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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 24:115-118, January 2003
© 2003 American Society of Neuroradiology

Case Report
BRAIN

Primary Diffuse Meningeal Melanomatosis: Radiologic-Pathologic Correlation

Maria-Giulia Pirini^a, Mario Mascalchi^c, Fabrizio Salvi^b, Carlo A. Tassinari^b, Licciana Zanella^d, Patrizia Bacchini^d, Franco Bertoni^d, Antonia D’Errico^a, Barbara Corti^a and Walter F. Grigioni^a

^a Pathology Unit of the Addarii Institute of Oncology, Policlinico S. Orsola-Malpighi, the University of Bologna, Italy
^b Neurology Division, Department of Clinical Neurosciences, Ospedale Bellaria, the University of Bologna, Italy
^c Radiodiagnostics Section, Department of Clinical Physiopathology, University of Florence, Italy
^d Pathology Section, Istituti Ortopedici Rizzoli, Bologna, Italy

Address reprint requests to Walter F. Grigioni, MD, Istituto Felice Addarii, Policlinico Sant’Orsola-Malpighi, Viale Ercolani 4/2, 40138 Bologna, Italy

Summary: We report a case of primary diffuse meningeal melanomatosis, a rare variant of primary malignant melanoma of the CNS, in a 68-year-old woman. The disease mimicked intracranial hypotension syndrome and was diagnosed only at autopsy (CSF cytologic results were negative). CT revealed hydrocephalus with effacement of the cerebral convexity sulci and abnormal contrast enhancement in the right sylvian and frontoparietal fissures, whereas MR imaging showed diffuse marked dural and leptomeningeal contrast enhancement. In retrospect, these nonspecific findings correlated with the extensive leptomeningeal invasion in the cerebral hemispheres, brain stem and spinal cord. The clinical, radiologic, and pathologic features of diffuse meningeal melanomatosis are reviewed.

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