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Moncur EM, Al-Ahmad S, Thom M, Craven CL, Choi D. Local recurrence of melanocytoma of the cervical spine. Acta Neurol Belg 2024:10.1007/s13760-023-02459-9. [PMID: 38319562 DOI: 10.1007/s13760-023-02459-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 12/07/2023] [Indexed: 02/07/2024]
Affiliation(s)
- Eleanor M Moncur
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK.
| | - Selma Al-Ahmad
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK
| | - Maria Thom
- Department of Neuropathology, Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Claudia L Craven
- Department of Neurosurgery, Cambridge University Hospitals, Hills Road, Cambridge, CB2 0QQ, UK
| | - David Choi
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK
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Wang C, Shao X, Zou Y. Primary intramedullary melanocytoma in the thoracic cord: a case report and literature review. Transl Cancer Res 2022; 11:928-934. [PMID: 35571657 PMCID: PMC9091001 DOI: 10.21037/tcr-21-2132] [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] [Received: 10/01/2021] [Accepted: 02/17/2022] [Indexed: 11/06/2022]
Abstract
Background Primary intramedullary melanocytoma (PIM) is extremely rare, only 25 cases of PIM have been reported previously. Herein we report a case of PIM in the thoracic cord and reviewed its clinicopathological features, imaging features, therapeutic strategies and prognosis to provide helpful information in the diagnosis and treatment of PIM. Case Description A 56-year-old man presented with weakness and numbness in both legs for several years. Contrast-enhanced magnetic resonance imaging (MRI) of the spinal cord was performed. Based on the imaging examination, cavernous malformation with subacute hematoma was considered as the initial diagnosis. However, histopathological and immunohistochemical analyses confirmed the final diagnosis of PIM in the thoracic cord after surgical resection. The patient had no signs of recurrence or metastasis during a 17-month follow-up. Conclusions MRI is the preferred method for the evaluation of PIM. PIM is characterized by a high signal on T1WI and a low signal on T2WI. It is difficult to make the differential diagnosis from cavernous malformation with hematoma before surgery due to its rarity. However, the symptom is not sudden but gradually worsened over a relatively long period in the PIM patients, which is an important difference from the cavernous malformation with hematoma. Therefore, PIM should receive diagnostic con¬sideration for an intramedullary lesion that is high signal on T1WI and low signal on T2WI in a patient with gradually worsened symptoms rather than sudden onset. It is of great importance for neurosurgeons and radiologists to recognize the characteristics of this disease, make the correct diagnosis in time and avoid delayed treatment.
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Affiliation(s)
- Chao Wang
- Department of Radiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaotong Shao
- Department of Radiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yi Zou
- Department of Pathology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Nepal S, Santipas B, Yotchai W, Chairatchaneeboon M, Wilartratsami S, Luksanapruksa P. Pigmented epithelioid melanocytoma (PEM) of the spine with compression fracture: case report. BMC Musculoskelet Disord 2022; 23:13. [PMID: 34980046 PMCID: PMC8725277 DOI: 10.1186/s12891-021-04923-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 11/29/2021] [Indexed: 12/02/2022] Open
Abstract
Background Pigmented epithelioid melanocytoma (PEM) is a sporadic type of pigmented melanocytic tumor with uncertain malignant potential. PEM arises as a solitary neoplasm that predominantly occurs spontaneously in otherwise healthy patients. Due to its rarity, a gold standard treatment regimen does not exist; however, symptomatic cases should be managed with radiotherapy and surgery. Case presentation A 28-year-old Thai female presented with a sudden onset of back pain and weakness of the lower extremities during the postpartum period. Magnetic resonance imaging demonstrated abnormal soft tissue formation from T4 to T7; it extended to the vertebral bodies, left neural foramina, and posterior columns of T6 and T7. The patient underwent complete tumor debulking, decompressive laminectomy from T4 to T8, and posterior instrumentation from T3 to T10. The histopathology and immunohistochemistry suggested PEM. The patient fully resolved back pain after surgery. Nevertheless, as the patient re-presented with a neurological deficit a few months after the operative intervention, it was decided to perform a surgical resection via an en bloc vertebrectomy. At the one-year follow-up, although the patient reported continued improvement of her back pain, there was no motor power improvement. Conclusions Spinal cord compression due to PEM is uncommon, especially in adults. Early diagnosis and treatment provide a good prognosis and help to regain lost neurological functions. Complete tumor removal and decompression of the spinal cord must be considered as a treatment strategy. Perioperative radiotherapy and chemotherapy have also been highlighted as treatment modalities for spinal tumors. With our reported case, early operative intervention coupled with radiotherapy produced satisfying outcomes.
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Affiliation(s)
- Sarthak Nepal
- Division of Spine Surgery, Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok Noi, Bangkok, 10700, Thailand
| | - Borriwat Santipas
- Division of Spine Surgery, Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok Noi, Bangkok, 10700, Thailand
| | - Wasan Yotchai
- Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Sirichai Wilartratsami
- Division of Spine Surgery, Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok Noi, Bangkok, 10700, Thailand
| | - Panya Luksanapruksa
- Division of Spine Surgery, Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok Noi, Bangkok, 10700, Thailand.
