1
|
Luo TF, Wang YB, Wang DH, Zhan S, Deng SL. Lateral ventricle pleomorphic xanthoastrocytoma concurrent with Dandy-Walker complex: A case report. Medicine (Baltimore) 2022; 101:e30492. [PMID: 36086683 PMCID: PMC10980463 DOI: 10.1097/md.0000000000030492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/03/2022] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Dandy-Walker complex and pleomorphic xanthoastrocytomas are both rare disease entities that typically manifest early in life and are associated with congenital etiological factors. Dandy-Walker complex is a cerebellar malformation associated with a series of anatomical changes. The disease onset is usually at birth or during infancy. Late onset in adulthood is uncommon. Pleomorphic xanthoastrocytoma is a rare WHO grade II astrocytic tumor affecting mainly young adults. Concomitant occurrence of Dandy-Walker complex and pleomorphic xanthoastrocytoma has not been previously reported. PATIENT CONCERNS AND DIAGNOSIS A 30-year-old woman with a previous history of unconfirmed resected lateral ventricle meningioma presented with severe headache for 1 day. Imaging examination revealed a mass in the right lateral ventricle with heterogeneous signal patterns, changes in the posterior fossa corresponding to a Dandy-Walker variant, and mild hydrocephalus. INTERVENTIONS AND OUTCOMES Surgical complete resection of the mass was achieved. postoperative histopathological examination confirmed WHO grade II pleomorphic xanthoastrocytoma. Three years postsurgery, ventriculoperitoneal shunt was performed due to worsening of hydrocephalus. The patient has since remained symptom-free. CONCLUSION This is the first report of concomitant occurrence of Dandy-Walker complex and pleomorphic xanthoastrocytoma. The association of neurological congenital malformation with intracranial neoplasms may be multifactorial, with underlying role of genetic mutations or chromosome alterations.
Collapse
Affiliation(s)
- Tian-Fei Luo
- Department of Neurology, First Hospital of Jilin University, Chang Chun, China
| | - Yu-Bo Wang
- Department of Oncological Neurosurgery, First Hospital of Jilin University, Chang Chun, China
| | - Dan-Hua Wang
- Department of Pathology, First Hospital of Jilin University, Chang Chun, China
| | - Shuang Zhan
- Department of Oncological Neurosurgery, First Hospital of Jilin University, Chang Chun, China
| | - Shuang-Lin Deng
- Department of Oncological Neurosurgery, First Hospital of Jilin University, Chang Chun, China
| |
Collapse
|
2
|
Liu BC, Wang YB, Liu Z, Jiao Y, Zhang XF. Neurocutaneous melanosis with an intracranial cystic-solid meningeal melanoma in an adult: A case report and review of literature. World J Clin Cases 2022; 10:5025-5035. [PMID: 35801056 PMCID: PMC9198853 DOI: 10.12998/wjcc.v10.i15.5025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/12/2022] [Accepted: 03/26/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Neurocutaneous melanosis (NCM) is a rare congenital, nonhereditary neurocutaneous syndrome that mainly occurs in children; adult NCM is very rare. Due to its rarity, the clinical features and treatment strategies for NCM remain unclear. The purpose of this study was to explore the clinical features, diagnosis, treatment and prognosis of NCM in adults. Most intracranial meningeal melanomas are solid masses, and cystic-solid malignant melanomas are very rare. Due to the lack of data, the cause of cystic changes and the effect on prognosis are unknown.
CASE SUMMARY A 41-year-old woman was admitted to the hospital with intermittent headache for 1 mo. Magnetic resonance imaging (MRI) showed a 4.7 cm × 3.6 cm cystic-solid mass in the left temporal lobe with peritumoral edema. The entire mass was removed, and postoperative pathology indicated malignant melanoma.
CONCLUSION MRI is the first-choice imaging approach for diagnosing central nervous system diseases in NCM patients, although cerebrospinal fluid may also be used. At present, there is no optimal treatment plan; gross total resection combined with BRAF inhibitors and MEK inhibitors might be the most beneficial treatment.
