title: Primary meningeal melanocytoma of the sellar region: review of the literature and differential diagnosis with special reference to angiographical features.
abstract: OBJECTIVE
  Primary intracranial melanocytomas are rare neoplasms, especially in the sellar region. Intracranial melanocytoma is usually a dural-based tumor, fed by dural arterial branches in a manner similar to meningioma. Primary sellar melanocytoma may be misdiagnosed as hemorrhagic pituitary macroadenoma, spindle cell oncocytoma, and intrasellar meningioma. These tumors differ in some radiological respects, but are difficult to differentiate preoperatively.
  
  
  METHODS
  Only five cases of primary sellar/suprasellar melanocytic tumors, excluding melanomas have been reported thus far. In this paper, we report an instructive new case of a 31-year-old woman presenting with a 2-year history of amenorrhea and an intrasellar mass with suprasellar extension, suggestive of hemorrhagic pituitary adenoma.
  
  
  RESULTS
  Transsphenoidal surgical excision was difficult due to extensive bleeding from the lesion, and at the time, the tumor could not be diagnosed histopathologically. Six years later, we operated again because of tumor regrowth. Angiography revealed a hypervascular tumor, which was fed from the dorsal sellar floor. We had difficulty resecting the tumor, but achieved total removal. Our case had typical radiographic characteristics of melanocytoma, revealed by both magnetic resonance imaging and angiography. However, it was difficult to reach a final diagnosis. Further histopathological examination, including immunohistochemical and ultrastructural studies, was helpful for diagnosis of melanocytoma.
  
  
  CONCLUSIONS
  Primary sellar melanocytic tumors are derived from melanocytes in the meningeal lining of the sellar floor or in the diaphragm sellae, based on both embryological assumptions and the clinical findings of our case. We discuss the problems of differential diagnosis and management of primary sellar melanocytic tumors.
authors.affiliation: Department of Neurosurgery, Kurume University School of Medicine, 67 Asahimachi, Kurume, 830-0011, Fukuoka, Japan, kiyo@med.kurume-u.ac.jp.
authors.forename: Kiyohiko
authors.initials: K
authors.lastname: Sakata
authors.forename: Junko
authors.initials: J
authors.lastname: Miyoshi
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Takeshige
authors.forename: Satoru
authors.initials: S
authors.lastname: Komaki
authors.forename: Naohisa
authors.initials: N
authors.lastname: Miyagi
authors.forename: Shinji
authors.initials: S
authors.lastname: Nakashima
authors.forename: Motohiro
authors.initials: M
authors.lastname: Morioka
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Sugita
mesh_terms: D000236:Adenoma / Q000098:blood supply* / Q000737:chemistry / Q000473:pathology; D000328:Adult; D014408:Biomarkers, Tumor / Q000032:analysis; D002533:Cerebral Angiography; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008279:Magnetic Resonance Imaging; D008544:Melanocytes / Q000737:chemistry / Q000473:pathology; D008577:Meningeal Neoplasms / Q000098:blood supply* / Q000737:chemistry / Q000473:pathology / Q000601:surgery; D010911:Pituitary Neoplasms / Q000098:blood supply* / Q000737:chemistry / Q000473:pathology; D011237:Predictive Value of Tests; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor