title: Meningeal melanomatosis: a challenge for timely diagnosis.
abstract: Neoplastic meningitis is a central nervous system complication that occurs in 3-5% of patients with cancer. Although most commonly seen in patients with disseminated disease, in a small percentage of patients, it may be the initial manifestation of cancer or even primitive in origin. In the absence of cancer history, the diagnosis of neoplastic meningitis may be challenging even for expert neurologists. Prognosis is poor, with a median overall survival of weeks from diagnosis. In the retrospective study herein, we described three cases of meningeal melanomatosis in patients without previous cancer history. The patients were diagnosed with significant delay (17 to 47 weeks from symptom onset) mainly due to the deferral in performing the appropriate testing. Even when the diagnosis was suspected, investigations by MRI, cerebrospinal fluid, or both proved at times unhelpful for confirmation. Prognosis was dismal, with a median survival of 4 weeks after diagnosis. Our observations are a cue to analyze the main pitfalls in the diagnosis of neoplastic meningitis in patients without cancer history and emphasize key elements that may facilitate early diagnosis.
authors: C. Mondino National Neurological Institute, Via Mondino 2, 27100 Pavia, Italy ; Neuroscience Consortium, University of Pavia, Monza Policlinico and Pavia Mondino, 27100 Pavia, Italy.
authors: Giulia
authors: 0000-0001-8798-9058
authors: G
authors: Berzero
authors: C. Mondino National Neurological Institute, Via Mondino 2, 27100 Pavia, Italy ; Neuroscience Consortium, University of Pavia, Monza Policlinico and Pavia Mondino, 27100 Pavia, Italy.
authors: Luca
authors: 0000-0002-4540-6886
authors: L
authors: Diamanti
authors: C. Mondino National Neurological Institute, Via Mondino 2, 27100 Pavia, Italy ; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service de Neurologie Mazarin, 75013 Paris, France.
authors: Anna Luisa
authors: AL
authors: Di Stefano
authors: C. Mondino National Neurological Institute, Via Mondino 2, 27100 Pavia, Italy.
authors: Paola
authors: P
authors: Bini
authors: C. Mondino National Neurological Institute, Via Mondino 2, 27100 Pavia, Italy.
authors: Diego
authors: 0000-0002-3014-3913
authors: D
authors: Franciotta
authors: Oncology Unit, Policlinico San Matteo Foundation IRCCS, 27100 Pavia, Italy.
authors: Ilaria
authors: I
authors: Imarisio
authors: Oncology Unit, Policlinico San Matteo Foundation IRCCS, 27100 Pavia, Italy.
authors: Paolo
authors: 0000-0002-9419-7160
authors: P
authors: Pedrazzoli
authors: Neurosurgery Unit, Policlinico San Matteo Foundation IRCCS, 27100 Pavia, Italy.
authors: Lorenzo
authors: L
authors: Magrassi
authors: Department of Molecular Medicine, Unit of Pathology, University of Pavia and Policlinico San Matteo Foundation IRCCS, 27100 Pavia, Italy.
authors: Patrizia
authors: P
authors: Morbini
authors: C. Mondino National Neurological Institute, Via Mondino 2, 27100 Pavia, Italy.
authors: Lisa Maria
authors: LM
authors: Farina
authors: C. Mondino National Neurological Institute, Via Mondino 2, 27100 Pavia, Italy ; Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy.
authors: Stefano
authors: S
authors: Bastianello
authors: C. Mondino National Neurological Institute, Via Mondino 2, 27100 Pavia, Italy ; Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy.
authors: Mauro
authors: M
authors: Ceroni
authors: C. Mondino National Neurological Institute, Via Mondino 2, 27100 Pavia, Italy.
authors: Enrico
authors: E
authors: Marchioni
mesh_terms: D000293:Adolescent; D000368:Aged; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008545:Melanoma / Q000175:diagnosis*; D008577:Meningeal Neoplasms / Q000175:diagnosis*; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies
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