J Korean Neurosurg Soc.  2015 Dec;58(6):554-556. 10.3340/jkns.2015.58.6.554.

Primary Intracranial Leptomeningeal Melanomatosis

• Kim DH
• Choi CY
• Lee CH
• Joo M

• KMID: 2151159
• DOI: http://doi.org/10.3340/jkns.2015.58.6.554

Abstract

Primary intracranial malignant melanoma is a very rare and highly aggressive tumor with poor prognosis. A 66-year-old female patient presented a headache that had been slowly progressing for several months. A large benign pigmented skin lesion was found on her back. A brain MRI showed multiple linear signal changes with branching pattern and strong enhancement in the temporal lobe. The cytological and immunohiostochemical cerebrospinal fluid examination confirmed malignant melanoma. A biopsy confirmed that the pigmented skin lesion on the back and the conjunctiva were benign nevi. We report a case of primary intracranial malignant melanoma and review relevant literatures.

Keyword

Primary; Melanoma; CNS; Subarachnoid hemorrhage; Leptomeninges

MeSH Terms

Aged
Biopsy
Brain
Cerebrospinal Fluid
Conjunctiva
Female
Headache
Humans
Magnetic Resonance Imaging
Melanoma
Nevus
Prognosis
Skin
Subarachnoid Hemorrhage
Temporal Lobe

Figure

• 

  Fig. 1 Brain CT shows diffuse high density lesion in the base of right temporal lobe which is similar finding with subarachnoid hemorrhage on non-contrast image (A). Strong enhancements with multiple, branching, linear pattern are seen in the same area (B).

• 

  Fig. 2 Brain MRI shows multiple, branching, linear high signal intensity lesions in the right temporal base on axial T1-WI (A), and also strong enhancements with same pattern are seen (B). These findings are mainly found in the lateral and inferior surfaces of the temporal lobe on enhanced sagittal (C) and coronal T1-WIs (D). Low signal intensity lesions with same patterns are seen in the same location on axial T2-WI (E).

• 

  Fig. 3 Pathological findings shows pleomorphic cells with abundant cytoplasm, abundant intracytoplasmic melanin pigments, nuclear pleomorphism, and prominent nucleoli (Papanicolaou stain, ×1000). These tumor cells showed strong immunoreactivity to HMB-45, S-100, and Melan-A on the immunohistochemical study.

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  Fig. 4 Photograph of skin lesion on the back. This lesion was confirmed as pigmented nevi through the biopsy.

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