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AN AUTOPSY CASE OF LEPTOMENINGEAL MALIGNANT MELANOMA ASSOCIATED WITH LEPTOMENINGEAL DERMOID CYST ON THE RIGHT PULVINAR Atsuo Miwa 1 , Masanobu Kitagawa 1 , Hiroaki Hondo 2 , Kazuo Washiyama 2 , Yoshiaki Sugiyama 2 , Syoichi Kawasaki 2 , Mitsunori Fukuda 2 1Department of Pathology, Faculty of Medicine, Toyama Medical and Pharmaceutical University 2Department of Neurosurgery, Toyama Prefectural Central Hospital pp.1187-1193
Published Date 1981/12/1
DOI https://doi.org/10.11477/mf.1406204857
  • Abstract
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An autopsied rare case of meningeal malignant melanoma associated with meningeal dermoid cyst is described. A 40-year-old male visited the Toyama Prefectural Central Hospital complaining of double vision in February 1979. As occipital headache, ocular pain and attacks of Jacksonian seizure developed in the following months, he was admitted to the department of neurosurgery on May 2 under the diagnosis of brain tumor. On admission left-sided hemiparesis was present. No abnormal cutaneous pigmentation was noted. The skull x-ray examination revealed a small bracket-shaped shadow of calcification in the pineal region. In the CT scan high density areas in the cortical or subcortical region of the right fronto-parietal lobe of the cerebrum and the right parasagittal regions were found. Also in the pineal region a higher density area was observed.

On May 5, 1979, craniotomy for removal of a black-colored tumor of the right fronto-parietal lobe, combined with ventriculo-peritoneal drainage, was performed. The pineal lesion was notexplored. The removed tumor was histologically confirmed to be malignant melanoma. The CT scan taken two months later revealed another high density area in the left cerebellar hemisphere in addition to the recurrent tumor in the right fronto-parietal lobe. The patient became comatose in August and expired on October 8. The duration of the illness was 8 months.

At autopsy, the brain was moderately swollen (1200g). The recurrent melanoma in the right fronto-parietal lobe invaded the cerebral substance deeply and an independent melanoma mass was also present in the left cerebellar hemisphere, extending to the middle peduncle. In the other part of the brain surface, there was irregularly distributed patchy network of black pigmentation, implying leptomeningeal involvement of the tumor. Most part of the spinal cord was wrapped with thick spread of the tumor, giving rise to partial softening of the cord at the level of Th. 5-Th. 10.

A clinically silent dermoid cyst measuring 2×3×3cm in size was found on the back of the right pulvinar with protrusion into the inferior horn of the ipsilateral lateral ventricle, which was identified to have arisen from the regional leptomeninx. Calcification was present in the wall of the cyst as well as inside of it, namely in the keratohyalin material. The pineal body was intact. The co-existence of the dermoid cyst with malignant melanoma of the leptomeninx suggests that the latter may have arisen from the heterotopic melanin producing cells in loco.


Copyright © 1981, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 2185-405X 印刷版ISSN 0006-8969 医学書院

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