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Open Access Case report

Intracranial melanocytic meningeal tumours and melanosis oculi: case report and literature review

Francesco Doglietto16*, Cesare Colosimo2, Libero Lauriola3, Mario Balducci4, Pasquale De Bonis1, Nicola Montano1, Gelareh Zadeh5, Giulio Maira1 and Roberto Pallini1

Author Affiliations

1 Institute of Neurosurgery, Catholic University School of Medicine, Rome, Italy

2 Institute of Radiology, Catholic University School of Medicine, Rome, Italy

3 Institute of Pathology, Catholic University School of Medicine, Rome, Italy

4 Institute of Radiotherapy, Catholic University School of Medicine, Rome, Italy

5 Division of Neurosurgery, Toronto Western Hospital, Toronto, ON, Canada

6 Catholic University School of Medicine, Institute of Neurosurgery, Largo A. Gemelli, 8 00168, Roma, Italy

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BMC Cancer 2012, 12:220  doi:10.1186/1471-2407-12-220

Published: 6 June 2012

Abstract

Background

Melanocytic meningeal tumours are rare extra-axial neoplasms of the nervous system, with only three reported cases in the cavernous sinus. Herein we describe for the first time the association of ocular melanosis and multiple intracranial melanocytic meningeal tumours, with the presenting lesion being in the cavernous sinus. The importance of this association is discussed together with the diagnostic and therapeutic challenges of the case.

Case presentation

A 20-year-old man presented with a left sixth cranial nerve deficit; general examination documented only congenital melanosis of the homolateral eye. MRI examination showed a space occupying lesion in the left cavernous sinus, which was followed conservatively for 2 years, until a new space occupying lesion was evident at the level of the right frontal convexity: both lesions presented with neuroradiological characteristics suggestive of melanin content.

The frontal convexity lesion was removed: intraoperatively the dura was markedly and diffusely melanotic. Histological examination documented a melanocytic meningeal tumour, with a proliferative index of 3 %. The patient underwent 3D-Conformal Radiation Therapy on the lesion of the cavernous sinus (total dose 5040 cGy), with initial tumour reduction. Three years later, due to a symptomatic growth, he underwent partial removal of the lesion in the cavernous sinus. Histological examination was unchanged. He then received adjuvant Temozolomide with Low Dose Fractionated Radiation Therapy (LD-FRT). Due to further disease progression cisplatin plus fotemustine were administered, concomitant with LD-FRT: after two cycles MRI documented significant disease regression. After a period of apparent disease control, the patient presented with persistent cough and evidence of multiple thoracic metastases, which lead to his death, seven years after presentation.

Conclusions

Intracranial melanocytic meningeal tumours are challenging lesions, both from a diagnostic and therapeutic point of view; though rare, the possible association with ocular melanosis should be recognized and might facilitate an early diagnosis. Surgery remains the best possible option when feasible. In the event of partial resection, this “benign” disease might be clinically aggressive.

Keywords:
Melanocytoma; Melanocytic meningeal tumour; Intracranial melanocytosis; Melanosis oculi; Cavernous sinus