Transition from meningeal melanocytoma to primary cerebral melanoma

Case report

Florian Roser M.D.1, Makoto Nakamura M.D.1, Almuth Brandis M.D.1, Volkmar Hans M.D.1, Peter Vorkapic M.D., Ph.D.1, and Madjid Samii M.D., Ph.D.1
View More View Less
  • 1 Department of Neurosurgery, Klinikum Hannover Nordstadt; Institute of Pathology, Klinikum Hannover; Institute for Neuropathology and German Brain Tumor Reference Center, University of Bonn; and International Neuroscience Institute, Hannover, Germany
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
Print or Print + Online

✓ The authors describe the first case of an intracranial transition of a melanocytoma into a primary malignant melanoma within a short time. A 37-year-old woman presented with progressive brainstem syndrome due to a tumor, originally diagnosed and treated 12 years earlier, that extended from the petroclival area to the anterior craniocervical junction. The histological workup following subtotal tumor resection of the initial tumor had revealed the typical features of a fibrous melanocytic meningioma without increased proliferation. Ten years after the patient had completed treatment for the melanocytic meningioma, control neuroimaging demonstrated growth of the residual tumor with compression of the brainstem. Another neurosurgical intervention revealed a dark tumor of hard consistency. At this time immunohistochemical examinations demonstrated melanocytic features (expression of vimentin, S100 protein, and melan A) of the lesion with focally increased proliferation (5% of Ki-67—positive cells) but no higher mitotic activity. Clinical signs of deterioration along with imaging-confirmed tumor progression precipitated another operation within 7 months. A neuropathological examination revealed epithelial and anaplastic changes and indicated that the MIB-1 indices were greater than 25%. Pleomorphic changes and a focal high mitotic activity led to the diagnosis of a primary cerebral malignant melanoma. The patient's later clinical course consisted of a rapid diffuse meningeal spread of the lesion throughout the entire brain and spine. Despite whole-brain and stereotactic radiation therapy as well as chemotherapy, the patient died 4 months after the last neuropathological diagnosis. Although grossly resembling a meningioma, melanocytomas lack the former's histological and immunohistochemical features. The biological behavior of a melanocytoma is variable and recurrence may happen after subtotal resection, but intracranial transition into a malignant melanoma has not been observed previously.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
  • 1.

    Botticelli AR, , Villani M, & Angiari P, et al: Meningeal melanocytoma of Meckel's cave associated with ipsilateral Ota's nevus. Cancer 51:23042310, 1983 Botticelli AR, Villani M, Angiari P, et al: Meningeal melanocytoma of Meckel's cave associated with ipsilateral Ota's nevus. Cancer 51:2304–2310, 1983

    • Search Google Scholar
    • Export Citation
  • 2.

    Brat DJ, , Giannini C, & Scheithauer BW, et al: Primary melanocytic neoplasms of the central nervous systems. Am J Surg Pathol 23:745754, 1999 Brat DJ, Giannini C, Scheithauer BW, et al: Primary melanocytic neoplasms of the central nervous systems. Am J Surg Pathol 23:745–754, 1999

    • Search Google Scholar
    • Export Citation
  • 3.

    Chen CJ, , Hsu YI, & Ho YS, et al: Intracranial meningeal melanocytoma: CT and MRI. Neuroradiology 39:811814, 1997 Chen CJ, Hsu YI, Ho YS, et al: Intracranial meningeal melanocytoma: CT and MRI. Neuroradiology 39:811–814, 1997

    • Search Google Scholar
    • Export Citation
  • 4.

    Chow M, , Clarke DB, & Maloney WJ, et al: Meningeal melanocytoma of the planum sphenoidale. Case report and review of the literature. J Neurosurg 94:841845, 2001 Chow M, Clarke DB, Maloney WJ, et al: Meningeal melanocytoma of the planum sphenoidale. Case report and review of the literature. J Neurosurg 94:841–845, 2001

    • Search Google Scholar
    • Export Citation
  • 5.

    Clarke DB, , Leblanc R, & Bertrand G, et al: Meningeal melanocytoma. Report of a case and a historical comparison. J Neurosurg 88:116121, 1998 Clarke DB, Leblanc R, Bertrand G, et al: Meningeal melanocytoma. Report of a case and a historical comparison. J Neurosurg 88:116–121, 1998

    • Search Google Scholar
    • Export Citation
  • 6.