Collapse
Affiliation(s)
- Bo-Chuan Liu
- Department of Neurosurgery, The Second Affiliated Hospital of Xi'an Medical University, Xi'an 710038, Shaanxi Province, China
| | - Yu-Bo Wang
- Department of Neurosurgery, First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Zhuang Liu
- Department of Neurosurgery, Dongfeng County Hospital, Liaoyuan 136300, Jilin Province, China
| | - Yan Jiao
- Department of Hepatobiliary and Pancreatic Surgery, First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Xian-Feng Zhang
- Department of Neurosurgery, First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| |
Collapse
|
3
|
Rahman RK, Majmundar N, Ghani H, San A, Koirala M, Gajjar AA, Pappert A, Mazzola CA. Neurosurgical management of patients with neurocutaneous melanosis: a systematic review. Neurosurg Focus 2022; 52:E8. [DOI: 10.3171/2022.2.focus21791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 02/21/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Neurocutaneous melanocytosis (NCM), also referred to as neurocutaneous melanosis, is a rare neurocutaneous disorder characterized by excess melanocytic proliferation in the skin, leptomeninges, and cranial parenchyma. NCM most often presents in pediatric patients within the first 2 years of life and is associated with high mortality due to proliferation of melanocytes in the brain. Prognosis is poor, as patients typically die within 3 years of symptom onset. Due to the rarity of NCM, there are no specific guidelines for management. The aims of this systematic review were to investigate approaches toward diagnosis and examine modern neurosurgical management of NCM.
METHODS
A systematic review was performed using the PubMed database between April and December 2021 to identify relevant articles using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Search criteria were created and checked independently among the authors. Inclusion criteria specified unique studies and case reports of NCM patients in which relevant neurosurgical management was considered and/or applied. Exclusion criteria included studies that did not report associated neurological diagnoses and neuroimaging findings, clinical reports without novel observations, and those unavailable in the English language. All articles that met the study inclusion criteria were included and analyzed.
RESULTS
A total of 26 extracted articles met inclusion criteria and were used for quantitative analysis, yielding a cumulative of 74 patients with NCM. These included 21 case reports, 1 case series, 2 retrospective cohort studies, 1 prospective cohort study, and 1 review. The mean patient age was 16.66 years (range 0.25–67 years), and most were male (76%). Seizures were the most frequently reported symptom (55%, 41/74 cases). Neurological diagnoses associated with NCM included epilepsy (45%, 33/74 cases), hydrocephalus (24%, 18/74 cases), Dandy-Walker malformation (24%, 18/74 cases), and primary CNS melanocytic tumors (23%, 17/74 cases). The most common surgical technique was CSF shunting (43%, 24/56 operations), with tethered cord release (4%, 2/56 operations) being the least frequently performed.
CONCLUSIONS
Current management of NCM includes CSF shunting to reduce intracranial pressure, surgery, chemotherapy, radiotherapy, immunotherapy, and palliative care. Neurosurgical intervention can aid in the diagnosis of NCM through tissue biopsy and resection of lesions with surgical decompression. Further evidence is required to establish the clinical outcomes of this rare entity and to describe the diverse spectrum of intracranial and intraspinal abnormalities present.
