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Unusual tonsillar herniation in meningeal melanocytoma: a case report.

Samimi K, Gharib MH, Rezaei-Kalantari K, Jafari M - Iran J Radiol (2012)

Bottom Line: In a 38-year-old man with a complaint of headache for a couple of years and recently added nausea, vomiting, diplopia, progressive visual blurring and hearing loss, magnetic resonance imaging (MRI) was remarkable for T1 shortening of leptomeninges and certain nodules in precontrast study.Subsequent contrast-enhanced MR imaging of the brain and spine revealed enhancement in the basal cisterns extending throughout the spinal canal.The characteristic shortening of T1 and T2 relaxation times in MRI as a result of the paramagnetic stable free radicals that exist within melanin, often suggests a diagnosis of a melanocytic leptomeningeal process.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Rasoul-e-Akram Hospital, Tehran University of Medical Sciences, Tehran, Iran.

ABSTRACT
Meningeal melanocytoma is a primary melanocytic neoplasm with certain MR and immunohistochemical characteristics worthy to note. In a 38-year-old man with a complaint of headache for a couple of years and recently added nausea, vomiting, diplopia, progressive visual blurring and hearing loss, magnetic resonance imaging (MRI) was remarkable for T1 shortening of leptomeninges and certain nodules in precontrast study. Subsequent contrast-enhanced MR imaging of the brain and spine revealed enhancement in the basal cisterns extending throughout the spinal canal. Contrast-enhanced MRI revealed diffuse enhancement in the basal cisterns extending throughout the spinal canal. Immunohistochemical analysis on one of the intraspinal nodules proposed leptomeningeal melanocytoma. The characteristic shortening of T1 and T2 relaxation times in MRI as a result of the paramagnetic stable free radicals that exist within melanin, often suggests a diagnosis of a melanocytic leptomeningeal process. Moreover, there are unique immunohistochemical characteristics for these varied lesions. In appropriate clinical settings, certain radiologic findings, especially both T1 and T2 shortening in nodular CNS lesions should propose meningeal melanocytoma.

No MeSH data available.


Related in: MedlinePlus

A, Brain mid-sagittal contrast enhanced T1-weighted image clearly depicts leptomeningeal lesions in the posterior fossa and resultant downward tonsillar herniation; B, Similar diffuse enhancing leptomeningeal lesions are notable in contrast enhanced T1 mid sagittal image through the cervical and upper thoracic spine. Tonsillar herniation is also visible in the top of this image. (C) Sagittal T2-weighted image through cervical and upper thoracic spine better delineates tonsillar herniation.
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fig586: A, Brain mid-sagittal contrast enhanced T1-weighted image clearly depicts leptomeningeal lesions in the posterior fossa and resultant downward tonsillar herniation; B, Similar diffuse enhancing leptomeningeal lesions are notable in contrast enhanced T1 mid sagittal image through the cervical and upper thoracic spine. Tonsillar herniation is also visible in the top of this image. (C) Sagittal T2-weighted image through cervical and upper thoracic spine better delineates tonsillar herniation.

Mentions: Because of progression of symptoms and development of hydrocephalus, the patient underwent a programmable VP shunt one year later, but thereafter, the patient’s complaints were still present. Further imaging examinations revealed aggravated brain and spinal lesions and a new onset tonsillar herniation (Figure 4). Thus, an elective posterior craniotomy for exploration, microdissection, biopsy taking and partial tumor debulking was undertaken. The patient was discharged with stable and acceptable general condition. Serial follow up visits were planned for the patient; however, unfortunately, corresponding medical records were not available at the time of writing this article.


Unusual tonsillar herniation in meningeal melanocytoma: a case report.

Samimi K, Gharib MH, Rezaei-Kalantari K, Jafari M - Iran J Radiol (2012)

A, Brain mid-sagittal contrast enhanced T1-weighted image clearly depicts leptomeningeal lesions in the posterior fossa and resultant downward tonsillar herniation; B, Similar diffuse enhancing leptomeningeal lesions are notable in contrast enhanced T1 mid sagittal image through the cervical and upper thoracic spine. Tonsillar herniation is also visible in the top of this image. (C) Sagittal T2-weighted image through cervical and upper thoracic spine better delineates tonsillar herniation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3569558&req=5

fig586: A, Brain mid-sagittal contrast enhanced T1-weighted image clearly depicts leptomeningeal lesions in the posterior fossa and resultant downward tonsillar herniation; B, Similar diffuse enhancing leptomeningeal lesions are notable in contrast enhanced T1 mid sagittal image through the cervical and upper thoracic spine. Tonsillar herniation is also visible in the top of this image. (C) Sagittal T2-weighted image through cervical and upper thoracic spine better delineates tonsillar herniation.
Mentions: Because of progression of symptoms and development of hydrocephalus, the patient underwent a programmable VP shunt one year later, but thereafter, the patient’s complaints were still present. Further imaging examinations revealed aggravated brain and spinal lesions and a new onset tonsillar herniation (Figure 4). Thus, an elective posterior craniotomy for exploration, microdissection, biopsy taking and partial tumor debulking was undertaken. The patient was discharged with stable and acceptable general condition. Serial follow up visits were planned for the patient; however, unfortunately, corresponding medical records were not available at the time of writing this article.

Bottom Line: In a 38-year-old man with a complaint of headache for a couple of years and recently added nausea, vomiting, diplopia, progressive visual blurring and hearing loss, magnetic resonance imaging (MRI) was remarkable for T1 shortening of leptomeninges and certain nodules in precontrast study.Subsequent contrast-enhanced MR imaging of the brain and spine revealed enhancement in the basal cisterns extending throughout the spinal canal.The characteristic shortening of T1 and T2 relaxation times in MRI as a result of the paramagnetic stable free radicals that exist within melanin, often suggests a diagnosis of a melanocytic leptomeningeal process.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Rasoul-e-Akram Hospital, Tehran University of Medical Sciences, Tehran, Iran.

ABSTRACT
Meningeal melanocytoma is a primary melanocytic neoplasm with certain MR and immunohistochemical characteristics worthy to note. In a 38-year-old man with a complaint of headache for a couple of years and recently added nausea, vomiting, diplopia, progressive visual blurring and hearing loss, magnetic resonance imaging (MRI) was remarkable for T1 shortening of leptomeninges and certain nodules in precontrast study. Subsequent contrast-enhanced MR imaging of the brain and spine revealed enhancement in the basal cisterns extending throughout the spinal canal. Contrast-enhanced MRI revealed diffuse enhancement in the basal cisterns extending throughout the spinal canal. Immunohistochemical analysis on one of the intraspinal nodules proposed leptomeningeal melanocytoma. The characteristic shortening of T1 and T2 relaxation times in MRI as a result of the paramagnetic stable free radicals that exist within melanin, often suggests a diagnosis of a melanocytic leptomeningeal process. Moreover, there are unique immunohistochemical characteristics for these varied lesions. In appropriate clinical settings, certain radiologic findings, especially both T1 and T2 shortening in nodular CNS lesions should propose meningeal melanocytoma.

No MeSH data available.


Related in: MedlinePlus