. This is clearly an important component of holistic patient care before, during, and after oncological treatment.
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Affiliation(s)
- C I Ripamonti
- Supportive Care in Cancer Unit, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan
| | - P Bossi
- Head and Neck Medical Oncology Unit, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan
| | - D Santini
- Medical Oncology Unit, Università Campus Bio-Medico, Rome, Italy
| | - M Fallon
- St Columba's Hospice Chair of Palliative Medicine, IGMM, University of Edinburgh, Edinburgh, UK
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