Upper New York State Society of Cytology,Inc.

Interesting Case 1

Submitted by: Sharon Leo, MS,CT(ASCP), IAC

University of Rochester Medical Center, Rochester, NY

History

A 27 year-old female presented with a history of mental status change and seizures. A cerebral spinal fluid was submitted for cytologic evaluation. The specimen was processed as a Thin Prep.

Cytologic Findings

Numerous small cells were present in the spinal fluid. The cells were single or in loose aggregates. The small nuclei were hyperchromatic with irregular chromatin and nuclear borders. Central macronucleoli were present in the majority of nuclei. The cytoplasm was granular and fragile. The indeterminate stained cytoplasm was scant and melanin pigment was absent. The brain tissue did have melanin pigment present.

Diagnosis/Discussion

Malignant tumor cells present derived from malignant melanoma. Tissue from the temporal lobe was also signed out as malignant melanoma.

Primary leptomeningeal melanoma probably has its origin from a small number of melanocytes present in leptomeninges(1). Melanocytes are also found on the spinal cord surface, the brainstem and the base of the brain(1). Primary leptomeningeal melanoma is a rare tumor with only 220 cases reported since 1859(1). In a Norway study of six cases, the mean age at diagnosis was 29 years(range 9-62 years), affected more whites than non-whites, and affected both sexes equally(1). Symptoms include change in mental status, seizures, and intracranial pressure secondary to hydrocephalus(1). MRI is the best imaging technique to use for this tumor(1). The average survival rate is only five months(1). Treatment is difficult since the tumor does does respond well to radiation therapy and mutiple sites may be involved(1).

References

1. www.ucsf.edu/nreview/06.4-oncology-histologicaltype/leptomeningmelanoma.html