Cervical Spinal Meningeal Melanocytoma Presenting as Intracranial Superficial Siderosis

Abstract

Meningeal melanocytoma is a rare pigmented tumor of the leptomeningeal melanocytes. This rare entity results in diagnostic difficulty in imaging unless clinical and histopathology correlation is performed. In this case report, we describe a case of meningeal melanocytoma of the cervical region presenting with superficial siderosis. Extensive neuroradiological examination is necessary to locate the source of the bleeding in such patients. Usually, the patient will be cured by the complete surgical excision of the lesion.

Intradural extramedullary meningeal melanocytoma: a case report and literature review

“…A preoperative differential of spinal meningeal melanocytomas is challenging due to their non-specific clinical and neurological presentations [ 5 ]. Clinical manifestations are usually progressive myelopathy and radiculopathy due to spinal cord and nerve root compression [ 6 ] as well as weakness, sensory deficits and progressive pain [ 5 ].…”

“…Radiologically, they appear as well-defined, extra-axial, isodense-to-hyperdense, homogeneous, contrast-enhancing mass lesions on CT. Their appearance is variable on MRI depending on melanin concentration [ 5 ]. MRI hyperintensity on T1-weighted imaging and iso-/hypointensity on T2-weighted imaging caused by melanin help to distinguish meningeal melanocytomas from other meningiomas [ 6 ].…”

“…Complete GTR is the treatment of choice, however, may not always be appropriate due to intraoperative haemorrhage risk [ 5 ]. The risk of tumour recurrence is noted even after GTR; therefore, adjuvant radiotherapy is advised [ 5 ].…”

“…Complete GTR is the treatment of choice, however, may not always be appropriate due to intraoperative haemorrhage risk [ 5 ]. The risk of tumour recurrence is noted even after GTR; therefore, adjuvant radiotherapy is advised [ 5 ]. Meningeal melanocytomas are associated with leptomeningeal spread [ 5 ] and a high risk of local recurrence [ 6 ].…”

Acute onset of paraplegia due to melanocytic cervicodorsal lesion

“…[ 3 , 6 ] Melanocytoma commonly presents in posterior fossa and foramen magnum, but only rarely in the spine. [ 2 ] Due to the benign nature of these tumors, and their typical slow growth, spinal symptoms/signs have a slow onset, and reflect the location of the lesion; acute paraplegia is very rare. [ 4 ] We treated this lesion as an acute spinal cord compression to grant the total neurological recovery of the patient, giving priority to clinical status with respect to complete removal of the tumor; although these are benign tumors, for gross total, subtotal or partial excision, the risk of recurrence is sufficiently high to warrant adjuvant radiation therapy.…”