Corrêa Diogo Goulart, Dos Santos Roberto Queiroz, Hygino da Cruz Luiz Celso
Clínica de Diagnóstico por Imagem (CDPI)/DASA, Avenida das Américas, 4666, 302A, 303, 307, 325, 326, Barra da Tijuca, Rio de Janeiro, RJ, Brazil.
Hospital Universitário Antônio Pedro, Federal Fluminense University, Avenida Marquês do Paraná, 303, Centro, Niterói, RJ, Brazil.
J Int Med Res. 2020 Oct;48(10):300060520966152. doi: 10.1177/0300060520966152.
Melanoma is a malignant neoplasm of melanin-producing cells. Melanoma usually occurs in the skin, but can also arise in any anatomical site that contains melanocytes, such as mucous membranes, the eyes, and the central nervous system (CNS). Primary CNS malignant melanoma most often develops in the leptomeninges. We report a case of a rare intramedullary melanoma of the thoracic spinal cord. A 78-year-old man was treated with surgery, radiotherapy, and immunotherapy for leptomeningeal spread. We also discuss the role of imaging methods in diagnosis and follow-up. Medullary melanoma occurs more frequently in adults. The most common presenting symptoms are the insidious onset of lower extremity weakness and paresthesia. Magnetic resonance imaging is the method of choice for evaluation. Although there are no imaging features to accurately distinguish primary malignant melanoma from other melanocytic or hemorrhagic tumors, hyperintensity on T1-weighted magnetic resonance imaging should lead to inclusion of this neoplasm in differential diagnosis of spinal cord tumors. Positron emission tomography-computed tomography is a useful auxiliary examination to evaluate the extent of local and metastatic disease. Surgical resection is the primary treatment for intramedullary melanoma. However, the efficacy of adjunctive radiotherapy and chemotherapy for primary spinal cord malignant melanoma is still controversial.
黑色素瘤是一种由产生黑色素的细胞构成的恶性肿瘤。黑色素瘤通常发生于皮肤，但也可出现在任何含有黑素细胞的解剖部位，如黏膜、眼睛和中枢神经系统（CNS）。原发性中枢神经系统恶性黑色素瘤最常发生于软脑膜。我们报告一例罕见的胸段脊髓髓内黑色素瘤病例。一名78岁男性因软脑膜播散接受了手术、放疗和免疫治疗。我们还讨论了影像学方法在诊断和随访中的作用。髓内黑色素瘤在成年人中更常见。最常见的首发症状是下肢无力和感觉异常的隐匿起病。磁共振成像（MRI）是评估的首选方法。尽管没有影像学特征能准确区分原发性恶性黑色素瘤与其他黑素细胞性或出血性肿瘤，但T1加权磁共振成像上的高信号强度应使该肿瘤纳入脊髓肿瘤的鉴别诊断中。正电子发射断层扫描-计算机断层扫描（PET-CT）是评估局部和转移性疾病范围的有用辅助检查。手术切除是髓内黑色素瘤的主要治疗方法。然而，辅助放疗和化疗对原发性脊髓恶性黑色素瘤的疗效仍存在争议。
