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Gold J, Hernandez NR, Wong T, Patel N, Weiner J, Hanft S. Primary Spinal Malignant Melanoma Mimicking a Cervical Nerve Root Schwannoma: Case Report and Literature Review. Asian J Neurosurg 2024; 19:540-550. [PMID: 39205889 PMCID: PMC11349406 DOI: 10.1055/s-0044-1787081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
Abstract
Primary spinal malignant melanoma (PSMM) is a rare cancer of the central nervous system (CNS), and PSMM of the spinal nerve root is even more extraordinary. PSMM of a nerve root can mimic the radiographic appearance of benign nerve sheath tumors, thus resulting in misdiagnosis until tissue diagnosis can be made. A 53-year-old African American woman presented with pain primarily involving the left aspect of her neck and shoulder for 2 years. Magnetic resonance imaging (MRI) of the cervical spine demonstrated a T1-hyperintense, T2-hypointense, homogenously enhancing, dumbbell-shaped, intradural extramedullary mass extending out through the left C2-3 foramen. A midline incision was used to perform a C2 and C3 laminectomy, and the mass was removed from the cavity. The histopathologic profile was consistent with the diagnosis of malignant melanoma. The present case report adds to the 110 cases of PSMM and the 20 cases of PSMM of the spinal nerve root in the existing body of literature. Radiographic and clinical features resemble that of the much more common schwannoma or neurofibroma requiring immunohistochemical analysis for definitive diagnosis. The optimal treatment for PSMM has not yet been defined due to its rarity and it is therefore important to report such cases in order to share our clinical experiences and provide data to other clinicians treating this uncommon disease.
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Affiliation(s)
- Justin Gold
- Department of Neurological Surgery, Cooper Medical of Rowan University, Camden, New Jersey, United States
| | - Nick R. Hernandez
- Department of Neurosurgery, Robert Wood Johnson Hospital, New Brunswick, New Jersey, United States
| | - Timothy Wong
- Department of Neurosurgery, Robert Wood Johnson Hospital, New Brunswick, New Jersey, United States
| | - Nitesh Patel
- Department of Neurosurgery, Robert Wood Johnson Hospital, New Brunswick, New Jersey, United States
| | - Joseph Weiner
- Department of Radiation Oncology, Robert Wood Johnson Hospital, New Brunswick, New Jersey, United States
| | - Simon Hanft
- Department of Neurological Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York, United States
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Khalilullah T, Mignucci-Jiménez G, Huffman H, Karthikeyan H, Hanif Z, Ariwodo O, Panchal RR. Surgical Management of Primary Thoracic Epidural Melanoma. Cureus 2024; 16:e54536. [PMID: 38516457 PMCID: PMC10956551 DOI: 10.7759/cureus.54536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 02/20/2024] [Indexed: 03/23/2024] Open
Abstract
In this study, we reported one of the first cases where a rare robotic-assisted platform with neuronavigation technology and carbon-fiber-polyetheretherketone (CF/PEEK) screws is employed to surgically treat multilevel thoracic primary spinal epidural melanoma. A 67-year-old male presented with left upper thoracic pain. His magnetic resonance imaging (MRI) of the thoracic spine revealed a dumbbell-shaped left epidural mass at the T2-3 level. Partial resection was performed due to tumor growth into the vertebral bodies and patient discretion for minimal surgery. The patient's neurological conditions improved postoperatively, with reduced reported symptoms of pain and numbness. Postoperative imaging showed evidence of appropriate spinal stabilization. Patient underwent stereotactic body radiation therapy (SBRT), and no adverse events were reported. This case reflects one of the first examples of treating thoracic epidural melanoma with the use of robotic-assisted navigation. Further prospective studies are needed to determine the efficacy of robot-assisted navigation for patients with primary spinal malignant melanoma which may open the possibility of surgery to once presumed non-operative patients.
