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Gold J, Hernandez NR, Wong T, Patel N, Weiner J, Hanft S. Primary Spinal Malignant Melanoma Mimicking a Cervical Nerve Root Schwannoma: Case Report and Literature Review. Asian J Neurosurg 2024; 19:540-550. [PMID: 39205889 PMCID: PMC11349406 DOI: 10.1055/s-0044-1787081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
Abstract
Primary spinal malignant melanoma (PSMM) is a rare cancer of the central nervous system (CNS), and PSMM of the spinal nerve root is even more extraordinary. PSMM of a nerve root can mimic the radiographic appearance of benign nerve sheath tumors, thus resulting in misdiagnosis until tissue diagnosis can be made. A 53-year-old African American woman presented with pain primarily involving the left aspect of her neck and shoulder for 2 years. Magnetic resonance imaging (MRI) of the cervical spine demonstrated a T1-hyperintense, T2-hypointense, homogenously enhancing, dumbbell-shaped, intradural extramedullary mass extending out through the left C2-3 foramen. A midline incision was used to perform a C2 and C3 laminectomy, and the mass was removed from the cavity. The histopathologic profile was consistent with the diagnosis of malignant melanoma. The present case report adds to the 110 cases of PSMM and the 20 cases of PSMM of the spinal nerve root in the existing body of literature. Radiographic and clinical features resemble that of the much more common schwannoma or neurofibroma requiring immunohistochemical analysis for definitive diagnosis. The optimal treatment for PSMM has not yet been defined due to its rarity and it is therefore important to report such cases in order to share our clinical experiences and provide data to other clinicians treating this uncommon disease.
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Affiliation(s)
- Justin Gold
- Department of Neurological Surgery, Cooper Medical of Rowan University, Camden, New Jersey, United States
| | - Nick R. Hernandez
- Department of Neurosurgery, Robert Wood Johnson Hospital, New Brunswick, New Jersey, United States
| | - Timothy Wong
- Department of Neurosurgery, Robert Wood Johnson Hospital, New Brunswick, New Jersey, United States
| | - Nitesh Patel
- Department of Neurosurgery, Robert Wood Johnson Hospital, New Brunswick, New Jersey, United States
| | - Joseph Weiner
- Department of Radiation Oncology, Robert Wood Johnson Hospital, New Brunswick, New Jersey, United States
| | - Simon Hanft
- Department of Neurological Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York, United States
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2
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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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3
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Khalilullah T, Mignucci-Jiménez G, Huffman H, Karthikeyan H, Hanif Z, Ariwodo O, Panchal RR. Surgical Management of Primary Thoracic Epidural Melanoma. Cureus 2024; 16:e54536. [PMID: 38516457 PMCID: PMC10956551 DOI: 10.7759/cureus.54536] [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: 12/30/2023] [Accepted: 02/20/2024] [Indexed: 03/23/2024] Open
Abstract
In this study, we reported one of the first cases where a rare robotic-assisted platform with neuronavigation technology and carbon-fiber-polyetheretherketone (CF/PEEK) screws is employed to surgically treat multilevel thoracic primary spinal epidural melanoma. A 67-year-old male presented with left upper thoracic pain. His magnetic resonance imaging (MRI) of the thoracic spine revealed a dumbbell-shaped left epidural mass at the T2-3 level. Partial resection was performed due to tumor growth into the vertebral bodies and patient discretion for minimal surgery. The patient's neurological conditions improved postoperatively, with reduced reported symptoms of pain and numbness. Postoperative imaging showed evidence of appropriate spinal stabilization. Patient underwent stereotactic body radiation therapy (SBRT), and no adverse events were reported. This case reflects one of the first examples of treating thoracic epidural melanoma with the use of robotic-assisted navigation. Further prospective studies are needed to determine the efficacy of robot-assisted navigation for patients with primary spinal malignant melanoma which may open the possibility of surgery to once presumed non-operative patients.
