Primary intramedullary melanoma of the spinal cord. Case report

Abstract

Authors report the case of a79 year old man. After weakness, paraesthesia and walking disturbances developing within weeks he was admitted to the Neurology Department of our institution. Upon negativity of Computed Tomography the Magnetic Resonance Investigation of the spinal cord revealed space constrictor process corresponding to thoracic vertebrae X- XI. This mass wasremoved surgically. Histology supplemented by immuno-histochemistry had proved malignant melanoma. Genetic test out of the removed neoplastic tissue was negative to BRAF-V600 E. The repeated thoroughly performed checks on the entire integument as well as negativity of the ophthalmic status has raised the possibility of primary melanoma originated from the spinal cord. No lymph node metastasiswas detected.Aftersurgery targeted X-ray irradiation was performed, followed by Pembrolizumab administration in monotherapy. This treatment was, however suspended due to rapidly developing side effects. As next Carboplatin therapy was started which was stopped after the 5th cycle due to side effects. The temporary remission has lasted for 7 months but the initial symptoms had returned with increasing pain. From this time urinary infection and disturbance of intestinal passage have dominated the clinical picture. Decubital ulceration and sepsis developed and the patient died 21 months after first appearance of clinical symptoms. Extreme
rarity and poor survival not exceeding 5 years are characteristics of the of reported cases.