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Affiliation(s)
| | - Giancarlo Mignucci-Jiménez
- Neurosurgery, Loyal and Edith Davis Neurosurgical Research Laboratory, Barrow Neurological Institute, Phoenix, USA
| | | | | | - Zaheer Hanif
- Neurosurgery, University of Texas Medical Branch, Galveston, USA
| | - Ogechukwu Ariwodo
- Neurosurgery, Philadelphia College of Osteopathic Medicine South Georgia, Moultrie, USA
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Abstract
Though metastasis and malignant infiltration of the peripheral nervous system is relatively rare, physicians should have a familiarity with their presentations to allow for prompt diagnosis and initiation of treatment. This article will review the clinical presentations, diagnostic evaluation, and treatment of neoplastic involvement of the cranial nerves, nerve roots, peripheral nerves, and muscle. Due to the proximity of the neural structure traversing the skull base, metastasis to this region results in distinctive syndromes, most often associated with breast, lung, and prostate cancer. Metastatic involvement of the nerve roots is uncommon, apart from leptomeningeal carcinomatosis and bony metastasis with resultant nerve root damage, and is characterized by significant pain, weakness, and numbness of an extremity. Neoplasms may metastasize or infiltrate the brachial and lumbosacral plexuses resulting in progressive and painful sensory and motor deficits. Differentiating neoplastic involvement from radiation-induced injury is of paramount importance as it dictates treatment and prognosis. Neurolymphomatosis, due to malignant lymphocytic infiltration of the cranial nerves, nerve roots, plexuses, and peripheral nerves, deserves special attention given its myriad presentations, often mimicking acquired demyelinating neuropathies.
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Shi YF, Chen YQ, Chen HF, Hu X. An atypical primary malignant melanoma arising from the cervical nerve root: A case report and review of literture. World J Clin Cases 2022; 10:381-387. [PMID: 35071542 PMCID: PMC8727269 DOI: 10.12998/wjcc.v10.i1.381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 10/29/2021] [Accepted: 11/30/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Primary melanomas affecting the central nervous system are very rare, and melanomas originating in the spinal canal or origin of the spinal nerve root are even rarer. As a consequence, not much is known about this.
CASE SUMMARY Here we report a case of primary malignant melanoma originating in the cervical spinal cord nerve root. A 64-year-old woman presented with symptoms of numbness in the right side of the neck, pain, and hypoesthesia in the right upper limb which persisted for 1 year. Neurological examination showed that the superficial sensation in the right upper limb had decreased with muscle strength of grade 4. Magnetic resonance imaging examination revealed a mass (approximately 2.5 cm × 1.4 cm × 1 cm) in the right side of the spinal canal in the C-2 plane. Based on findings obtained during operation, perioperative examination, pathological diagnosis, and the diagnostic criteria of primary central melanoma proposed by Hayward, the mass was confirmed to be a melanoma of intraspinal nerve root origin.
CONCLUSION This is the first case of primary malignant melanoma originating from cervical spinal cord nerve roots and spread along the inside and outside of the spinal canal. The clinical relevance of this case is discussed to provide new insights into the differential diagnosis of intraspinal tumours. Further studies are needed to better understand the mechanisms driving the growth pattern and development of this type of tumour.
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Affiliation(s)
- Yi-Feng Shi
- Department of Neurosurgery, West China Hospital, Chengdu 610041, Sichuan Province, China
| | - Yu-Qi Chen
- Department of Neurosurgery, West China Hospital, Chengdu 610041, Sichuan Province, China
| | - Hai-Feng Chen
- Department of Neurosurgery, West China Hospital, Chengdu 610041, Sichuan Province, China
| | - Xin Hu
- Department of Neurosurgery, West China Hospital, Chengdu 610041, Sichuan Province, China
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Takagi Y, Yamada H, Ebara H, Hayashi H, Kidani S, Okamoto S, Toyooka K, Nanpo K, Kitano Y, Terahata S, Tsuchiya H. Thoracic extradural malignant melanoma with unknown primary. BJR Case Rep 2020; 6:20200042. [PMID: 33299592 PMCID: PMC7709069 DOI: 10.1259/bjrcr.20200042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 06/22/2020] [Accepted: 06/27/2020] [Indexed: 11/26/2022] Open
Abstract
Primary extradural spinal melanoma is a very rare lesion. Here, we report a thoracic extradural malignant melanoma in a 77-year-old male. MRI showed a dorsal spinal extradural tumour at the T6–T8 level. The tumour showed hyperintensity on T1W imaging and mixed hypointensity and hyperintensity on T2W imaging. Gadolinium-enhanced MRI showed high enhancement on the lesion. Information on imaging findings for extradural spinal melanoma appears very limited. We discuss the MRI findings from this case, which can be considered typical of extradural spinal melanoma and review the literature.
