Spinal and cerebral leptomeningeal melanoma metastases

Case contributed by Dr Ernest Lekgabe

Presentation

Back pain and features of cord compression. ?Cauda equina syndrome. History of prostate cancer.

Patient Data

Age: 65
Gender: Male

Lobulated left cerebellopontine angle cistern extra-axial lesion with high intrinsic T1 signal intensity and vividly enhancing. The lesion has a dural tail at the level of the jugular foramen.

Pre-and post contrast sequences performed.

A small round lesion in the inferior aspect of the T11 vertebral body is T1 hypointense and enhances vividly raising suspicion for metastasis on the current clinical context.

Between the T8 and T9 vertebral body levels there is a vividly enhancing lobulated mass which has an intramedullary component contiguous with an exophytic component that projects from the right lateral aspect of the cord, 10 x 11 x 19 mm. A small cystic non-enhancing focus lies at the superior margin of the enhancing mass. More diffuse central cord T2 hyperintensity compatible with oedema extends between the level of T5/6 and T10/11.

In addition, there is nodular leptomeningeal enhancement about the conus and distal cord. Nodular enhancement surrounds the distal cord and conus, along the nerve roots of the cord, and in the sacral cul-de-sac, with most prominent nodular involvement at L3 and L4/5 levels.

There is a small enhancing intraosseous lesion in the posterior inferior corner of the L2 vertebral body which is likely a metastasis.

Note made of left renal parapelvic cyst.

Conclusion

Multifocal intra dural enhancing lesions: At T9 level is a 19 x 11 mm lobulated enhancing mass which has component exophytic from the right lateral aspect of the cord and a component which invaginates into the cord, with small peritumoural cyst and associated cord oedema.

Extensive nodular enhancing leptomeningeal disease extending from the distal cord and conus, involving nerve roots of the cauda equina and sacral cul-de- sac.

Likely bone metastases at T11 and L2 vertebral bodies. 

Case Discussion

Histology:

Leptomeningeal spinal metastases - black tumour.

MACROSCOPIC DESCRIPTION:

1. "Thoracic spine tumour": Four pieces of brown to black polypoid tissue between 3mm and 6mm. A1. 2. "Thoracic spine tumour": Three brown to black tissue fragments 3mm, 4mm and 10mm. A1.

MICROSCOPIC DESCRIPTION:

1,2. The sections show features of malignant tumour, forming sheets. The tumour cells are plump spindled in appearance. They have enlarged pleomorphic nuclei, prominent nucleoli and moderate amounts of eosinophilic cytoplasm. Some of the tumour cells contain brown pigment in their cytoplasm. No evidence of lymphovascular invasion is seen. The tumour cells are SOX-10 and melan-A positive. The features are those of melanoma.

DIAGNOSIS: 1,2. Thoracic spine tumour: Metastatic melanoma.

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Case information

rID: 51466
Case created: 17th Feb 2017
Last edited: 20th Feb 2017
Inclusion in quiz mode: Included

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