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A rare primary sellar melanoma. Case report
Jochen Tüttenberg1, Wolfram Fink, Walter Back
1Department of Neurosurgery, University Hospital Mannheim, Mannheim, Germany. jochen.tuettenberg@nch.ma.uni-heidelberg.de
Journal of Neurosurgery
|May 13, 2004
Summary
A rare primary sellar melanoma, mimicking a pituitary tumor, was successfully treated in a 37-year-old woman. Management involved surgical removal and stereotactic radiotherapy, achieving a 24-month progression-free survival.
Area of Science:
- Neuro-oncology
- Endocrinology
- Ophthalmology
Background:
- Primary sellar melanomas are exceptionally rare, with only five cases previously reported in medical literature.
- The case involved a 37-year-old woman presenting with rapid vision loss due to chiasmal syndrome.
Observation:
- Magnetic resonance (MR) imaging revealed an intra- and suprasellar mass compressing the optic chiasm.
- The lesion's heterogeneous signal on MR imaging led to an initial misdiagnosis of hemorrhagic pituitary macroadenoma.
- Histological examination confirmed a malignant melanocytic tumor, immunopositive for S100 protein and HMB-45.
Findings:
- This case represents the sixth reported instance of primary sellar melanoma and the third evaluated with MR imaging.
- The patient underwent transsphenoidal resection followed by stereotactically guided radiotherapy.
- A 24-month follow-up demonstrated no evidence of tumor recurrence, marking the first reported case with such progression-free survival.
Implications:
- The findings suggest that primary sellar melanoma should be considered in the differential diagnosis of sellar masses, especially those with heterogeneous MR imaging characteristics.
- Effective management appears to involve gross-total surgical removal combined with postoperative stereotactic radiotherapy.
- This case highlights the importance of thorough histopathological and immunohistochemical analysis for accurate diagnosis and treatment planning of rare sellar tumors.