Spinal meningeal melanocytoma: A rare meningeal tumor

Shanthi, Vissa; Ramakrishna, Baddukonda Appala; Bheemaraju, Vydehi; Rao, Nandam Mohan; Athota, Venkata Ramana Murthy

doi:10.4103/0972-2327.74192

Cited by 13 publications

(11 citation statements)

References 6 publications

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“…Spinal melanocytomas mostly occur in the cervical or thoracic spine and usually present as intradural and extramedullary lesions on imaging. () Melanocytic neoplasms form a continuum from a well‐differentiated melanocytoma to frankly malignant melanoma. Melanocytomas are discrete, non‐infiltrative tumors composed of bland spindle or oval shaped cells with variable melanin content and without cytologic atypia or mitoses.…”

Section: Discussionmentioning

confidence: 99%

72 Year Old Female with Leg Weakness

Mahta¹,

Borys

Carter

et al. 2014

Brain Pathology

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A 72 year old female with no significant past medical history who had chronic low back pain was referred to our center for evaluation of an incidentally discovered intramedullary lesion in her thoracic spine after her recent fall. On exam she was neurologically intact. MRI of thoracic spine revealed a well-defined intramedullary lesion with an intradural component measuring about 1 cm. (Fig 1a, left) There was a mildly increased T2 signal with enhancement. It was considered an incidental finding and the initial plan was close observation, given her unwillingness for any surgical intervention, in addition to the small size of the lesion, lack of neurological deficits and its benign appearance on imaging. Based on imaging, the differential was a low-grade astrocytoma, ependymoma or an intramedullary schwannoma. After about 3 years, in a follow up visit, we noticed a mild weakness in her left lower extremity and some gait unsteadiness. This was accompanied by a significant increase in the size of the lesion (Fig 1a, right), so she agreed to an excisional biopsy. Intraoperatively the lesion was noted to be a bluish, firm mass with a good plane at the level of T10/11. NEUROPATHOLOGICAL FINDINGSH&E stained sections showed a discrete non-infiltrative spindle cell neoplasm with moderate to high cellularity. Interwoven fascicles of neoplastic cells ranged from plumply spindle shaped with ovoid nuclei to more overtly fusiform with slender bipolar nuclei. In a few fields clusters of tumor cells had polygonal contours and appeared vaguely epithelial. Melanin was distributed as a fine dusting within fusiform cells and clumpy aggregates in melanophages. (Fig 1b) Nucleoli were distinct or slightly prominent only in a few fields, and some nuclei had longitudinal grooves. Prolonged scrutiny was required for the identification of even a rare mitotic figure and there was no necrosis. The tumor cells were positive for S-100, HMB-45 (Fig 1c), and MART-1. An iron stain was negative confirming the melanotic nature of the brown granular pigment. A MIB-1 preparation labeled less than 1% of tumor nuclei. Electron microscopy showed that the melanin containing tumor cells lacked basal lamina. In addition, in the cytoplasm of these cells, a full range of melanized structures was observed in various stages of maturation ranging from the premelanosomes to fully melanized organelles. (Fig 1d) Premelanosomes were abundant and had the characteristic "zipper"-like cores. (Fig 1e) What is your diagnosis Figure 1.

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Section: Discussionmentioning

confidence: 99%

72 Year Old Female with Leg Weakness

Mahta¹,

Borys

Carter

et al. 2014

Brain Pathology

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“…Most commonly they are located over the posterior fossa and the cervical spinal cord. Spinal melanocytomas are also rare and their description is limited to case reports (3,5,6,11). We report a case of a cervicomedullary junction melanocytoma and review the literature in brief.…”

Section: Introductionmentioning

confidence: 95%

“…The mainstay of treatment is surgical excision (5)(6)(7)(8)(9)(10)(11). A review of the literature on spinal meningeal melanocytoma shows that total resection was achieved in 8 of the 10 operated cases (10).…”