Collapse
Affiliation(s)
- Raphia K. Rahman
- Rowan University School of Osteopathic Medicine, Stratford, New Jersey
| | - Neil Majmundar
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Hira Ghani
- New York Institute of Technology College of Osteopathic Medicine, Glen Head, New York
| | - Ali San
- Kansas City University College of Osteopathic Medicine, Kansas City, Missouri
| | - Monika Koirala
- Kansas City University College of Osteopathic Medicine, Kansas City, Missouri
| | - Avi A. Gajjar
- Department of Chemistry, Union College, Schenectady, New York; and
| | - Amy Pappert
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Newark, New Jersey
| | - Catherine A. Mazzola
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| |
Collapse
|
4
|
Furukawa K, Kikui S, Takeshima T, Yamamoto T, Ozaki A. [An adult case of neurocutaneous melanosis with acute exacerbation after a long asymptomatic period following excision of a melanocytic nevus]. Rinsho Shinkeigaku 2021; 61:844-850. [PMID: 34789628 DOI: 10.5692/clinicalneurol.cn-001641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Neurocutaneous melanosis is caused by postzygotic NRAS mutations in neural crest cells, resulting in large or multiple nevi in the skin and proliferation of leptomeningeal melanocytes in the central nervous system. The onset of neurological symptoms is usually before the age of 2 years, but it can also occur in adults. A 35-year-old male had been asymptomatic for a long time after excision of a large congenital melanocytic nevus, but he developed headache, disturbance of consciousness, and seizure. Methotrexate was ineffective, cerebral pressure was decreased by spinal drainage, and steroid pulse therapy was temporarily effective. Seizures and disturbance of consciousness worsened and the patient died on the 92nd day. Cerebrospinal fluid human melanin black-45 immunostaining and serum 5-S-cysteinyldopa (5-S-CD) were useful in diagnosing melanocytic proliferation, and serum 5-S-CD may be useful in predicting prognosis.
Collapse
Affiliation(s)
- Koji Furukawa
- Department of Neurology, Osaka Saiseikai Nakatsu Hospital.,Department of Neurology, Kitano Hospital, Tazuke Kohukai Medical Research Institute
| | - Shoji Kikui
- Department of Neurology, Social Medical Corporation Kotobukikai Tominaga Hospital
| | - Takao Takeshima
- Department of Neurology, Social Medical Corporation Kotobukikai Tominaga Hospital
| | - Toru Yamamoto
- Department of Neurology, Osaka Saiseikai Nakatsu Hospital
| | - Akihiko Ozaki
- Department of Neurology, Osaka Saiseikai Nakatsu Hospital.,Department of Neurology, Japanese Red Cross Osaka Hospital
| |
Collapse
|
5
|
Ruggieri M, Polizzi A, Catanzaro S, Bianco ML, Praticò AD, Di Rocco C. Neurocutaneous melanocytosis (melanosis). Childs Nerv Syst 2020; 36:2571-2596. [PMID: 33048248 DOI: 10.1007/s00381-020-04770-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 06/23/2020] [Indexed: 02/03/2023]
Abstract
Neurocutaneous melanosis (NCM; MIM # 249400; ORPHA: 2481], first reported by the Bohemian pathologist Rokitansky in 1861, and now more precisely defined as neurocutaneous melanocytosis, is a rare, congenital syndrome characterised by the association of (1) congenital melanocytic nevi (CMN) of the skin with overlying hypertrichosis, presenting as (a) large (LCMN) or giant and/or multiple (MCMN) melanocytic lesions (or both; sometimes associated with smaller "satellite" nevi) or (b) as proliferative melanocytic nodules; and (2) melanocytosis (with infiltration) of the brain parenchyma and/or leptomeninges. CMN of the skin and leptomeningeal/nervous system infiltration are usually benign, more rarely may progress to melanoma or non-malignant melanosis of the brain. Approximately 12% of individuals with LCMN will develop NCM: wide extension and/or dorsal axial distribution of LCMN increases the risk of NCM. The CMN are recognised at birth and are distributed over the skin according to 6 or more patterns (6B patterns) in line with the archetypical patterns of distribution of mosaic skin disorders. Neurological manifestations can appear acutely in infancy, or more frequently later in childhood or adult life, and include signs/symptoms of intracranial hypertension, seizures/epilepsy, cranial nerve palsies, motor/sensory deficits, cognitive/behavioural abnormalities, sleep cycle anomalies, and eventually neurological deterioration. NMC patients may be symptomatic or asymptomatic, with or without evidence of the typical nervous system changes at MRI. Associated brain and spinal cord malformations include the Dandy-Walker malformation (DWM) complex, hemimegalencephaly, cortical dysplasia, arachnoid cysts, Chiari I and II malformations, syringomyelia, meningoceles, occult spinal dysraphism, and CNS lipoma/lipomatosis. There is no systemic involvement, or only rarely. Pathogenically, single postzygotic mutations in the NRAS (neuroblastoma RAS viral oncogene homologue; MIM # 164790; at 1p13.2) proto-oncogene explain the occurrence of single/multiple CMNs and melanocytic and non-melanocytic nervous system lesions in NCM: these disrupt the RAS/ERK/mTOR/PI3K/akt pathways. Diagnostic/surveillance work-ups require physical examination, ophthalmoscopy, brain/spinal cord magnetic resonance imaging (MRI) and angiography (MRA), positron emission tomography (PET), and video-EEG and IQ testing. Treatment strategies include laser therapy, chemical peeling, dermabrasion, and surgical removal/grafting for CMNs and shunt surgery and surgical removal/chemo/radiotherapy for CNS lesions. Biologically targeted therapies tailored (a) BRAF/MEK in NCM mice (MEK162) and GCMN (trametinib); (b) PI3K/mTOR (omipalisib/GSK2126458) in NMC cells; (c) RAS/MEK (vemurafenib and trametinib) in LCMNs cells; or created experimental NMC cells (YP-MEL).
