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[Primitive malignant melanoma arising in a spinal nerve root. A case report]
J-F Mineo1, M-M P-Ruchoux, D Pasquier
1Service de Neurochirurgie, Hôpital Roger-Salengro, Centre Hospitalier Régional et Universitaire de Lille. j-mineo@CHRU-lille.fr
Neuro-Chirurgie
|July 15, 2006
Summary
This case study details a rare primitive malignant melanoma in a spinal nerve root, initially misdiagnosed as schwannoma due to imaging. The tumor showed aggressive features despite slow clinical progression, leading to metastasis and death.
Area of Science:
- Neurosurgery
- Oncology
- Radiology
Background:
- Primitive malignant melanoma of the spine is exceptionally rare.
- Spinal nerve root tumors often present with symptoms mimicking benign conditions like schwannoma.
Observation:
- A 39-year-old woman presented with chronic low back pain and neurological deficits.
- MRI revealed an enlarged L3 nerve root with L3/L4 foramen scalloping, initially suggesting schwannoma.
- Histopathology confirmed a malignant melanoma with a high proliferation index.
Findings:
- The tumor exhibited T1 hyperintensity on MRI, a feature suggestive of melanocytic origin.
- Immunohistochemistry confirmed melanin pigment and melanoma markers (HMB-45, S100).
- Despite complete surgical removal and radiotherapy, the patient developed fatal pulmonary metastasis.
Implications:
- This case highlights the diagnostic challenges in differentiating rare spinal melanomas from benign tumors based on imaging alone.
- Early recognition of subtle MRI signs, like T1 hyperintensity, is crucial for suspecting melanocytic lesions.
- The variable clinical course of spinal melanomas underscores the need for careful histopathological evaluation and prognosis assessment.
