gms | German Medical Science

58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. bis 29.04.2007, Leipzig

Intraspinal malignant melanoma – a diagnostic challenge! A case report

Intraspinales malignes Melanom – eine diagnostische Herausforderung! Ein Fallbericht

Meeting Abstract

Suche in Medline nach

  • corresponding author F. Lohmann - Neurochirurgische Klinik, Knappschaftskrankenhaus Recklinghausen, Recklinghausen
  • R. Luckner - Neurochirurgische Klinik, Knappschaftskrankenhaus Recklinghausen, Recklinghausen
  • V. H. Hans - Institut für Neuropathologie, Evangelisches Krankenhaus Bielefeld, Bielefeld
  • M. J. A. Puchner - Neurochirurgische Klinik, Knappschaftskrankenhaus Recklinghausen, Recklinghausen

Deutsche Gesellschaft für Neurochirurgie. 58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC). Leipzig, 26.-29.04.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. DocP 045

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Veröffentlicht: 11. April 2007

© 2007 Lohmann et al.
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Objective: Intraspinal extramedullary lesions located in the lumbar spine are mostly schwannomas, meningiomas or ependymomas. We present the unusual case of multiple malignant melanomas in the cauda equina associated with intracranial non basal subarachnoid hemorrhage.

Methods: A 53-year-old male was admitted with a 3 weeks' history of progressive lumbar pain and a bilateral leg weakness without sensory or urogenital/anal sphincter impairment. Neurologic examination revealed a mild paraparesis. MR imaging of the spine showed multiple intradural extramedullar contrast enhancing masses from L1 to the os sacrum. They varied from 0.5 to 2 cm in size. Neurofibromatosis or metastasis was suspected. Neither café-au-lait spots nor lesions in the thorax or the abdomen could be discovered on CT scans. In MR imaging of the cranium subarachnoid hemorrhage was discovered along the hemispheres. Lumbar puncture repeatedly revealed hemorrhageous cerebrospinal fluid, and cytologic examination showed nonspecific malignant cells. To establish the diagnosis surgical resection of the lesion at L3 level was performed via a hemilaminectomy.

Results: Intraoperatively, multiple pigmented masses adherent to the nerve roots were partially removed preserving the fascicles. The patient's postoperative course was uneventful, motor function improved, and pain decreased. Histologic evaluation showed malignant melanoma. No primary lesion could be found on either dermatologic or ophthalmologic examination so that primary meningeal melanoma is the final diagnosis. Control MR imaging 4 weeks after the initial imaging demonstrated no significant progress of the residual lesions. A chemotherapy with temozolomide was initiated.

Conclusions: Primary malignant melanoma of the meninges is a rare entity posing diagnostic problems. It has not only to be differentiated from the common intradural extramedullary tumours but also from benign melanocytomas and pigmented schwannomas. Surgical intervention is justified to establish the diagnosis.