Why is the Prognosis of Primary Pineal Melanoma Poor?
Now open: Certificate Course in Management of Covid-19 by Govt. Of Gujarat and PlexusMDKnow more...Now open: Certificate Course in Management of Covid-19 by Govt. Of Gujarat and PlexusMDKnow more...
Primary melanomas of the central nervous system are unusual, with an incidence rate of 0.005 cases per 100,000 people. Those in the pineal region are extremely rare and difficult to diagnose.

A 22-year-old woman presented with a month old history of headache, 3 kg weight loss and gait disturbance. Her pain was not relieved by pain medications such as aspirin. CT scan showed a hyperdense mass in her pineal region and MRI of her brain revealed a solid mass causing obstructive hydrocephalus. The tumor measured 1.8×1.5×1.7cm.

The patient underwent a craniotomy. A gross total resection of the tumor through a supracerebellar infratentorial approach

Three weeks after discharge, she was readmitted with the diagnosis of distal deep vein thrombosis in her left leg. During treatment, she died of a cardiopulmonary arrest, having survived only 12 weeks after the start of her initial symptoms.

Points Worth Discussion:-
1. CNS melanomas are quite rare. These tumors may occur de novo or in association with neurocutaneous melanosis.
2. Primary CNS melanomas have a pathology indistinguishable compared to that of melanomas arising within the skin, eye or other mucosal sites.
3. Although MRI is the gold standard for imaging a patient with a suspected PPM, this tumor cannot be reliably distinguished by neuroimaging alone.
4. The outcome in PPM with leptomeningeal dissemination is very poor. This patient died 49 days after surgery, which could have been due to physical inactivity after her surgery, causing deep vein thrombosis and a pulmonary embolism.

Source: https://jmedicalcasereports.biomedcentral.com/articles/10.1186/1752-1947-6-165
D●●●●j B●●●●●k and 2 other likes this