Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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October 26, 2015
Spinal Meningeal Melanocytoma
- Background:
- Meningeal melanocytoma is a rare tumor arising from melanocytes of the leptomeninges, which usually has benign histologic features and good prognosis. However, there is potential for local recurrence, malignant transformation, and distant metastasis.
- Meningeal melanocytoma has only been reported in the posterior fossa and spine, and can be intra-axial (intramedullary) or extra-axial (extramedullary) in location.
- In the spine, these lesions are most commonly intradural extramedullary.
- Clinical Presentation: Most patients present clinically with a slow, progressive history of myeloradiculopathy.
- Key Diagnostic Features: MRI shows well-defined, round, or ovoid masses, which are typically hyperintense on T1-weighted sequences (melanin), hypointense on T2-weighted sequences, and enhance with gadolinium.
- DDx:
- Meningioma
- Pigmented schwannoma
- Melanoma
- Treatment Options: Complete resection plus radiotherapy. Follow-up imaging is needed to monitor for tumor recurrence.
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