CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2022; 41(03): e288-e292
DOI: 10.1055/s-0042-1743105
Case Report

Malignant Ocular Melanoma with Intradural Cervical Metastasis: Case Report and Literature Review[*]

Melanoma ocular maligno com metástase cervical intradural: Relato de caso e revisão de literatura
1   School of Medicine, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, PR, Brazil
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2   Medicine Program, Universidade Positivo (UP), Curitiba, PR, Brazil
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3   Department of Neurosurgery, Faculdade de Medicina, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil
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4   Department of Pathology, Hospital Erasto Gaertner, Curitiba, PR, Brazil
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5   Department of Neurosurgery, Hospital Erasto Gaertner, Curitiba, PR, Brazil
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5   Department of Neurosurgery, Hospital Erasto Gaertner, Curitiba, PR, Brazil
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5   Department of Neurosurgery, Hospital Erasto Gaertner, Curitiba, PR, Brazil
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6   Department of Pharmaceutical Sciences, Faculdade de Farmácia, Universidade Positivo (UP), Curitiba, PR, Brazil
› Author Affiliations
Funding Statement The authors declare that no funding has been received pertaining to the present article.

Abstract

Introduction The occurrence of malignant ocular melanomas is uncommon, and the association of these tumors with intradural extramedullary metastases in the cervical spine is exceptionally rare.

Case Report A 62-year-old woman undergoing adjuvant chemotherapy after surgical treatment for malignant ocular melanoma begins to experience vertigo and headache. The condition evolved with walking difficulty and neck pain that was exacerbated by swallowing and mobilizing the neck. During her ocular melanoma follow-up, lesions suggestive of metastasis in the central nervous system were not evidenced until this moment. The physical examination did not show significant findings, and a cranial computed tomography scan was performed. The image showed a hyperdense lesion with postcontrast enhancement inside the vertebral canal, at the level of C1-C2. Spinal decompression and subtotal resection were performed. The anatomopathological report revealed intradural metastasis of a malignant ocular melanoma. The postoperative period was uneventful, with significant pain improvement and no recurrences.

Conclusion Intradural extramedullary metastases are rare presentations of malignant ocular melanoma. In addition, less than ten similar cases have been reported in the literature. When caring for a patient with melanoma and neurological deficits, always consider evaluating central nervous system metastases. To evaluate this patient, a sensible and detailed neurological exam is extremely important to recognize the location of the deficits and guide the best approach, such as an indication for surgery.

Resumo

Introdução É infrequente a ocorrência dos melanomas oculares malignos, e menos frequente ainda é a sua associação às metástases intradurais extramedulares na região cervical.

Relato de Caso Uma mulher de 62 anos, submetida a quimioterapia adjuvante após tratamento cirúrgico para melanoma ocular maligno, abre um quadro de vertigem e cefaleia. O quadro evoluiu com dificuldade para deambular e dor cervical que se exacerbava ao se alimentar e mobilizar o pescoço. Durante o seguimento do melanoma ocular, não foram evidenciadas lesões sugestivas de metástase no sistema nervoso central até este momento. O exame físico não denotou alterações significativas, sendo então realizada tomografia computadorizada de crânio, cuja imagem evidenciou lesão hiperdensa com realce após contraste no interior do canal vertebral, no nível de C1-C2. Foram realizadas descompressão medular e ressecção subtotal, cujo laudo anatomopatológico revelou metástase intradural do melanoma ocular maligno. O pós-operatório seguiu sem intercorrências, com melhora significativa da dor e ausência de recidivas.

Conclusão As metástases intradurais extramedulares são apresentações raras de melanoma ocular maligno. Além disso, há menos de dez casos similares relatados na literatura mundial. Ao tratar de um paciente com melanoma e déficits neurológicos, sempre considere avaliar metástases no sistema nervoso central. Para avaliar este paciente, um exame neurológico criterioso e detalhado é essencial para reconhecer a localização dos déficits e guiar o manejo adequado, como a indicação cirúrgica.

Ethics Statement

The present study was approved by the Ethics in Research Committee of Centro de Projetos de Ensino e Pesquisa (CEPEP) from Hospital Erasto Gaertner, in the city of Curitiba, Southern Brazil, and approved under CAAE number 87548518.2.0000.0098. Written consent was obtained from the patient.


* Study conducted at Hospital Erasto Gaertner, Curitiba - PR, Brazil.




Publication History

Received: 14 August 2021

Accepted: 20 December 2021

Article published online:
23 September 2022

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