Melanotic Schwannoma of the Cervical Spine Progressing With Pulmonary Metastasis: Case Report

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概要

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• Melanotic schwannoma (MS) is an unusual variant of nerve sheath neoplasm. Only 10% of these tumors will undergo malignant degeneration, with exceedingly rare reported metastasis. We present a 32-year-old woman with a 6-month history of cervical pain and left arm progressive weakness. Neurological examination showed a left upper limb radicular pain, with pyramidal syndrome at C5 level. The magnetic resonance imaging (MRI) study highlighted an intradural extramedullary heterogeneous mass along the spinal cord at the C4–C5 level, slightly hyperintense with T1 and hypointense with T2-weighted sequences, invading the left neural foramen. The patient underwent C3–C5 laminectomy with total resection of a black tumor. In the postoperative period, a patent deficit of shoulder abduction ensued related to the nervous section. Microscopically, compactly fascicles of spindle-shaped cells with pleomorphic and hypercromatic nuclei, dark brown intracellular pigments, as well as some mitotic figures were seen. Immunohistochemical stains for S-100, Human Melanoma Black-45 (HMB-45), and vimentin were positive, with Ki-67 Labelling Index (LI) of 15% compatible with MS. Six months after radiotherapy she presents local recurrence and lung metastatic dissemination of the MS. She underwent left pulmonary segmentectomy, followed by chemotherapy and radiosurgery. The patient developed a febrile neutropenia and worsening of general status, and died after 3 months due to respiratory complications. MS are rare tumors with potential for local recurrence and distal metastasis. Complete surgical resection remains as the treatment of choice, once the uncommon cases with malignant progression shows low response to chemo and radiotherapy.

• 社団法人 日本脳神経外科学会の論文

著者

• Faria Mario

  Department Of Physiology And Pharmacology Faculty Of Medicine Federal University Of Ceara

• QUEIROZ Luciano

  Department of Pathologic Anatomy, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (FCM-UNICAMP)

• CHADDAD-NETO Feres

  Department of Neurosurgery, Hospital Municipal Dr. Mário Gatti

• DÓRIA-NETTO Ricardo

  Department of Neurosurgery, Hospital Municipal Dr. Mário Gatti

• OSUGUE Gustavo

  Department of Neurosurgery, Hospital Municipal Dr. Mário Gatti

• FARIA Mário

  Department of Neurosurgery, Hospital Municipal Dr. Mário Gatti

関連論文

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• Expression of Ki-67, Topoisomerase IIα and c-MYC in astrocytic tumors : Correlation with the histopathological grade and proliferative status
• Melanotic Schwannoma of the Cervical Spine Progressing With Pulmonary Metastasis: Case Report

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