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Affiliation(s)
- Yasutaka Takagi
- Department of Orthopaedic Surgery, Tonami General Hospital, 1-61 Shintomi-cho, Tonami City, Toyama, Japan
| | - Hiroshi Yamada
- Department of Orthopaedic Surgery, Tonami General Hospital, 1-61 Shintomi-cho, Tonami City, Toyama, Japan
| | - Hidehumi Ebara
- Department of Orthopaedic Surgery, Tonami General Hospital, 1-61 Shintomi-cho, Tonami City, Toyama, Japan
| | - Hiroyuki Hayashi
- Department of Orthopaedic Surgery, Tonami General Hospital, 1-61 Shintomi-cho, Tonami City, Toyama, Japan
| | - Satoshi Kidani
- Department of Orthopaedic Surgery, Tonami General Hospital, 1-61 Shintomi-cho, Tonami City, Toyama, Japan
| | - Shunro Okamoto
- Department of Orthopaedic Surgery, Tonami General Hospital, 1-61 Shintomi-cho, Tonami City, Toyama, Japan
| | - Kazu Toyooka
- Department of Orthopaedic Surgery, Tonami General Hospital, 1-61 Shintomi-cho, Tonami City, Toyama, Japan
| | - Kazuhiro Nanpo
- Department of Orthopaedic Surgery, Tonami General Hospital, 1-61 Shintomi-cho, Tonami City, Toyama, Japan
| | - Yoshiyuki Kitano
- Department of Orthopaedic Surgery, Tonami General Hospital, 1-61 Shintomi-cho, Tonami City, Toyama, Japan
| | - Shintaro Terahata
- Department of Diagnostic Pathology, Tonami General Hospital, 1-61 Shintomi-cho, Tonami City, Toyama, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kanazawa University, 13-1 Takara-machi, Kanazawa City, Ishikawa 920-8641, Japan
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Tang S, Zuo J, Zhang H, Wu Z, Liang B. Spinal Metastatic Melanoma with Unknown Primary Lesions Presenting as Radiculopathy: Case Report and Literature Review. World Neurosurg 2020; 140:320-324. [PMID: 32428722 DOI: 10.1016/j.wneu.2020.05.067] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Metastatic malignant melanoma of the spine is rare, while the spinal metastatic melanoma with unknown primary lesions presenting as radiculopathy is even rarer. Summarizing and analyzing this disease can provide insight into disease development and allow optimization of clinical management. CASE DESCRIPTION A 55-year-old male patient was admitted to our institution presenting with lower back pain that had persisted for 3 years. It was aggravated, with radiating pain in bilateral lower extremities lasting 2 weeks. Neurologic examination revealed bilateral L5 motor deficit with paresis. Radiologic findings showed an irregularly destructive lesion of the L5 vertebral body, and the lesion extended dorsally, obstructing the spinal canal. The patient underwent complete resection of the L5 vertebral tumor with titanium mesh implantation and posterior fusion and instrumentation from L3-S2. The pathologic diagnosis after surgery was malignant melanoma. No obvious primary lesion was detected anywhere on the skin surface, mucosa, and retina. A postoperative positron emission tomography-computed tomography scan of the whole body displayed no abnormal uptake in other parts of the body. However, the patient didn't receive any chemotherapy or radiotherapy. Five months after operation, the tumor recurred and metastasis was detected in other sites. CONCLUSIONS Although spinal metastatic melanoma with unknown primary lesions presenting as radiculopathy is rare, effective management and treatment of these patients remains an important challenge for surgeons. Surgical resection can alleviate patients' chief complaints and improve their quality of life. However, it may not prolong the survival period and improve the prognosis. Postoperative radiotherapy and/or chemotherapy may be needed.
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Affiliation(s)
- Shenghui Tang
- Department of Orthopaedics, the Fifth Affiliated Hospital, Southern Medical University, Guangzhou, China
| | - Junhua Zuo
- Department of Gastroenterology, the Fifth Affiliated Hospital, Southern Medical University, Guangzhou, China
| | - Haonan Zhang
- Department of Orthopaedics, the Fifth Affiliated Hospital, Southern Medical University, Guangzhou, China
| | - Zhanglin Wu
- Department of Orthopaedics, the Fifth Affiliated Hospital, Southern Medical University, Guangzhou, China
| | - Biru Liang
- Department of Orthopaedics, the Fifth Affiliated Hospital, Southern Medical University, Guangzhou, China.
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Marek T, Laughlin RS, Howe BM, Spinner RJ. Perineural Spread of Melanoma to the Brachial Plexus: Identifying the Anatomic Pathway(s). World Neurosurg 2018; 111:e921-e926. [DOI: 10.1016/j.wneu.2018.01.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 12/30/2017] [Accepted: 01/04/2018] [Indexed: 10/18/2022]
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