Collapse
Affiliation(s)
- Martino Ruggieri
- Unit of Rare Diseases of the Nervous System in Childhood, Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy.
| | - Agata Polizzi
- Chair of Pediatrics, Department of Educational Sciences, University of Catania, Catania, Italy
| | - Stefano Catanzaro
- Unit of Rare Diseases of the Nervous System in Childhood, Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
- Unit of Neonatology and Neonatal Intensive Care Unit (NICU), AOU "Policlinico", PO "San Marco", University of Catania, Catania, Italy
| | - Manuela Lo Bianco
- Postgraduate Programme in Pediatrics, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Andrea D Praticò
- Unit of Rare Diseases of the Nervous System in Childhood, Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
| | - Concezio Di Rocco
- Pediatric Neurosurgery, International Neuroscience Institute (INI), Hannover, Germany
| |
Collapse
|
6
|
Calbet-Llopart N, Pascini-Garrigos M, Tell-Martí G, Potrony M, Martins da Silva V, Barreiro A, Puig S, Captier G, James I, Degardin N, Carrera C, Malvehy J, Etchevers HC, Puig-Butillé JA. Melanocortin-1 receptor (MC1R) genotypes do not correlate with size in two cohorts of medium-to-giant congenital melanocytic nevi. Pigment Cell Melanoma Res 2020; 33:685-694. [PMID: 32323445 DOI: 10.1111/pcmr.12883] [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: 01/21/2020] [Revised: 04/07/2020] [Accepted: 04/16/2020] [Indexed: 01/29/2023]
Abstract
Congenital melanocytic nevi (CMN) are cutaneous malformations whose prevalence is inversely correlated with projected adult size. CMN are caused by somatic mutations, but epidemiological studies suggest that germline genetic factors may influence CMN development. In CMN patients from the U.K., genetic variants in MC1R, such as p.V92M and loss-of-function variants, have been previously associated with larger CMN. We analyzed the association of MC1R variants with CMN characteristics in two distinct cohorts of medium-to-giant CMN patients from Spain (N = 113) and from France, Norway, Canada, and the United States (N = 53), similar at the clinical and phenotypical level except for the number of nevi per patient. We found that the p.V92M or loss-of-function MC1R variants either alone or in combination did not correlate with CMN size, in contrast to the U.K. CMN patients. An additional case-control analysis with 259 unaffected Spanish individuals showed a higher frequency of MC1R compound heterozygous or homozygous variant genotypes in Spanish CMN patients compared to the control population (15.9% vs. 9.3%; p = .075). Altogether, this study suggests that MC1R variants are not associated with CMN size in these non-UK cohorts. Additional studies are required to define the potential role of MC1R as a risk factor in CMN development.