    Cordoba A, , Tunon T, & Vazquez JJ: Melanocitoma meningeo. Presentacion de un caso y revision de la literature. Arch Neurobiol 52:9399, 1989 Cordoba A, Tunon T, Vazquez JJ: Melanocitoma meningeo. Presentacion de un caso y revision de la literature. Arch Neurobiol 52:93–99, 1989

    • Search Google Scholar
    • Export Citation
  • 7.

    Ferracini R, , Gardini G, & Brisigotti M, et al: Metastasizing meningeal melanocytoma. Tumori 66:405408, 1980 Ferracini R, Gardini G, Brisigotti M, et al: Metastasizing meningeal melanocytoma. Tumori 66:405–408, 1980

    • Search Google Scholar
    • Export Citation
  • 8.

    Leonardi MA, , Lumenta CB, & Stolzle A, et al: Unusual clinical presentation of a meningeal melanocytoma with seizures: case report and review of the literature. Acta Neurochir 140:621628, 1998 Leonardi MA, Lumenta CB, Stolzle A, et al: Unusual clinical presentation of a meningeal melanocytoma with seizures: case report and review of the literature. Acta Neurochir 140:621–628, 1998

    • Search Google Scholar
    • Export Citation
  • 9.

    Lesoin F, , Leys D, & Pasquier F, et al: Melanotic meningioma. Report of a case and review of the literature. Neurochirurgia 28:205207, 1985 Lesoin F, Leys D, Pasquier F, et al: Melanotic meningioma. Report of a case and review of the literature. Neurochirurgia 28:205–207, 1985

    • Search Google Scholar
    • Export Citation
  • 10.

    Limas C, & Tio FO: Meningeal melanocytoma (“melanotic meningioma”). Its melanocytic origin as revealed by electron microscopy. Cancer 30:12861294, 1972 Limas C, Tio FO: Meningeal melanocytoma (“melanotic meningioma”). Its melanocytic origin as revealed by electron microscopy. Cancer 30:1286–1294, 1972

    • Search Google Scholar
    • Export Citation
  • 11.

    Meyer D, , Ge J, & Blinder KJ, et al: Malignant transformation of an optic disk melanocytoma. Am J Ophthalmol 127:710714, 1999 Meyer D, Ge J, Blinder KJ, et al: Malignant transformation of an optic disk melanocytoma. Am J Ophthalmol 127:710–714, 1999

    • Search Google Scholar
    • Export Citation
  • 12.

    Nakagawa H, , Hayakawa T, & Niiyama K, et al: Long-term survival after removal of primary intracranial malignant melanoma. Case report. Acta Neurochir 101:8488, 1989 Nakagawa H, Hayakawa T, Niiyama K, et al: Long-term survival after removal of primary intracranial malignant melanoma. Case report. Acta Neurochir 101:84–88, 1989

    • Search Google Scholar
    • Export Citation
  • 13.

    O'Brien TF, , Moran M, & Miller JH, et al: Meningeal melanocytoma. An uncommon diagnostic pitfall in surgical neuropathology. Arch Pathol Lab Med 119:542546, 1995 O'Brien TF, Moran M, Miller JH, et al: Meningeal melanocytoma. An uncommon diagnostic pitfall in surgical neuropathology. Arch Pathol Lab Med 119:542–546, 1995

    • Search Google Scholar
    • Export Citation
  • 14.

    Rades D, , Tatagiba M, & Brandis A, et al: Stellenwert der Strahlentherapie bei der Behandlung des meningealen Melanozytoms. Strahlenther Onkol 178:336342, 2002 Rades D, Tatagiba M, Brandis A, et al: Stellenwert der Strahlentherapie bei der Behandlung des meningealen Melanozytoms. Strahlenther Onkol 178:336–342, 2002

    • Search Google Scholar
    • Export Citation
  • 15.

    Ray BS, & Foot NC: Primary melanotic tumors of the meninges: resemblance to meningiomas. Report of two cases in which operation was performed. Arch Neurol Psychiatry 44:104117, 1940 Ray BS, Foot NC: Primary melanotic tumors of the meninges: resemblance to meningiomas. Report of two cases in which operation was performed. Arch Neurol Psychiatry 44:104–117, 1940

    • Search Google Scholar
    • Export Citation
  • 16.

