Melanotic schwannoma of the cervical spine progressing with pulmonary metastasis: case report.
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.
Department of Neurosurgery, Hospital Municipal Dr. Mário Gatti.
Mário Henrique Girão
MH
Faria
Ricardo Henrique
RH
Dória-Netto
Gustavo Jun
GJ
Osugue
Luciano de Souza
Lde S
Queiroz
Feres Eduardo
FE
Chaddad-Neto
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002574:Cervical Vertebrae / Q000737:chemistry / Q000601:surgery; D003131:Combined Modality Therapy; D017809:Fatal Outcome; D064147:Febrile Neutropenia / Q000209:etiology; D005260:Female; D006801:Humans; D007796:Laminectomy; D008175:Lung Neoplasms / Q000556:secondary*; D008279:Magnetic Resonance Imaging; D058950:Melanoma-Specific Antigens / Q000032:analysis; D020460:Melanosomes / Q000648:ultrastructure; D009363:Neoplasm Proteins / Q000032:analysis; D009442:Neurilemmoma / Q000737:chemistry / Q000556:secondary* / Q000601:surgery; D011013:Pneumonectomy; D016634:Radiosurgery; D009418:S100 Proteins / Q000032:analysis; D013120:Spinal Cord Neoplasms / Q000737:chemistry / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D014746:Vimentin / Q000032:analysis; D058951:gp100 Melanoma Antigen
D058950:Melanoma-Specific Antigens; D009363:Neoplasm Proteins; C548637:PMEL protein, human; D009418:S100 Proteins; D014746:Vimentin; D058951:gp100 Melanoma Antigen