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Primary meningeal melanocytoma of the sellar region: review of the literature and differential diagnosis with special reference to angiographical features

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Abstract

Purpose

Primary intracranial melanocytomas are rare neoplasms, especially in the sellar region. Intracranial melanocytoma is usually a dural-based tumor, fed by dural arterial branches in a manner similar to meningioma. Primary sellar melanocytoma may be misdiagnosed as hemorrhagic pituitary macroadenoma, spindle cell oncocytoma, and intrasellar meningioma. These tumors differ in some radiological respects, but are difficult to differentiate preoperatively.

Methods

Only five cases of primary sellar/suprasellar melanocytic tumors, excluding melanomas have been reported thus far. In this paper, we report an instructive new case of a 31-year-old woman presenting with a 2-year history of amenorrhea and an intrasellar mass with suprasellar extension, suggestive of hemorrhagic pituitary adenoma.

Results

Transsphenoidal surgical excision was difficult due to extensive bleeding from the lesion, and at the time, the tumor could not be diagnosed histopathologically. Six years later, we operated again because of tumor regrowth. Angiography revealed a hypervascular tumor, which was fed from the dorsal sellar floor. We had difficulty resecting the tumor, but achieved total removal. Our case had typical radiographic characteristics of melanocytoma, revealed by both magnetic resonance imaging and angiography. However, it was difficult to reach a final diagnosis. Further histopathological examination, including immunohistochemical and ultrastructural studies, was helpful for diagnosis of melanocytoma.

Conclusions

Primary sellar melanocytic tumors are derived from melanocytes in the meningeal lining of the sellar floor or in the diaphragm sellae, based on both embryological assumptions and the clinical findings of our case. We discuss the problems of differential diagnosis and management of primary sellar melanocytic tumors.

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Conflict of interest

The authors have no personal financial and institutional interest in any of the drugs, materials, or devices described in this article.

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Authors and Affiliations

  1. Department of Neurosurgery, Kurume University School of Medicine, 67 Asahimachi, Kurume, 830-0011, Fukuoka, Japan

    Kiyohiko Sakata, Junko Miyoshi, Nobuyuki Takeshige, Satoru Komaki, Naohisa Miyagi, Shinji Nakashima & Motohiro Morioka

  2. Department of Pathology, Kurume University School of Medicine, Fukuoka, Japan

    Yasuo Sugita

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  1. Kiyohiko Sakata
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  2. Junko Miyoshi
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  3. Nobuyuki Takeshige
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  4. Satoru Komaki
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  5. Naohisa Miyagi
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Correspondence to Kiyohiko Sakata.

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Sakata, K., Miyoshi, J., Takeshige, N. et al. Primary meningeal melanocytoma of the sellar region: review of the literature and differential diagnosis with special reference to angiographical features. Pituitary 18, 685–694 (2015). https://doi.org/10.1007/s11102-015-0635-8

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