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68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

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Melanoma and Melanotic Schwannoma: A Challenging Histological and Clinical Distinction

Meeting Abstract

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  • Julia Velz - University Hospital Zürich, Department of Neurosurgery, Zürich, Switzerland
  • Marian Christoph Neidert - University Hospital Zurich, Department of Neurosurgery, Zürich, Switzerland
  • Elisabeth Rushing - University Hospital Zürich, Department of Neuropathology, Zürich, Switzerland
  • David Bellut - University Hospital Zürich, Department of Neurosurgery, Zürich, Switzerland
  • Luca Regli - UniversitätsSpital Zürich , Klinik für Neurochirurgie, Zürich, Switzerland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocP 069

doi: 10.3205/17dgnc632, urn:nbn:de:0183-17dgnc6328

Published: June 9, 2017

© 2017 Velz et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: Melanotic schwannoma (MS) is a very rare neoplasm composed of Schwann cells with the capacity of melanogenesis. Here we report the case of a 32-year-old women with a 2-year history of intermittent thoracic and upper abdominal pain. An intra- and paraspinal, extradural mass Th10-Th12 was found on MRI and the patient underwent surgical resection of this mass.

Methods: Intra- and paraspinal resection of the tumor was performed. The infiltrated Th11 nerve root was resected as well as the facet joints of Th10/11 and Th11/12 and the rib head of Th11. A transpedicular stabilization and posterior spondylodesis Th10-Th12 was performed. Gömöri reticulin stain and immunohistochemical examination with the melanocytic marker, PanMela and S100 was obtained, as well as a LNA-PCR to detect point mutations in the V600 region of BRAF.

Results: Histological examination revealed a reticulin-rich melanotic S100 positiv tumor with extensive pericellular depositions. A malignant melanoma could not be formally excluded, however the tumor had the morphological appearance of a melanotic schwannoma.

Conclusion: Even to date, the histological diagnosis of MS is challenging due to a lack of specific markers that distinguish the entity from melanoma. Since the distinction between melanoma and melanotic schwannoma is clinically relevant, reticulin stain or immunostaining with laminin and collagen IV should be performed on a regular basis in these cases.