    Rodriguez y Baena R, , Gaetani P, & Danova M, et al: Primary solitary intracranial melanoma: case report and review of the literature. Surg Neurol 38:2637, 1992 Rodriguez y Baena R, Gaetani P, Danova M, et al: Primary solitary intracranial melanoma: case report and review of the literature. Surg Neurol 38:26–37, 1992

    • Search Google Scholar
    • Export Citation
  • 17.

    Russell DS, & Rubinstein LJ: Pathology of Tumors of the Nervous System, ed 5. London: Arnold, 1989, pp 792808 Russell DS, Rubinstein LJ: Pathology of Tumors of the Nervous System, ed 5. London: Arnold, 1989, pp 792–808

    • Search Google Scholar
    • Export Citation
  • 18.

    Sharma PM, , Sangal K, & Malik P, et al: Malignant transformation of optic disc melanocytoma? A clinical dilemma at presentation with a review of the literature. Ophthalmologica 216:292295, 2002 Sharma PM, Sangal K, Malik P, et al: Malignant transformation of optic disc melanocytoma? A clinical dilemma at presentation with a review of the literature. Ophthalmologica 216:292–295, 2002

    • Search Google Scholar
    • Export Citation
  • 19.

    Shields JA, , Shields CL, & Eagle RC Jr, et al: Malignant melanoma associated with melanocytoma of the optic disc. Ophthalmology 97:225230, 1990 Shields JA, Shields CL, Eagle RC Jr, et al: Malignant melanoma associated with melanocytoma of the optic disc. Ophthalmology 97:225–230, 1990

    • Search Google Scholar
    • Export Citation
  • 20.

    Skarli SO, , Wolf AL, & Kristt DA, et al: Melanoma arising in a cervical spinal nerve root: report of a case with a benign course and malignant features. Neurosurgery 34:533537, 1994 Skarli SO, Wolf AL, Kristt DA, et al: Melanoma arising in a cervical spinal nerve root: report of a case with a benign course and malignant features. Neurosurgery 34:533–537, 1994

    • Search Google Scholar
    • Export Citation
  • 21.

    Theunissen P, , Spincemaille G, & Pannebakker M, et al: Meningeal melanoma associated with nevus of Ota: case report and review. Clin Neuropathol 12:125129, 1993 Theunissen P, Spincemaille G, Pannebakker M, et al: Meningeal melanoma associated with nevus of Ota: case report and review. Clin Neuropathol 12:125–129, 1993

    • Search Google Scholar
    • Export Citation
  • 22.

    Vasdev A, , David P, & Villemot D, et al: Apparently primary malignant melanoma of the cerebellopontine angle. One case. J Neuroradiol 17:152156, 1990 Vasdev A, David P, Villemot D, et al: Apparently primary malignant melanoma of the cerebellopontine angle. One case. J Neuroradiol 17:152–156, 1990

    • Search Google Scholar
    • Export Citation
  • 23.

    Virchow R: Pigment und diffuse Melanose der Arachnoides. Arch Pathol Anat 16:180182, 1859 Virchow R: Pigment und diffuse Melanose der Arachnoides. Arch Pathol Anat 16:180–182, 1859

    • Search Google Scholar
    • Export Citation
  • 24.

    Woodruff WW Jr, , Djang WT, & McLendon RE, et al: Intracerebral malignant melanoma: high-field-strength MR imaging. Radiology 165:209213, 1987 Woodruff WW Jr, Djang WT, McLendon RE, et al: Intracerebral malignant melanoma: high-field-strength MR imaging. Radiology 165:209–213, 1987

    • Search Google Scholar
    • Export Citation
  • 25.

    Yamane K, , Shima T, & Okada Y, et al: Primary pineal melanoma with long-term survival: case report. Surg Neurol 42:433437, 1994 Yamane K, Shima T, Okada Y, et al: Primary pineal melanoma with long-term survival: case report. Surg Neurol 42:433–437, 1994

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 472 86 9
Full Text Views 200 16 0
PDF Downloads 132 11 0
EPUB Downloads 0 0 0