Primary malignant melanoma in the pineal region.
Primary malignant melanoma in the pineal region.
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DOI：
10.3340/jkns.2014.56.6.504
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发表时间：
2014-12
影响因子：
1.6
通讯作者：
Hong YK
中科院分区：
文献类型：
--
作者：
Park JH;Hong YK
一名59岁男性患者有5个月的步态障碍和记忆障碍病史。他最初的脑部计算机断层扫描显示松果体区有3.5×2.8厘米大小的高密度肿块。肿瘤在T2加权像上呈低信号，在T1加权像上呈高信号，中央部分不均匀强化。肿瘤均经枕天幕入路全切除。手术野可见黑色肿块，术后组织病理学检查确诊为恶性黑色素瘤。全脊柱磁共振成像和全身18-氟-脱氧葡萄糖正电子发射断层扫描不能显示该黑色素瘤的原发部位。医生对他的皮肤和粘膜进行了仔细的体检，发现他的左腿上有深色色素性病变，但包括磁共振图像和皮肤活检在内的其他检查显示阴性。结果，最终诊断为原发性松果体恶性黑色素瘤。他接受了全脑放射治疗，并在没有化疗的情况下延长了局部增强放疗。他的手术前症状消失了，也没有发现其他特定的神经缺陷。他的后续影像研究显示，直到术后26周才出现复发或远处转移。原发性松果体恶性黑色素瘤是一种极为罕见的颅内肿瘤，自1899年以来仅有17例报告。最新的病例报告显示，肿瘤次全切除、全脑切除和扩大局部放射治疗效果良好，不需要化疗。我们的病例是另一个结果，证明全肿瘤切除加放射治疗可能是目前松果体区原发恶性黑色素瘤的最佳治疗方法。
A 59-year-old male patient had 5-month history of gait disturbance and memory impairment. His initial brain computed tomography scan showed 3.5×2.8 cm sized mass with high density in the pineal region. The tumor was hypointense on T2 weighted magnetic resonance images and hyperintense on T1 weighted magnetic resonance images with heterogenous enhancement of central portion. The tumor was totally removed via the occipital transtentorial approach. Black mass was observed in the operation field, and after surgery, histopathological examination confirmed the diagnosis of malignant melanoma. Whole spine magnetic resonance images and whole body 18-fluoro-deoxyglucose positron emission tomography could not demonstrate the primary site of this melanoma. Scrupulous physical examination of his skin and mucosa was done and dark pigmented lesion on his left leg was found, but additional studies including magnetic resonance images and skin biopsy showed negative finding. As a result, final diagnosis of primary pineal malignant melanoma was made. He underwent treatment with the whole brain radiotherapy and extended local boost irradiation without chemotherapy. His preoperative symptoms were disappeared, and no other specific neurological deficits were founded. His follow-up image studies showed no recurrence or distant metastasis until 26 weeks after surgery. Primary pineal malignant melanomas are extremely rare intracranial tumors, and only 17 cases have been reported since 1899. The most recent case report showed favorable outcome by subtotal tumor resection followed by whole brain and extended local irradiation without chemotherapy. Our case is another result to prove that total tumor resection with radiotherapy can be the current optimal treatment for primary malignant melanoma in the pineal region.
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