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CASE REPORT   

Chirurgia 2018 August;31(4):147-50

DOI: 10.23736/S0394-9508.17.04745-3

Copyright © 2017 EDIZIONI MINERVA MEDICA

lingua: Inglese

A rare case of primary intradural spinal melanoma presenting with a cauda equina syndrome

Ricardo DIAZ-ROMERO 1 , Claudia BALHEN MARTIN 2

1 Department of Neurosurgery, Hospital Universitario Insular of Las Palmas, Las Palmas of Gran Canaria, Spain; 2 Department of Radiology, Hospital Universitario Insular of Las Palmas, Las Palmas of Gran Canaria, Spain


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The vast majority of melanomas of the CNS appear as a result of metastases. The primary spinal melanoma is a very rare entity with only 60 cases reported in the literature. A case of 41-year-old man with acute cauda equina syndrome is presented. The MRI reveals an intradural lesion from T12 to L3 on T1-weighted was heterogeneous hyperintense and homogeneous hypointense on T2, The differential diagnosis included spinal subdural hematoma and intradural pigmented tumor. An urgent thoracolumbar laminectomy from T11 to L3 was performed, an extensive dark tumor mixed with hemorrhage from T12 to L3 was found, due to an infiltrative dissemination of the tumor a subtotal resection was achieved. In the postoperative period the patient improved of cauda equina syndrome, the histologic analysis confirmed the diagnosis of a malignant melanoma. The patient underwent fractioned radiotherapy and chemotherapy, nevertheless 4 months later suffered from multiple cerebellar metastases with a fatal outcome. There are three reports of primary spinal melanoma located at cauda equina, none with a complete cauda equina syndrome neither with such rapid clinical deterioration and extension as the present case had. The primary spinal melanoma is a very rare entity, radiologic features on MRI may vary due to paramagnetic susceptibility effect of the melanin and intratumoral hemorrhage what makes pathological examination essential for diagnosis. Complete surgical excision should be attempted whenever is possible, in most cases radiotherapy and chemotherapy are indicated and the prognosis is variable probably influenced by the grade of dissemination of the tumor at the time of the diagnosis.


KEY WORDS: Melanoma - Polyradiculopathy - Surgery

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