Collapse
Affiliation(s)
- Neus Calbet-Llopart
- Dermatology Department, Melanoma Unit, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain
| | - Mirella Pascini-Garrigos
- Dermatology Department, Melanoma Unit, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Gemma Tell-Martí
- Dermatology Department, Melanoma Unit, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain
| | - Miriam Potrony
- Dermatology Department, Melanoma Unit, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain
| | - Vanessa Martins da Silva
- Dermatology Department, Melanoma Unit, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Alicia Barreiro
- Dermatology Department, Melanoma Unit, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Susana Puig
- Dermatology Department, Melanoma Unit, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain
| | - Guillaume Captier
- Plastic pediatric surgery, University of Montpellier Hospital, Montpellier, France
| | - Isabelle James
- Service de Chirurgie Réparatrice de l'Enfant, Clinique du Val d'Ouest, Ecully, France
| | - Nathalie Degardin
- Service de Chirurgie Plastique Réparatrice, Hôpital de la Timone Enfants, Marseille, France.,Faculté de Médecine, Marseille Medical Genetics, Aix-Marseille Univ, INSERM, U1251, Marseille, France
| | - Cristina Carrera
- Dermatology Department, Melanoma Unit, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain
| | - Josep Malvehy
- Dermatology Department, Melanoma Unit, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain
| | - Heather C Etchevers
- Faculté de Médecine, Marseille Medical Genetics, Aix-Marseille Univ, INSERM, U1251, Marseille, France
| | - Joan Anton Puig-Butillé
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain.,Molecular Biology CORE, Biomedical Diagnostic Center (CDB), Melanoma Unit, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| |
Collapse
|
7
|
Omar AT, Bagnas MAC, Del Rosario-Blasco KAR, Diestro JDB, Khu KJO. Shunt Surgery for Neurocutaneous Melanosis with Hydrocephalus: Case Report and Review of the Literature. World Neurosurg 2018; 120:583-589.e3. [DOI: 10.1016/j.wneu.2018.09.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 08/30/2018] [Accepted: 09/02/2018] [Indexed: 12/19/2022]
|
8
|
Stambolliu E, Ioakeim-Ioannidou M, Kontokostas K, Dakoutrou M, Kousoulis AA. The Most Common Comorbidities in Dandy-Walker Syndrome Patients: A Systematic Review of Case Reports. J Child Neurol 2017. [PMID: 28635420 DOI: 10.1177/0883073817712589] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Dandy-Walker syndrome (DWS) is a rare neurologic multi-entity malformation. This review aimed at reporting its main nonneurologic comorbidities. METHODS Following PRISMA guidelines, search in Medline was conducted (2000-2014, keyword: dandy-walker). Age, sex, country, DWS type, consanguinity or siblings with DWS, and recorded coexistent conditions (by ICD10 category) were extracted for 187 patients (46.5% male, 43% from Asia) from 168 case reports. RESULTS Diagnosis was most often set in <1 year old (40.6%) or >12 years old (27.8%). One-third of cases had a chromosomal abnormality or syndrome (n = 8 PHACE), 27% had a cardiovascular condition (n = 7 Patent Ductus Arteriosus), 24% had a disease of eye and ear (n = 9 cataract); most common malignancy was nephroblastoma (n = 8, all Asian). Almost one-fifth had a mental illness diagnosis; only 6.4% had mild or severe intellectual disability. CONCLUSION The spread of comorbidities calls for early diagnosis and multidisciplinary research and practice, especially as many cases remain clinically asymptomatic for years.
