Primary hemorrhagic intramedullary melanoma. Case report with emphasis on the difficult preoperative diagnosis
L Denaro1, R Pallini, L Di Muro
1Department of Neurosurgery, Catholic University School of Medicine, Rome, Italy. lucadenaro@hotmail.com
Abstract:
Primary melanoma of the central nervous system (CNS) is rare and primary spinal melanoma (PSM) is even more unusual. Preoperative diagnosis of melanocytic lesion as a PSM is difficult, because of the heterogeneous magnetic resonance (MR) signal intensity, due to hemorrhagic foci and melanin deposits. We describe the case of a 68 year-old male with a MR showing at Th8-Th9 level a well-defined intramedullary lesion; for the characteristics of hemorrhagic signal on MR and its association with a presumptive brain cavernoma, a preoperative diagnosis of intramedullary cavernous angioma was suspected. Pathological examination revealed a melanoma, and for the absence of other localizations outside the spinal cord, a diagnosis of primary spinal melanoma was established. The growth of PSM is slower and survival is longer than in the most common spinal metastasis from skin melanoma. Patients who undergo surgical excision, alone or associated with additional treatments, often show a long survival. We report this case to underline the importance and difficulties concerning the preoperative diagnosis of a hemorrhagic intramedullary lesion.
Insights
Primary spinal melanoma (PSM) is a rare central nervous system (CNS) tumor. This case highlights diagnostic challenges of PSM, emphasizing the need for careful evaluation of intramedullary lesions.
Area of Science:
- Neurology
- Oncology
- Pathology
Background:
- Primary melanoma of the central nervous system (CNS) is rare, with primary spinal melanoma (PSM) being exceptionally unusual.
- Accurate preoperative diagnosis of PSM is challenging due to heterogeneous magnetic resonance (MR) signal intensity caused by hemorrhagic foci and melanin deposits.
Observation:
- A 68-year-old male presented with a well-defined intramedullary lesion at the Th8-Th9 level.
- Initial MR imaging suggested an intramedullary cavernous angioma due to hemorrhagic signals and association with a presumptive brain cavernoma.
- Pathological examination confirmed melanoma, and the absence of other localizations established the diagnosis of primary spinal melanoma.
Findings:
- Primary spinal melanoma exhibits slower growth and longer survival rates compared to metastatic melanoma of the skin.
- Surgical excision, with or without adjuvant therapies, is associated with prolonged survival in PSM patients.
Implications:
- This case underscores the diagnostic difficulties associated with preoperative identification of hemorrhagic intramedullary lesions.
- Increased awareness and advanced diagnostic strategies are crucial for timely and accurate diagnosis of rare spinal cord tumors like PSM.
