Meningeal malignant melanoma in a child: immunocytological diagnosis

A 10 year old boy, who was thought to have had a traumatic intracranial hemorrhage, was transferred to our Children's Medical Center. In spite of conservative treatment, he developed dysarthria, systemic convulsions, unconsciousness, quadriplegia, and consecutive paralysis of the cranial nerves. Magnetic resonance imaging scans demonstrated areas of increased signal intensity around the brain stem. The cerebrospinal fluid (CSF) contained a few large cells with abundant melanin-like granules, and numerous bizarre cells. The latter were considered to be malignant melanoma cells on immunocytological examination. Chemotherapy with dimethyltriazenoimidazole carboxamide (DTIC) and interferon beta (IFN-beta) was ineffective and he expired. Autopsy revealed diffuse infiltration of malignant melanoma cells into the meninges. We think that immunocytological examination of CSF is advisable for correct and rapid diagnosis.