Korean J Radiol.  2013 Apr;14(2):343-349. 10.3348/kjr.2013.14.2.343.

F-18 Fluorodeoxyglucose PET/CT and Post Hoc PET/MRI in a Case of Primary Meningeal Melanomatosis

• Lee HJ
• Ahn BC
• Hwang SW
• Cho SK
• Kim HW
• Lee SW
• Hwang JH
• Lee J

• KMID: 1482798
• DOI: http://doi.org/10.3348/kjr.2013.14.2.343

Abstract

Primary meningeal melanomatosis is a rare, aggressive variant of primary malignant melanoma of the central nervous system, which arises from melanocytes within the leptomeninges and carries a poor prognosis. We report a case of primary meningeal melanomatosis in a 17-year-old man, which was diagnosed with 18F-fluorodeoxyglucose (F-18 FDG) PET/CT, and post hoc F-18 FDG PET/MRI fusion images. Whole-body F-18 FDG PET/CT was helpful in ruling out the extracranial origin of melanoma lesions, and in assessing the therapeutic response. Post hoc PET/MRI fusion images facilitated the correlation between PET and MRI images and demonstrated the hypermetabolic lesions more accurately than the unenhanced PET/CT images. Whole body F-18 FDG PET/CT and post hoc PET/MRI images might help clinicians determine the best therapeutic strategy for patients with primary meningeal melanomatosis.

Keyword

Meningeal melanomatosis; F-18 FDG; PET/CT; post hoc PET/MRI

MeSH Terms

Adolescent
Brain Neoplasms/*diagnosis/radionuclide imaging
Fluorodeoxyglucose F18/diagnostic use
Humans
*Magnetic Resonance Imaging
Male
Melanoma/*diagnosis/radionuclide imaging
Meningeal Neoplasms/*diagnosis/radionuclide imaging
*Positron-Emission Tomography and Computed Tomography
Radiopharmaceuticals/diagnostic use
Whole Body Imaging
Radiopharmaceuticals
Fluorodeoxyglucose F18

Figure

• 

  Fig. 1 F-18 FDG PET/CT and post hoc PET/MR images, and microscopic findings of primary meningeal melanomatosis. A. Initial F-18 FDG PET/CT scan revealed hypermetabolic lesions along leptomeninges on frontal and temporal lobes bilaterally, and no other hypermetabolic lesion in whole body. B. Second pre-treatment F-18 FDG PET/CT scan revealed aggravation of hypermetabolic leptomeningeal lesions (arrows), compared with lesions on initial F-18 FDG PET/CT scan. C. Third post-treatment F-18 FDG PET/CT scan showed decreased F-18 FDG uptake and extent of hypermetabolic leptomeningeal lesions compared with lesions on pre-treatment F-18 FDG PET/CT. F-18 FDG PET/CT = F-18 fluorodeoxyglucose positron emission tomography/computed tomography. D. Initial post hoc PET/MR images showed more hypermetabolic leptomeningeal lesions, corresponding to enhancing lesions on T1-weighted contrast-enhanced MR images than unenhanced F-18 FDG PET/CT images. E, G. Pre-treatment post hoc PET/MR images revealed aggravation of hypermetabolic lesions (arrows) corresponded to enhancing lesions on T1-weighted contrast-enhanced MR images, compared with lesions on initial post hoc PET/MRI images. F. Post-treatment post hoc PET/MR images showed decreased F-18 FDG uptake and extent of hypermetabolic leptomeningeal lesions on PET images. Post-treatment contrast-enhanced T1-weighted MRI also showed slight decrease in size of enhancing leptomeningeal lesions, suggesting partial therapeutic response. F-18 FDG PET/CT = F-18 fluorodeoxyglucose positron emission tomography/computed tomography. H. Tumor cells showed eosinophilic cytoplasm with pleomorphic vesicular nuclei and prominent eosinophilic nucleoli. Prominent melanin pigments are also observed (HE, × 200). I. Tumor cells were immunohistochemically strongly positive for HMB-45 (× 200). J. Tumor cells were immunohistochemically strongly positive for S-100 (× 200). K. Ki-67 labeling index of tumor was approximately 10% (× 200). F-18 FDG PET/CT = F-18 fluorodeoxyglucose positron emission tomography/computed tomography.

