A Child with Primary Leptomeningeal Melanoma

Abstract

Primary malignant melanoma of the meninges is an exceedingly rare neoplasm. Usually its symptoms include raised intracraneal pressure resulting from hydrocephalus seconday to tumoral obliteration of cisternal basal cisterns, but the passage of time from initial symptomalogy to diagnosis is frequently delayed. A 12-year-old male with primary letomeningeal melanoma is reported. At the beginning, he presented with vomiting, headache, complex seizures, fever four months before the admission in the hospital where progressive loss of consciouness after admission. Lumbar puncture reveled high protein level, normal glucose level and 50 leucocytes/mm3 with 86% polymorphic cells. Magnetic ressonance imaging of the brain was referred and in T1-weighted images revealed a diffuse enhancement of the leptomeninges on right frontal cortical. An open brain biopsy trough was performed, after exclusion of the infectious nervous system disease. Histological examination revealed massive infiltration of meninges with brown tumor cells. These cells stained positive for HMB-45, S-100 protein and vimentin. The patient received post operative radiation therapy, but died after three months of the diagnosis with septic shock and epileptical status.