Collapse
Affiliation(s)
- Emelina Stambolliu
- 1 Society of Junior Doctors, Athens, Greece.,2 Department of Internal Medicine, General Hospital of Kalavryta, Kalavryta, Greece
| | | | | | - Maria Dakoutrou
- 1 Society of Junior Doctors, Athens, Greece.,5 First Department of Paediatrics, "Aghia Sophia" Children's Hospital, University of Athens, Greece
| | - Antonis A Kousoulis
- 1 Society of Junior Doctors, Athens, Greece.,6 Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| |
Collapse
|
9
|
Neurocutaneous Melanosis Presenting as Cavernous Hemangioma Persistent Abdominal Pain. J Craniofac Surg 2016; 28:e168-e170. [PMID: 27792104 DOI: 10.1097/scs.0000000000003190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Neurocutaneous melanosis (NCM) is a rare congenital syndrome characterized by the presence of multiple congenital melanocytic nevi and the proliferation of melanocytes in the central nervous system. The authors present a 9-year-old Chinese boy whose clinical manifestations are intermittent headache for 2 months and persistent abdominal pain for 10 days. 3D-reconstruction computed tomography angiography image, digital subtraction angiography, and magnetic resonance imaging plus angiography (MRI+MRA) examinations results suggested that cavernoma at left frontal lobe potentially associated with hemorrhage. In addition, miliary abnormal signals were widely scattered on MRA image so that other malignant metastatic diseases cannot be ruled out. GI physical examination had not any abnormal findings, antispasmodic drugs were ineffective but antiepilepsy drugs were effective to abdominal pain. In surgery, no cavernoma was noticed but an accumulation of densely melanocytic mass located at the lesion on radiology images. The lesions spread along with perivascular of sylvian veins and leptomeningeal. Pathology investigation demonstrated brain metastatic malignant melanoma associated with hemosiderosis. The lesion of brain parenchyma was totally removed but the spread lesions could not be treated with surgery. Adjuvant radiotherapy was performed but failed to control the malignant development, still the patient died in 3 months postinitial operation. The authors conclude that abdominal pain was a manifestation of epilepsy related to the frontal lobe lesion. Neurocutaneous melanosis is a rare disease, brain metastases result in abdominal pain is rare even more, and it is worth the attention of clinicians.
Collapse
|
10
|
Shohoud SA, Azab WA, Alsheikh TM, Hegazy RM. Blake's pouch cyst and Werdnig-Hoffmann disease: Report of a new association and review of the literature. Surg Neurol Int 2014; 5:S282-8. [PMID: 25225621 PMCID: PMC4163908 DOI: 10.4103/2152-7806.139390] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 06/19/2014] [Indexed: 12/26/2022] Open
Abstract
Background: We report a case of a neonate with proximal spinal muscular atrophy (SMA) type 1 (also known as Werdnig-Hoffmann disease or severe infantile acute SMA) associated with a Blake's pouch cyst; a malformation that is currently classified within the spectrum of Dandy-Walker complex. The association of the two conditions has not been previously reported in the English literature. A comprehensive review of the pertinent literature is presented. Case Description: A male neonate was noted to have paucity of movement of the four limbs with difficulty of breathing and poor feeding soon after birth. Respiratory distress with tachypnea, necessitated endotracheal intubation and mechanical ventilation. Pregnancy was uneventful except for decreased fetal movements reported by the mother during the third trimester. Neurological examination revealed generalized hypotonia with decreased muscle power of all limbs, nonelicitable deep tendon jerks, and occasional tongue fasciculations. Molecular genetic evaluation revealed a homozygous deletion of both exons 7 and 8 of the survival motor neuron 1 (SMN1) gene, and exon 5 of the neuronal apoptosis inhibitory protein (NAIP) gene on the long arm of chromosome 5 consistent with Werdnig-Hoffmann disease (SMA type 1). At the age of 5 months, a full anterior fontanelle and abnormal increase of the occipito-frontal circumference were noted. Computed tomographic (CT) scan and magnetic resonance imaging (MRI) of the brain revealed a tetraventricular hydrocephalus and features of Blake's pouch cyst of the fourth ventricle. Conclusions: This case represents a previously unreported association of Blake's pouch cyst and SMA type 1.