Reference

1. Savitz MH, Anderson PJ. Primary melanoma of the leptomeninges: a review. Mt Sinai J Med. 1974. 41:774–791.

2. Smith AB, Rushing EJ, Smirniotopoulos JG. Pigmented lesions of the central nervous system: radiologic-pathologic correlation. Radiographics. 2009. 29:1503–1524.

3. Gaetani P, Martelli A, Sessa F, Zappoli F, Rodriguez R, Baena . Diffuse leptomeningeal melanomatosis of the spinal cord: a case report. Acta Neurochir (Wien). 1993. 121:206–211.

4. Sagiuchi T, Ishii K, Utsuki S, Asano Y, Tsukahara S, Kan S, et al. Increased uptake of technetium-99m-hexamethylpropyleneamine oxime related to primary leptomeningeal melanoma. AJNR Am J Neuroradiol. 2002. 23:1404–1406.

5. Nicolaides P, Newton RW, Kelsey A. Primary malignant melanoma of meninges: atypical presentation of subacute meningitis. Pediatr Neurol. 1995. 12:172–174.

6. Bang OY, Kim DI, Yoon SR, Choi IS. Idiopathic hypertrophic pachymeningeal lesions: correlation between clinical patterns and neuroimaging characteristics. Eur Neurol. 1998. 39:49–56.

7. Zadro I, Brinar VV, Barun B, Ozretić D, Pazanin L, Grahovac G, et al. Primary diffuse meningeal melanomatosis. Neurologist. 2010. 16:117–119.

8. Wadasadawala T, Trivedi S, Gupta T, Epari S, Jalali R. The diagnostic dilemma of primary central nervous system melanoma. J Clin Neurosci. 2010. 17:1014–1017.

9. Pirini MG, Mascalchi M, Salvi F, Tassinari CA, Zanella L, Bacchini P, et al. Primary diffuse meningeal melanomatosis: radiologic-pathologic correlation. AJNR Am J Neuroradiol. 2003. 24:115–118.

10. Bar-Shalom R, Yefremov N, Guralnik L, Gaitini D, Frenkel A, Kuten A, et al. Clinical performance of PET/CT in evaluation of cancer: additional value for diagnostic imaging and patient management. J Nucl Med. 2003. 44:1200–1209.

11. Czernin J, Allen-Auerbach M, Schelbert HR. Improvements in cancer staging with PET/CT: literature-based evidence as of September 2006. J Nucl Med. 2007. 48:Suppl 1. 78S–88S.

12. Louis DN, Ohgaki H, Wiestler OD, Cavenee WK, Burger PC, Jouvet A, et al. The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol. 2007. 114:97–109.

13. Hayward RD. Malignant melanoma and the central nervous system. A guide for classification based on the clinical findings. J Neurol Neurosurg Psychiatry. 1976. 39:526–530.

14. Nakhleh RE, Wick MR, Rocamora A, Swanson PE, Dehner LP. Morphologic diversity in malignant melanomas. Am J Clin Pathol. 1990. 93:731–740.

15. Ohsie SJ, Sarantopoulos GP, Cochran AJ, Binder SW. Immunohistochemical characteristics of melanoma. J Cutan Pathol. 2008. 35:433–444.

16. Brat DJ, Giannini C, Scheithauer BW, Burger PC. Primary melanocytic neoplasms of the central nervous systems. Am J Surg Pathol. 1999. 23:745–754.

17. Liubinas SV, Maartens N, Drummond KJ. Primary melanocytic neoplasms of the central nervous system. J Clin Neurosci. 2010. 17:1227–1232.

18. Lee NK, Lee BH, Hwang YJ, Sohn MJ, Chang S, Kim YH, et al. Findings from CT, MRI, and PET/CT of a primary malignant melanoma arising in a spinal nerve root. Eur Spine J. 2010. 19:Suppl 2. S174–S178.

19. Bastiaannet E, Oyen WJ, Meijer S, Hoekstra OS, Wobbes T, Jager PL, et al. Impact of [18F]fluorodeoxyglucose positron emission tomography on surgical management of melanoma patients. Br J Surg. 2006. 93:243–249.