Melanocytomas of the central nervous system are rare benign or intermediate grade
localized melanocytic tumors. Despite its benign nature, it can follow a locally aggressive
course with propensity to recur. We present the case of a 29 years old female who
presented with a recurrent lesion in cervical spine and rapidly progressing quadriparesis.
On examination, there was loss of power in right-sided extremities and reduction in
sensations in left-sided extremities. Magnetic resonance imaging spine revealed a
homogeneously enhancing intradural extramedullary dumbbell-shaped mass lesion at C4/5
level with extension through right C4 neural foramina to the extraforamina space,
causing severe spinal cord compression. Intraoperatively, bluish-colored tumor was
identified along with underlying hematoma. Gross total excision of the tumor was done.
Tumor was received in the histopathology department in multiple black-colored fragments.
Microscopically, a heavily pigmented tumor was seen with the sheets and nodules of
polygonal cells with large nuclei and prominent nucleoli. Differentials considered
were meningeal melanocytoma and malignant melanoma. On immunohistochemistry, the tumor
cells showed diffuse positivity for HMB 45 and S100. Ki 67 index was around 1%. On
radiological review, the tumor was fairly well circumscribed and did not infiltrate
the adjacent tissues. There was no evidence of any lesions elsewhere in the body.
Considering these features, the tumor was diagnosed with meningeal melanocytoma. Postoperatively,
there was significant immediate improvement in quadriparesis and patient could walk
with minimal support.
Key-words:
Cervical spine - HMB45 - melanocytoma - melanoma - pigmented schwannoma