Collapse
Affiliation(s)
- Sherien A Shohoud
- Neonatal Intensive Care Unit, Ibn Sina Hospital, Kuwait City, Kuwait
| | - Waleed A Azab
- Department of Neurosurgery, Ibn Sina Hospital, Kuwait City, Kuwait
| | - Tarek M Alsheikh
- Department of Neurosurgery, Ibn Sina Hospital, Kuwait City, Kuwait
| | - Rania M Hegazy
- Department of Diagnostic Radiology, Jahra Hospital, Kuwait City, Kuwait
| |
Collapse
|
11
|
Sung KS, Song YJ. Neurocutaneous melanosis in association with dandy-walker complex with extensive intracerebral and spinal cord involvement. J Korean Neurosurg Soc 2014; 56:61-5. [PMID: 25289129 PMCID: PMC4185324 DOI: 10.3340/jkns.2014.56.1.61] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 01/09/2014] [Accepted: 07/15/2014] [Indexed: 02/02/2023] Open
Abstract
Neurocutaneous melanosis (NCM) is a rare congenital syndrome consisting of benign or malignant melanotic tumors of the central nervous system with large or numerous cutaneous melanocytic nevi. The Dandy-Walker complex (DWC) is characterized by an enlarged posterior fossa with high insertion of the tentorium, hypoplasia or aplasia of the cerebellar vermis, and cystic dilatation of the fourth ventricle. These each two conditions are rare, but NCM associated with DWC is even more rare. Most patients of NCM with DWC present neurological symptoms early in life such as intracranial hemorrhage, hydrocephalus, and malignant transformation of the melanocytes. We report a 14-year-old male patient who was finally diagnosed as NCM in association with DWC with extensive intracerebral and spinal cord involvement.
Collapse
Affiliation(s)
- Kyoung-Su Sung
- Department of Neurosurgery, College of Medicine, Dong-A University, Busan, Korea
| | - Young-Jin Song
- Department of Neurosurgery, College of Medicine, Dong-A University, Busan, Korea
| |
Collapse
|
12
|
Abstract
Neurocutaneous melanosis or neurocutaneous melanocytosis is a rare sporadic congenital disorder characterized by the presence of giant and/or multiple satellite congenital melanocytic nevi in the skin and benign melanocytic pigmentation of the leptomeninges. These two defining features were recognized more than a century ago. A third characteristic feature is proliferative nodules arising from giant nevi. The etiology is unknown, but neurocutaneous melanosis is considered a developmental disorder of melanocyte precursors from neural crest. The distinctive unique distribution of the congenital giant nevi that gives a "garment" appearance is also an expression of the neural crest. The neurological manifestations often appear in infancy.The special association of neurocutaneous melanosis with Dandy-Walker malformation complex may be explained by a common pathogenesis. Mortality in infancy and childhood is high.
Collapse
|
13
|
Kim KH, Chung SB, Kong DS, Seol HJ, Shin HJ. Neurocutaneous melanosis associated with Dandy-Walker complex and an intracranial cavernous angioma. Childs Nerv Syst 2012; 28:309-14. [PMID: 22134415 DOI: 10.1007/s00381-011-1638-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Accepted: 11/17/2011] [Indexed: 12/29/2022]
Affiliation(s)
- Kyung Hwan Kim
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Gangnam-gu, Seoul, Republic of Korea
| | | | | | | | | |
Collapse
|
14
|
Cho IY, Hwang SK, Kim SH. Dandy-walker malformation associated with neurocutaneous melanosis. J Korean Neurosurg Soc 2011; 50:475-7. [PMID: 22259699 DOI: 10.3340/jkns.2011.50.5.475] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Revised: 04/07/2011] [Accepted: 11/14/2011] [Indexed: 11/27/2022] Open
Abstract
Neurocutaneous melanosis associated with Dandy-Walker malformation is a rare dysmorphogenesis that is associated with single or multiple giant pigmented cutaneous nevi and diffuse involvement of the central nervous system. In this article, we present a 2-month-old patient with neurocutaneous melanosis associated with Dandy-Walker malformation. In addition, we reviewed the literature and discussed the pathogenesis based on the preferred hypotheses.
Collapse
Affiliation(s)
- In Yong Cho
- Department of Neurosurgery, College of Medicine, Ewha Womans University, Seoul, Korea
| | | | | |
Collapse
|