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Suprasellar Melanocytoma with Leptomeningeal Seeding: An Aggressive Clinical Course for a Histologically Benign Tumor. Case Rep Radiol 2021; 2021:7306432. [PMID: 34671496 PMCID: PMC8523264 DOI: 10.1155/2021/7306432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 08/16/2021] [Accepted: 09/03/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Meningeal melanocytoma (MM) is a very rare neuroectodermal neoplasm arising from the leptomeninges. Primary suprasellar melanocytomas are exceedingly rare, with only a handful of cases reported. The systemic spread of a nontransformed meningeal melanocytoma is an unusual occurrence. Herein, we report the first case of a primary sellar melanocytoma with cerebral and spinal meningeal seeding. Case Report. A 30-year-old male with no previous medical history presented to the endocrinology department with a loss of body hair. The endocrine workup concluded with isolated hypogonadotropic hypogonadism. The Magnetic Resonance Imaging (MRI) of the brain and sella revealed a large suprasellar mass continuous with the infundibulum of the pituitary gland. It was heterogeneously hyperintense on T1-, T2-, and FLAIR-weighted images and was enhanced with contrast, along with cerebral and spinal leptomeningeal spread. The patient was referred to the neurosurgery department, and a lumbar spine biopsy was indicated. The histopathological examination was suggestive of a grade I meningeal pigmented melanocytoma. Conclusion Thus, primary sellar melanocytomas with leptomeningeal spread are an extremely rare phenomenon. Metastatic malignant melanoma should be ruled out. Being aware of differential diagnosis and the unusual behavior of meningeal melanocytoma will be necessary to manage the patient appropriately. Complete tumor resection is the best treatment whenever possible, and radiotherapy should be considered in case of unresectability or partial resection.
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Covington S, Severson M, Shaeffer P, McGaffey D, Garlanger K. Primary Melanocytomas of the Spinal Cord: Case Studies and Rehabilitation Perspectives. Arch Rehabil Res Clin Transl 2021; 3:100143. [PMID: 34589693 PMCID: PMC8463447 DOI: 10.1016/j.arrct.2021.100143] [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: 11/19/2022] Open
Abstract
Primary melanocytomas of the central nervous system are rare tumors arising from leptomeningeal melanocytes. Only 29 cases have been reported in the literature. Presenting symptoms may include insidious onset of back pain, slowly progressive neurologic deficits such as weakness and sensory changes, and bowel and bladder dysregulation. Advanced imaging including magnetic resonance imaging can be helpful in lesion localization but does not distinguish between primary and metastatic melanoma. In this case series, we present 3 patients with nontraumatic spinal cord injuries secondary to primary central nervous system malignant melanocytomas who were admitted to a single inpatient rehabilitation facility within a 12-month time frame. These cases highlight the importance of the rehabilitation team in the continuum of care for patients undergoing resection of primary melanocytomas of the spinal cord. The rehabilitation team should be involved in the preoperative counseling setting, immediately postoperatively, and in follow-up care to assess for signs of recurrence. A comprehensive multidisciplinary approach including physical and occupational therapists, rehabilitation nurses, rehabilitation neuropsychologists, and physiatrists is important for optimizing the function of these patients.
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Affiliation(s)
- Stephen Covington
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN
- Corresponding author Stephen Covington, DO, Department of Physical Medical and Rehabilitation, Mayo Clinic, 200 1st Ave. SW, Rochester, MN 55905.
| | - Matthew Severson
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN
| | - Patrick Shaeffer
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN
| | - Derek McGaffey
- Department of Graduate Medical Education, Saint Louis University School of Medicine, St. Louis, MO
| | - Kristin Garlanger
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN
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Flores A, Gadot R, Noorbhai I, Hall H, Heck KA, Raper DMS, Xu D, Karas P, Mandel JJ, Ropper AE. S-100-negative, GNA11 mutation-positive intramedullary meningeal melanocytoma of the thoracic spine: A radiographic challenge and histologic anomaly. Surg Neurol Int 2021; 12:315. [PMID: 34345456 PMCID: PMC8326103 DOI: 10.25259/sni_416_2021] [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] [Received: 04/26/2021] [Accepted: 06/02/2021] [Indexed: 11/04/2022] Open
Abstract
Background: Intramedullary melanocytomas are exceedingly rare and their management is largely based on case reports and small clinical series. They have characteristic imaging and histologic findings that can aid in their diagnosis. Genetic testing may be required for definitive diagnosis and management guidance in ambiguous cases. Case Description: We present the case of a thoracic intramedullary meningeal melanocytoma in a patient unable to undergo an MRI. Conclusion: This is the first reported S-100-negative case with genetic testing to support the diagnosis of a rare intramedullary melanocytoma.
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Affiliation(s)
- Alex Flores
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States
| | - Ron Gadot
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States
| | - Ibrahim Noorbhai
- Department of Neurology Baylor College of Medicine, Houston, Texas, United States
| | - Hayden Hall
- Department of Neurology Baylor College of Medicine, Houston, Texas, United States
| | - Kent Alan Heck
- Department of Pathology, Baylor College of Medicine, Houston, Texas, United States
| | | | - David Xu
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States
| | - Patrick Karas
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States
| | - Jacob J Mandel
- Department of Neurology Baylor College of Medicine, Houston, Texas, United States
| | - Alexander Eli Ropper
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States
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