A Y Lu1, A R Patel2, G A Kuzmik1, K-K Atsina1, R A Bronen3, P M Jabbour4, D M Hasan5, A O Vortmeyer6, B G Welch2, K R Bulsara7. 1. Department of Neurosurgery, Yale School of Medicine, New Haven CT 06510, United States. 2. University of Texas Southwestern Medical Center, Dallas TX 75390, United States. 3. Department of Neurosurgery, Yale School of Medicine, New Haven CT 06510, United States; Department of Diagnostic Radiology, Yale University School of Medicine, New Haven CT 06510, United States. 4. Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia PA 19107, United States. 5. Department of Neurosurgery, University of Iowa, Iowa City, IA 52242, United States. 6. Department of Pathology, Yale School of Medicine, New Haven CT 06510, United States. 7. Department of Neurosurgery, Yale School of Medicine, New Haven CT 06510, United States. Electronic address: ketan.bulsara@yale.edu.
Abstract
BACKGROUND: Melanoma lesions in the brainstem can be difficult to distinguish radiographically and clinically from cavernous malformations. However, the treatment modalities and clinical course of these two diseases differ considerably. We report two cases of melanoma presenting as brainstem hemorrhages. CASE DESCRIPTION: A 69-year-old male was found to have a hemorrhagic lesion of the right dorsal midbrain. After a repeat hemorrhage, the lesion was resected and found to be hyperchromatic. Nonetheless, the patient suffered rebleeding and died 3 months later. A 62-year-old female was similarly found to have an acute pontine hemorrhage. After resection of the lesion, she underwent whole-brain radiation therapy but ultimately died 5.5 months later. The histopathology of both lesions was consistent with melanoma. CONCLUSIONS: Melanoma in the brainstem can mimic cavernous malformations. While management of these lesions includes stereotactic radiosurgery, whole-brain radiation, and surgical resection, metastatic brainstem melanoma follows an aggressive clinical course with a poor prognosis.
BACKGROUND:Melanoma lesions in the brainstem can be difficult to distinguish radiographically and clinically from cavernous malformations. However, the treatment modalities and clinical course of these two diseases differ considerably. We report two cases of melanoma presenting as brainstem hemorrhages. CASE DESCRIPTION: A 69-year-old male was found to have a hemorrhagic lesion of the right dorsal midbrain. After a repeat hemorrhage, the lesion was resected and found to be hyperchromatic. Nonetheless, the patient suffered rebleeding and died 3 months later. A 62-year-old female was similarly found to have an acute pontine hemorrhage. After resection of the lesion, she underwent whole-brain radiation therapy but ultimately died 5.5 months later. The histopathology of both lesions was consistent with melanoma. CONCLUSIONS:Melanoma in the brainstem can mimic cavernous malformations. While management of these lesions includes stereotactic radiosurgery, whole-brain radiation, and surgical resection, metastatic brainstem melanoma follows an aggressive clinical course with a poor prognosis.
Keywords:
Brain stem; Cavernous malformations of CNS and retina; Malformations caverneuses du système nerveux central et de la rétine; Melanoma; Mélanome; Tronc cérébral