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J Neurol Surg Rep 2014; 75(01): e93-e97
DOI: 10.1055/s-0034-1372474
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Primary Leptomeningeal Melanoma of the Cervical Spine Mimicking a Meningioma—A Case Report

Sascha Marx
1   Department of Neurosurgery, University of Greifswald, Sauerbruchstraße, Greifswald, Germany
,
Steffen K. Fleck
1   Department of Neurosurgery, University of Greifswald, Sauerbruchstraße, Greifswald, Germany
,
Jotham Manwaring
2   Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida
,
Silke Vogelgesang
3   Department of Neuropathology, University of Greifswald, Greifswald, Germany
,
Soenke Langner
4   Institut of Radiology and Neuroradiology, University of Greifswald, Sauerbruchstraße, Greifswald, Germany
,
Henry W.S. Schroeder
1   Department of Neurosurgery, University of Greifswald, Sauerbruchstraße, Greifswald, Germany
› Author Affiliations
Further Information

Publication History

19 December 2013

13 January 2014

Publication Date:
12 May 2014 (online)

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Abstract

Background and Importance Primary leptomeningeal melanoma (PLM) is highly malignant and exceedingly rare. Due to its rarity, diagnostic and treatment paradigms have been slow to evolve. We report the first case of a PLM that mimics a cervical spine meningioma and then discuss the current clinical, radiologic, and pathologic diagnostic methodologies as well as expected outcomes related to this disease.

Clinical Presentation A 54-year-old woman presented a dural-based extramedullary solid mass ventral to the C2–C3 spinal cord causing spinal cord compression without cord signal changes, characteristic of meningioma. Intraoperative microscopic inspection revealed numerous black spots littering the surface of the dura; the tumor itself was yellow in appearance and had a soft consistency. Pathologic analysis of the specimen revealed a malignant melanin-containing tumor. No primary site was found, so a diagnosis of primary leptomeningeal melanoma was made, and the patient subsequently received interferon therapy. To date (2 years postoperatively), no local or systemic recurrence of the tumor has been identified.

Conclusion As with most rare tumors, case reports constitute the vast majority of references to PLM. Only an increased awareness and an extensive report of each individual case can help diagnose and clarify the nature of PLM. Clinicians need to be aware of such malignant conditions when diagnosing benign tumoral lesions of the spine such as meningiomas.

Keywords

CSF analysis - histology - meningioma - misdiagnosis - MRI characteristics - primary leptomeningeal melanoma
 

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