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Affiliation(s)
| | - Giancarlo Mignucci-Jiménez
- Neurosurgery, Loyal and Edith Davis Neurosurgical Research Laboratory, Barrow Neurological Institute, Phoenix, USA
| | | | | | - Zaheer Hanif
- Neurosurgery, University of Texas Medical Branch, Galveston, USA
| | - Ogechukwu Ariwodo
- Neurosurgery, Philadelphia College of Osteopathic Medicine South Georgia, Moultrie, USA
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4
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Zhang M, Liu R, Xiang Y, Mao J, Li G, Ma R, Sun Z. Primary Spinal Cord Melanoma: A Case Report and a Systemic Review of Overall Survival. World Neurosurg 2018; 114:408-420. [PMID: 29614357 DOI: 10.1016/j.wneu.2018.03.169] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 03/22/2018] [Accepted: 03/23/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND The incidence of primary spinal cord melanoma (PSCM) is rare. Several case series and case reports have been published in the literature. However, the predictive factors of PSCM survival and management options are not discussed in detail. METHODS We present a case of PSCM; total resection was achieved and chemotherapy was given postoperatively. A comprehensive search was performed on PubMed's electronic database using the words "primary spinal cord melanoma." Survival rates with various gender, location, treatment, and metastasis condition were collected from the published articles and analyzed. RESULTS Fifty nine cases were eligible for the survival analysis; 54% were male and 46% were female. Patient sex did not influence overall survival. The most common location was the thorax. Patient sex and tumor location did not influence overall survival. The major presenting symptoms were weakness and paresthesia of the extremities. Metastasis or dissemination was noted in 45.16% of 31 patients. In the Kaplan-Meier survival analysis, patients who had metastasis had the worst prognosis. Extent of resection was not related to mortality. Patients who received surgery and surgery with adjuvant therapy had a better median survival than did those who had adjuvant therapy alone. Prognosis was worst in those patients who underwent only adjuvant therapy without surgery (5 months). CONCLUSIONS Surgery is the first treatment of choice in treating PSCM. The goal of tumor resection is to reduce symptoms. Adjuvant therapy after surgery had a beneficial effect on limiting the metastasis.
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Affiliation(s)
- Mingzhe Zhang
- Department of Neurosurgery, Harrison International Peace Hospital, Hebei Medical University, Hebei, China
| | - Raynald Liu
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Yi Xiang
- Department of Neurosurgery, Harrison International Peace Hospital, Hebei Medical University, Hebei, China
| | - Jianhui Mao
- Department of Neurosurgery, Harrison International Peace Hospital, Hebei Medical University, Hebei, China
| | - Guangjie Li
- Department of Neurosurgery, Harrison International Peace Hospital, Hebei Medical University, Hebei, China
| | - Ronghua Ma
- Department of Neurosurgery, Harrison International Peace Hospital, Hebei Medical University, Hebei, China
| | - Zhaosheng Sun
- Department of Neurosurgery, Harrison International Peace Hospital, Hebei Medical University, Hebei, China.
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5
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Cicuendez M, Paredes I, Munarriz PM, Hilario A, Cabello A, Lagares A. Primary melanoma of the cauda equina: Case report and review of the literature. Neurocirugia (Astur) 2012; 23:112-5. [PMID: 22561234 DOI: 10.1016/j.neucir.2012.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2011] [Accepted: 02/02/2012] [Indexed: 02/07/2023]
Abstract
The authors report the case of an 82 year-old woman with a primary malignant melanoma of the cauda equina resembling lumbar schwannoma in the MRI study. Melanocytic neoplasms are very rare but they should be included in the differential diagnosis of lesions involving the spinal nerves. The treatment of choice for these lesions is complete resection followed by radiotherapy. The outcomes reported in the literature are variable and are associated with the age of presentation, histopathological findings, extent of surgical resection and absence of metastatic lesions.
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Affiliation(s)
- Marta Cicuendez
- Department of Neurosurgery, Hospital 12 de Octubre, Madrid, Spain
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6
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Findings from CT, MRI, and PET/CT of a primary malignant melanoma arising in a spinal nerve root. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2010; 19 Suppl 2:S174-8. [PMID: 20127497 DOI: 10.1007/s00586-010-1285-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Revised: 12/29/2009] [Accepted: 01/14/2010] [Indexed: 10/19/2022]
Abstract
Primary spinal malignant melanoma is an extremely rare condition. We here describe a case of a 71-year-old Asian female presenting with left upper extremity tingling sensation. Computed tomography (CT) showed a homogeneously enhanced mass occupying the left neural foramen at the C6-7 level. Magnetic resonance imaging revealed enhanced mass in intra- and extradural space compressing the spinal cord at this level. It also widened the neural foramen mimicking neurofibroma or schwannoma. Partial resection of the mass was performed. Pathologic diagnosis of the mass was malignant melanoma. Postoperative whole body positron emission tomography/CT scan demonstrated an intense (18)F-FDG uptake at the residual mass site without abnormal uptake at other sites in the body.