Section: Melanocytic Tumors Of the Cns May Be Classified As Low Gradementioning

confidence: 99%

Craniovertebral junction melanocytoma: a case report

Bhargava

Grewal²,

Dewan³

et al. 2011

Turkish Neurosurgery

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Melanocytomas are rare melanocytic tumors of the central nervous system and its presence at the foramen magnum is extremely rare. We report a case of a 55-year-old male presenting with progressive quadriparesis over one year. Imaging showed a well-defined intradural extramedullary lobulated mass at craniovertebral junction towards the left side and extending to left C2-3 neural foramina. Patient was operated through foramen magnum approach with near total excision of tumor. On a ten-month follow up, he was ambulatory with normal motor power on right side of body and left lower limb and with motor power of 4-/5 in left upper limb. Histopathology and immunohistochemistry confirmed the lesion to be a melanocytoma. KeywOrds: Melanocytoma, Foramen magnum, Craniovertebral junction ÖZMelanositomlar merkez sinir sisteminin nadir melanositik tümörleridir ve foramen magnumda bulunmaları son derece nadirdir . Bir yıl boyunca ilerleyen kuadraparezili 55 yaşında bir erkek olguyu sunuyoruz. Görüntüleme kraniyovertebral bileşkede sol tarafta, sol C2-3 nöral foramenlere doğru uzanan iyi tanımlanmış bir intradural ekstramedüller lobule kitle gösterdi. Hasta foramen magnum yaklaşımıyla ameliyat edildi ve tümör hemen hemen tümüyle eksize edildi. On aylık takipte vücudun sağ tarafı ve sol alt uzuvda normal motor güç ve sol üst uzuvda 4-/5 motor güçle hareket edebilir hale geldi. Histopatoloji ve immünohistokimya lezyonun bir melanositom olduğunu gösterdi.

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“…3 They originate from the melanocytes along the neural crest with typical occurrence in the leptomeninges. 4 Females are more commonly affected than males with a peak incidence in the fifth decade. 4 The clinical presentation of these patients vary from minimal vague symptoms to myelopathy mimicking other intradural space-occupying lesions.…”

Section: Brat Et Al Classified Melanotic Lesions Into Low-mentioning

confidence: 99%

“…4 Females are more commonly affected than males with a peak incidence in the fifth decade. 4 The clinical presentation of these patients vary from minimal vague symptoms to myelopathy mimicking other intradural space-occupying lesions. 1 Melanocytomas, though considered benign, can undergo malignant transformation into melanomas.…”

Section: Brat Et Al Classified Melanotic Lesions Into Low-mentioning

confidence: 99%

Intradural Intramedullary Primary Spinal Melanocytoma: A Rare Case Report

Ganesan

Acharya

Kalra

et al. 2016

Indian Journal of Neurosurgery

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Spinal melanocytomas are rare pigmented tumors of the central nervous system commonly affecting females in their fifth decades. It has been reported in various locations with intradural intramedullary being the rarest. Patients can present with varied symptomatology from mild backache to frank myelopathy. Here we report a case of 34-year-old man with no medical comorbidities with vague backache associated with numbness of anterior aspect of right thigh for 1 year aggravated by activities and relieved by rest. His neurologic examination revealed normal power and sensation in both lower limbs except for decreased temperature sensation in right L2 dermatome. MRI of dorsolumbar spine revealed a well-defined lesion that was hyperintense in T1- and hypointense in T2-weighted image at D11–12 region with uniform bright enhancement in gadolinium-enhanced T1 image. The patient underwent laminectomy of D11 and D12, and an en bloc excision was done. Diagnosis of primary intradural intramedullary melanocytoma was made from histopathologic examination. Spinal melanocytomas should be considered as a differential diagnosis for intradural space-occupying lesions. MRI remains the investigation of choice for diagnosis, but histopathologic examination is required to confirm and differentiate from other pigmented tumors and malignant melanomas. Total surgical excision of the tumor remains the standard treatment with radiotherapy reserved for cases of incomplete excision and recurrences.

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Spinal meningeal melanocytoma: A rare meningeal tumor

Cited by 13 publications

References 6 publications

72 Year Old Female with Leg Weakness

72 Year Old Female with Leg Weakness

Craniovertebral junction melanocytoma: a case report

Intradural Intramedullary Primary Spinal Melanocytoma: A Rare Case Report

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