Department of Orthopaedics, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Department of Orthopaedics, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
World Neurosurg. 2019 Sep;129:143-147. doi: 10.1016/j.wneu.2019.05.147. Epub 2019 Jun 7.
Primary melanocytic neoplasms in the central nervous system are rare lesions arising from leptomeningeal melanocytes. These lesions produce neural deficits that resemble those of a meningioma or a schwannoma radiologically.
A tumor around the left S1 root with an extension into the left paraspinal compartment was identified in a 32-year-old female with persistent left leg pain for 6 months. The tumor was hyperintense on T1-weighted image and hypointense on T2-weighted image with a homogeneous enhancement. The clinical features, radiologic presentations, treatment choice, and pathologic characteristic were illustrated. The treatment outcome was compared with those reported in the previous literature. The tumor was en-bloc resected with the S1 nerve root reserved. Grossly, the tumor was a soft, capsulated, well-circumscribed, black pigmented lesion. Immunohistochemistry revealed that the tumor cells were positive for HMB-45, S-100 protein, and vimentin. The patient's symptoms were greatly relieved postoperatively. No signs of local recurrence were observed.
Spinal meningeal melanocytoma inside the nerve root is rare and benign. It is difficult to diagnose and often misdiagnosed as schwannoma or meningioma. HMB-45 has been suggested as a significant marker for the diagnosis of meningeal melanocytoma. Complete surgical resection is recommended as the primary treatment. Radiotherapy, chemotherapy, and other treatments can be selected as adjuvant therapies, but their effects are controversial. The recurrence and metastasis rates also remain unclear.
中枢神经系统原发性黑色素瘤是一种罕见的起源于软脑膜黑色素细胞的病变。这些病变产生的神经功能缺损与脑膜瘤或神经鞘瘤相似，在影像学上。
一位 32 岁女性患者因左腿持续疼痛 6 个月，在左侧 S1 神经根周围发现肿瘤，并延伸至左侧脊柱旁间隙。肿瘤在 T1 加权图像上呈高信号，在 T2 加权图像上呈低信号，呈均匀强化。展示了临床特征、影像学表现、治疗选择和病理特征。并将治疗结果与以前文献报道的结果进行了比较。肿瘤连同 S1 神经根整块切除。大体上，肿瘤呈软、包膜、边界清楚、黑色色素沉着病变。免疫组化显示肿瘤细胞 HMB-45、S-100 蛋白和波形蛋白阳性。术后患者症状明显缓解。未见局部复发迹象。
神经根内的脊髓脑脊膜黑色素细胞瘤罕见且良性。诊断困难，常误诊为神经鞘瘤或脑膜瘤。HMB-45 已被建议作为脑膜黑色素细胞瘤诊断的重要标志物。推荐行完整的手术切除作为主要治疗方法。放疗、化疗和其他治疗方法可作为辅助治疗选择，但疗效存在争议。复发和转移率仍不清楚。
