Primary cervicothoracic melanoma of spinal cord: a case report and literature review

Abstract

A 53-year-old male patient presented progressive numbness and weakness in the right limbs for a 2-year duration. Magnetic resonance imaging scans revealed an intramedullary lesion crossed over cervical and thoracic levels accompanied by syringomyelia at the proximal end of the lesion. The patient underwent subtotal resection of the neoplasm. The histological findings of the tumor were consistent with primary intramedullary malignant melanoma and not initial ependymoma after careful dermatologic and ophthalmologic re-examination. Primary melanoma of the spinal cord, particularly cervicothoracic localization with syringomyelia, is seldom reported in the literature. We report a case of this uncommon tumor and also discuss the clinical course, diagnosis, and treatment.

Keywords: CSEP; DSEP; cervicothoracic; electromyogram; primary; spinal cord.

Figure 1

Magnetic resonance imaging (MRI). (A–C) An intramedullary tumor was located at C6–T4 with mixture of iso- and hypointensity on sagittal T1-weighted image (T1WI) (A), non-homogeneous hypointensity on sagittal T2-weighted image (T2WI) (B), and slightly non-homogeneous enhancement on sagittal T1WI with gadolinium (C). (D, E) Long T1 [(D), sagittal] and long T2 [(E), sagittal] signals with increased signal intensity of fat-suppressed images [(F), sagittal] at the level between medulla and C6 suggestive of syringomyelia at the proximal end of the lesion.

Figure 2

Intraoperative photograph showing the darkly pigmented intramedullary lesion with multiple small satellite lesions under the pia (A). After spinal cord incision, the coal cinder-like lesions were removed in piecemeal, and multiple biopsies were taken (B, C).

Figure 3

Neoplasm was densely cellular arranged in nests and sheets with deposition of abundant melanin pigment [(A); hematoxylin and eosin (H&E), magnification ×100]; pleomorphic ovoid, spindle, or polygonal cells with significant nuclear atypia characterized by large nuclei, high nuclear-to-cytoplasmic ratio, and scattered mitosis [(B); H&E, magnification ×200]; representative necrosis in the tumor [(C); H&E, magnification ×200]; tumor cells with granular cytoplasmic pigmentation were arranged around the vascellum [(D); H&E, magnification ×200]; positive staining for HMB-45, S-100, and MelanA [(E–G); magnification ×200]; Ki-67 labeling indices counted more than 50% denoted pigmented cells that were mitotically active [(H); magnification ×200].