Primary versus Secondary Central Nervous System Melanoma: a Diagnostic Dilemma and Report of a Case
Malignant melanoma is a cancer of melanocytic origin, typically cutaneous. Despite recent advances, the prognosis is poor. Brain metastases occur in approximately 7-16% of cases and leptomeningeal metastases in 5-7%. Primary central nervous system (CNS) melanoma is rare, accounting for 1% of all mel...
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Bucharest College of Physicians
2019-03-01
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| Series: | Modern Medicine |
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| author | LEFTER Antonia DUMITRESCU Laura GOBEJ Ionut SOCOLIUC Claudiu FLOREA Andreea ORBAN Irina TANASESCU Radu POPESCU Bogdan Ovidiu |
| author_facet | LEFTER Antonia DUMITRESCU Laura GOBEJ Ionut SOCOLIUC Claudiu FLOREA Andreea ORBAN Irina TANASESCU Radu POPESCU Bogdan Ovidiu |
| author_sort | LEFTER Antonia |
| collection | DOAJ |
| description | Malignant melanoma is a cancer of melanocytic origin, typically cutaneous. Despite recent advances, the prognosis is poor. Brain metastases occur in approximately 7-16% of cases and leptomeningeal metastases in 5-7%. Primary central nervous system (CNS) melanoma is rare, accounting for 1% of all melanoma cases and 0.07% of brain tumors. Methods: A 65-year old man presented with haemorrhagic venous infarction of the left temporal lobe, leading to reversible motor aphasia and right-sided hemiparesis. Brain magnetic resonance imaging also revealed peculiar supratentorial cerebral and meningeal lesions suggesting neoplasia or vasculitis. Ancillary tests were unremarkable, a brain biopsy was proposed, but the patient declined. After 1.5 years symptoms recurred and imaging studies found progression of lesions, with necrosis and surrounding vasogenic oedema. The patient finally agreed to a brain biopsy for conclusive diagnosis. Results: Histopathological and immunohistochemical assessment was consistent with malignant pigmented melanoma. There were no suspicious primary lesions, but the patient recounted having had a thoracic skin lump excised some years prior, allegedly benign, yet unavailable for second opinion. Conclusion: In suspicious CNS presentations, histopathological reevaluation of previously excised skin lesions is advised, especially if brain biopsy cannot be performed. Albeit rare, primary CNS melanoma should also be considered. |
| format | Article |
| id | doaj-art-9d45fe151b014f699f2422f02c1a3659 |
| institution | Kabale University |
| issn | 1223-0472 2360-2473 |
| language | English |
| publishDate | 2019-03-01 |
| publisher | Bucharest College of Physicians |
| record_format | Article |
| series | Modern Medicine |
| spelling | doaj-art-9d45fe151b014f699f2422f02c1a36592025-08-20T03:38:40ZengBucharest College of PhysiciansModern Medicine1223-04722360-24732019-03-012613539https://doi.org/10.31689/rmm.2019.26.1.35Primary versus Secondary Central Nervous System Melanoma: a Diagnostic Dilemma and Report of a CaseLEFTER Antonia0DUMITRESCU Laura1GOBEJ Ionut2SOCOLIUC Claudiu3FLOREA Andreea4ORBAN Irina5TANASESCU Radu6POPESCU Bogdan Ovidiu7Department of Neurology, Colentina Clinical Hospital, Bucharest, RomaniaDepartment of Neurology, Colentina Clinical Hospital, Bucharest, RomaniaDepartment of Neurosurgery, Colentina Clinical Hospital, Bucharest, RomaniaDepartment of Anatomic Pathology, Colentina Clinical Hospital, Bucharest, RomaniaDepartment of Neurology, Colentina Clinical Hospital, Bucharest, RomaniaDepartment of Neurology, Colentina Clinical Hospital, Bucharest, RomaniaDepartment of Neurology, Colentina Clinical Hospital, Bucharest, RomaniaDepartment of Neurology, Colentina Clinical Hospital, Bucharest, RomaniaMalignant melanoma is a cancer of melanocytic origin, typically cutaneous. Despite recent advances, the prognosis is poor. Brain metastases occur in approximately 7-16% of cases and leptomeningeal metastases in 5-7%. Primary central nervous system (CNS) melanoma is rare, accounting for 1% of all melanoma cases and 0.07% of brain tumors. Methods: A 65-year old man presented with haemorrhagic venous infarction of the left temporal lobe, leading to reversible motor aphasia and right-sided hemiparesis. Brain magnetic resonance imaging also revealed peculiar supratentorial cerebral and meningeal lesions suggesting neoplasia or vasculitis. Ancillary tests were unremarkable, a brain biopsy was proposed, but the patient declined. After 1.5 years symptoms recurred and imaging studies found progression of lesions, with necrosis and surrounding vasogenic oedema. The patient finally agreed to a brain biopsy for conclusive diagnosis. Results: Histopathological and immunohistochemical assessment was consistent with malignant pigmented melanoma. There were no suspicious primary lesions, but the patient recounted having had a thoracic skin lump excised some years prior, allegedly benign, yet unavailable for second opinion. Conclusion: In suspicious CNS presentations, histopathological reevaluation of previously excised skin lesions is advised, especially if brain biopsy cannot be performed. Albeit rare, primary CNS melanoma should also be considered.https://medicinamoderna.ro/wp-content/uploads/2019/03/2019-1-35.pdfmelanomacerebral metastasessecond opinion |
| spellingShingle | LEFTER Antonia DUMITRESCU Laura GOBEJ Ionut SOCOLIUC Claudiu FLOREA Andreea ORBAN Irina TANASESCU Radu POPESCU Bogdan Ovidiu Primary versus Secondary Central Nervous System Melanoma: a Diagnostic Dilemma and Report of a Case Modern Medicine melanoma cerebral metastases second opinion |
| title | Primary versus Secondary Central Nervous System Melanoma: a Diagnostic Dilemma and Report of a Case |
| title_full | Primary versus Secondary Central Nervous System Melanoma: a Diagnostic Dilemma and Report of a Case |
| title_fullStr | Primary versus Secondary Central Nervous System Melanoma: a Diagnostic Dilemma and Report of a Case |
| title_full_unstemmed | Primary versus Secondary Central Nervous System Melanoma: a Diagnostic Dilemma and Report of a Case |
| title_short | Primary versus Secondary Central Nervous System Melanoma: a Diagnostic Dilemma and Report of a Case |
| title_sort | primary versus secondary central nervous system melanoma a diagnostic dilemma and report of a case |
| topic | melanoma cerebral metastases second opinion |
| url | https://medicinamoderna.ro/wp-content/uploads/2019/03/2019-1-35.pdf |
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