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7
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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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8
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NISHIHARA M, SASAYAMA T, KONDOH T, TANAKA K, KOHMURA E, KUDO H. Long-Term Survival After Surgical Resection of Primary Spinal Malignant Melanoma -Case Report-. Neurol Med Chir (Tokyo) 2009; 49:546-8. [DOI: 10.2176/nmc.49.546] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Takashi SASAYAMA
- Department of Neurosurgery, Kobe University Graduate School of Medicine
| | - Takeshi KONDOH
- Department of Neurosurgery, Kobe University Graduate School of Medicine
| | - Kazuhiro TANAKA
- Department of Neurosurgery, Kobe University Graduate School of Medicine
| | - Eiji KOHMURA
- Department of Neurosurgery, Kobe University Graduate School of Medicine
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9
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Naing A, Messina JL, Vrionis FR, Daud AI. Uncommon manifestations of common malignancies: case 3. Malignant melanoma arising from a spinal nerve root. J Clin Oncol 2004; 22:3194-5. [PMID: 15284274 DOI: 10.1200/jco.2004.09.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Aung Naing
- H. Lee Moffitt Cancer Center & Research Institute, Cutaneous Oncology and Neurosurgery Program, Tampa, FL, USA
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10
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Sanz-Trelles A, Arranz-Salas IM, Valenzuela-Serrano MI. Melanoma arising in and limited to a spinal nerve root of the cauda equina. Histopathology 2004; 43:603-4. [PMID: 14636261 DOI: 10.1111/j.1365-2559.2003.01679.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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11
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Brat DJ, Giannini C, Scheithauer BW, Burger PC. Primary melanocytic neoplasms of the central nervous systems. Am J Surg Pathol 1999; 23:745-54. [PMID: 10403296 DOI: 10.1097/00000478-199907000-00001] [Citation(s) in RCA: 200] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Primary melanocytic neoplasms of the central nervous system (CNS) consist of a spectrum ranging from well-differentiated melanocytoma to its overtly malignant counterpart, melanoma. Diagnostically difficult intermediate lesions lie between these extremes. Clinicopathologic features of 33 cases were studied to define histologic appearances, diagnostic criteria, and the clinical behavior of lesions along this spectrum. Seventeen cases were well-differentiated, solitary leptomeningeal tumors classified as melanocytomas. They contained variably pigmented melanocytic cells arranged in tight nests, sheets, or fascicles. Mitotic rates ranged from zero to one per 10 high-power fields (HPFs), with most having zero per 10 HPFs. All tumors were immunoreactive for HMB-45 and S-100 protein and negative for epithelial membrane antigen. MIB-1 staining was low (<1-2%). Nuclei were regular, often with small, eosinophilic nucleoli. These lesions arose predominantly in the spinal canal (65%) in patients ranging in age from 17 to 73 years. None recurred after surgical resection. In contrast to these benign lesions, there were 13 cases with histologic and cytologic features consistent with those of malignant melanoma. These cases contained larger, cytologically atypical, pigmented tumor cells growing in loose nests or sheets, often with CNS invasion or necrosis. Some contained bizarre, pleomorphic nuclei; others were densely cellular and mitotically active, but less pleomorphic. Mitotic rates (mean, 5.7 per 10 HPFs) and MIB-1 labeling indices (mean, 8.1%) were higher than those of melanocytomas. Melanomas occurred at spinal (38%), posterior fossa (38%), and supratentorial (23%) levels in patients ranging in age from 15 to 71 years. After resection, 8 of 13 lesions recurred, with four being fatal (mean survival, 14 months). Of five totally resected melanomas, four did not recur (mean follow-up, 26 months). Three intermediate-grade melanocytic tumors could not be classified as melanocytoma or melanoma. All showed sheetlike growth patterns, microscopic CNS invasion, and occasional mitoses. MIB-1 staining ranged from 1% to 4%. One tumor recurred after 17 months; one patient was lost to follow-up after 5 months; and the third died after surgery. Although melanocytic tumors represent a spectrum of lesions, certain histopathologic features are helpful in predicting biologic behavior.
