- Department of Neurosurgery Shinshu University School of Medicine, Matsumoto, Japan
- Department of Pathology, Shinshu University School of Medicine, Matsumoto, Japan
Nunung Nur Rahmah
Department of Neurosurgery Shinshu University School of Medicine, Matsumoto, Japan
DOI:10.4103/2152-7806.70853© 2010 Rahmah NN This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
How to cite this article: Rahmah NN, Horiuchi T, Nakayama J, Nitta J, Hongo K. Cutaneous malignant melanoma “recurred as” or “in coexistence” with meningioma?. Surg Neurol Int 06-Oct-2010;1:60
How to cite this URL: Rahmah NN, Horiuchi T, Nakayama J, Nitta J, Hongo K. Cutaneous malignant melanoma “recurred as” or “in coexistence” with meningioma?. Surg Neurol Int 06-Oct-2010;1:60. Available from: http://sni.wpengine.com/surgicalint_articles/cutaneous-malignant-melanoma-recurred-as-or-in-coexistence-with-meningioma/
Background:The authors report a rare case of a patient with previously treated cutaneous malignant melanoma that recurred 1 year later as an intracranial meningioma.
Case Description:A 20-year-old woman presented with exophthalmos, diplopia and a mass in the left supraorbital area. Imaging study revealed an enhanced intracranial extradural mass with bone destruction. The patient had a history of cutaneous malignant melanoma surgery on the same location 1 year before. The patient underwent left frontotemporal craniotomy for total resection of the mass. Histological study revealed the intracranial mass to be an atypical meningioma.
Conclusion:To our knowledge, this is a rare report of a patient with this tumor occurrence. This case serves to remind neurosurgeons of the potential existence of benign and/ or malignant tumors of neural crest origin.
Keywords: Malignant melanoma, meningioma, neural crest, recurrence, coexistence-losomarginal artery
Cutaneous melanoma is an increasingly prevalent disease. It is currently the third most common cause of cerebral metastases after lung and breast cancers.[
A 20-year-old Japanese woman had a history of cutaneous malignant melanoma on the left supraorbital area. Computed tomography (CT) scan showed no bone and intracranial involvement [
Postoperative gallium scintigraphy scanning did not reveal any recurrence or metastasis. No chemotherapy or radiotherapy was performed, because informed consent could not be obtained. One year later, she was referred to our service because of exophthalmic left eye and diplopia. She had no family history of melanoma or other malignancies. Visual acuities were normal, external eye movement of the left eye was slightly reduced and other neurological findings were normal.
CT scan showed an enhanced mass on the left supraorbital area with bone involvement [
Left frontotemporal craniotomy was performed. During the surgery, the tumor was found to be black, soft, easy to bleed and was tightly adhered to the dura. Total resection of the tumor was achieved. No surgery-related complication was found postoperatively. No adjuvant therapy was given to the patient postoperatively. Histology of the intracranial tumor indicated the close proliferation of short spindle tumor cells focally, showing a vague wheel-like formation [
Postoperative condition was uneventful with normal neurological findings. External eye movement was improved. One year later, the patient was admitted to hospital because of liver metastases of melanoma. Histology showed characteristics of malignant melanoma. She died in the same year.
Melanoma has a propensity for multiorgan involvement, and central nervous system complications are frequent.[
Preoperatively, the mass was presumed to be an intracranial recurrence of melanoma since the imaging findings of intracranial melanoma can vary from hypointensity to hyperintensity to its surrounding brain structures, and slightly to homogeneously enhanced mass.[
Histopathological study of this case revealed an atypical meningioma, which was completely beyond our expectation. Tumor to tumor metastases have been documented;[
Of the first possibility mentioned above, tumor to tumor metastasis, mechanisms of its changes are not well understood. Baruch mentioned the roles of chemokines and their receptors in organ selectivity in metastasis.[
Another possibility is the coexistence of melanoma and meningioma. Warwar et al. reported a 64-year-old woman who was referred for evaluation of diabetic retinopathy and was found with right superolateral periorbital neurofibroma, a right sphenoid wing meningioma, and a left choroidal juxtapapillary malignant melanoma. The patient then underwent excision for the periorbital mass and the meningioma. Eye enucleation was performed to the choroidal tumor. No recurrence was found during 1-year follow-up.[
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