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Affiliation(s)
- D J Brat
- Department of Pathology, Emory University, Atlanta, Georgia 30322, USA
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12
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Salpietro FM, Alafaci C, Gervasio O, La Rosa G, Baio A, Francolini DC, Batolo D, Tomasello F. Primary cervical melanoma with brain metastases. Case report and review of the literature. J Neurosurg 1998; 89:659-66. [PMID: 9761064 DOI: 10.3171/jns.1998.89.4.0659] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Primary intramedullary melanoma is a very rare tumor that occurs most frequently in the middle or lower thoracic spinal cord. The authors present a case of primary cervical cord melanoma that developed in a 62-year-old man who was surgically treated and subsequently underwent radiation therapy. Clinical and histogenetic features of this neoplasm and results of chemo-. radio-, and immunotherapy are reported. Both "dysembryogenetic" and "mesodermal" hypotheses on the origin of primary spinal melanoma are discussed.
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Affiliation(s)
- F M Salpietro
- Department of Neurosurgery, University of Messina, Italy.
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13
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Salpietro FM, Alafaci C, Gervasio O, La Rosa G, Tomasello F, Baio A, Francolini DC, Batolo D. Primary intramedullary melanoma. Neurosurg Focus 1998. [DOI: 10.3171/foc.1998.4.5.7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Primary intramedullary melanoma is a very rare tumor, most frequently occurring in the middle or lower thoracic spinal cord. The authors present a new case of primary cervical cord melanoma that developed in a 62-year-old man whose tumor was surgically treated and subsequently received radiation therapy. Clinical and histogenetic features of this neoplasm, results of chemo-, radio-, and immunotherapy are reported. Both “disembryogenetic” and “mesodermal” hypotheses on the origin of primary spinal melanoma are discussed.
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14
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Salame K, Merimsky O, Yosipov J, Reider-Groswasser I, Chaitchik S, Ouaknine GE. Primary intramedullary spinal melanoma: diagnostic and treatment problems. J Neurooncol 1998; 36:79-83. [PMID: 9525829 DOI: 10.1023/a:1005770929074] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A 76-year old female patient with 9 year history of right mastectomy for an infiltrating ductal breast cancer and no evidence of recurrent nor metastatic disease, was admitted due to pain in the lower thoracic area radiating bilaterally to the posterior aspect of the chest wall at the same level, difficulties in micturition, urinary hesitancy, and progressive weakness of the lower limbs. Primary intramedullary spinal tumor was demonstrated by a MRI study of the spine, partially resected, and found to be a malignant melanoma on pathological study. Postoperative irradiation and administration of dexamethasone did not improve the neurologic status.
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Affiliation(s)
- K Salame
- Department of Neurosurgery, Tel-Aviv Sourasky Medical Center and Sackler School of Medicine, Israel
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15
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Melanoma Arising in a Cervical Spinal Nerve Root. Neurosurgery 1994. [DOI: 10.1097/00006123-199403000-00023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Skarli SO, Wolf AL, Kristt DA, Numaguchi Y. Melanoma arising in a cervical spinal nerve root: report of a case with a benign course and malignant features. Neurosurgery 1994; 34:533-7; discussion 637. [PMID: 8190231 DOI: 10.1227/00006123-199403000-00023] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
A 20-year-old caucasian woman with a 5-year history of right arm, neck, and back pain sought treatment when an automobile accident (4 months before admission) exacerbated her pain. Magnetic resonance imaging revealed an intra- and extradural mass compressing the spinal cord at the C5-C6 level. It also extended into and widened the neural foramen, mimicking a neurofibroma. A single cafe-au-lait spot was discovered in the inguinal region. A two-staged surgical resection was performed on an apparent hemorrhagic C6 nerve root mass. The mass exhibited diagnostic features of a malignant melanoma histologically, immunocytochemically, and ultrastructurally. A search for a primary lesion outside the nervous system or other metastases during an 8-year period from the onset of symptoms has been negative. The patient's chronic history, evidence of neural foraminal enlargement, and the absence of other malignant melanoma lesions or subsequent metastases indicates that this lesion may be a primary melanoma of the nerve root with a benign course.
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Affiliation(s)
- S O Skarli
- Division of Neurosurgery, University of Maryland Medical Systems, Baltimore
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