Líquido cefalorraquiano no diagnóstico de metástase cérebro-meníngea de melanoma maligno derivado de nevo melanocítico gigante congênito: relato de caso

Rolim, José Augusto B.; Barsottini, Orlando G. R; Prado, Gilmar F.; Nakandakare, Fernando; Reis, Maria L. A. A.; Reis-Filho, J. B.

doi:10.1590/S0004-282X1996000300019

Resumos

Relatamos o caso de um paciente, de 28 anos, portador de nevo melanocítico gigante congênito(NMGC), com transformação em melanoma e metastátase no sistema nervoso central (SNC). Descrevemos resumidamente as características patológicas de ambas as lesões(NMGC e melanoma), a frequência de malignização do NMGC, os órgãos mais frequentemente acometidos pelas metastases do melanoma - dando ênfase ao acometimento do SNC - além dos fatores que podem levar à malignização do NMGC, os exames usados para o diagnóstico das metástases no SNC - ressaltando a importância do líquido cefalorraquiano - e algumas modalidades terapêuticas para o melanoma com acometimento do SNC.

Melanoma maligno; metástase; sistema nervoso central; líquido cefalorraquidiano; nevo melanocítico gigante congênito

We describe the case of a 28-year-old man with a giant congenital melanocytic nevus (GCMN) with malignant transformation to melanoma and metastasis on the central nervous system (CNS). We also make a summary of the pathological features from both lesions(GCMN and melanoma), the occurrence of malignancy of GCMN, the organs more frequently involved with metastatic melanoma - with emphasis to involvement of CNS -just as the factors that cause malignant transformation of GCMN; the methods to diagnose metastases in CNS - emphasizing the importance of cerebrospinal fluid - and some therapeutical modalities for the metastatic melanoma in CNS.

Melanoma; metastases; central nervous system; cerebrospinal fluid; giant congenital melanocytic nevus

Líquido cefalorraquiano no diagnóstico de metástase cérebro-meníngea de melanoma maligno derivado de nevo melanocítico gigante congênito: relato de caso

Cerebral spinal fluid to diagnose CNS metastasis from malignant melanoma arising in a giant congenital melanocytic nevus: case report

José Augusto B. Rolim^I; Orlando G. R Barsottini^I; Gilmar F. Prado^II; Fernando Nakandakare^II; Maria L. A. A. Reis^III; J. B. Reis-Filho^IV

^IMédico-Residente do 3° ano de Neurologia da EPM-UNIFESP

^IIMédico Chefe do Plantão do Pronto Socorro de Neurologia da EPM-UNIFESP

^IIIBióloga do Setor de LCR da EPM-UNIFESP

^IVProfessor-Adjunto, Pesquisador do CNPq e Chefe do Setor de LCR da Disciplina de Neurologia da EPM-UNIFESP

RESUMO

Relatamos o caso de um paciente, de 28 anos, portador de nevo melanocítico gigante congênito(NMGC), com transformação em melanoma e metastátase no sistema nervoso central (SNC). Descrevemos resumidamente as características patológicas de ambas as lesões(NMGC e melanoma), a frequência de malignização do NMGC, os órgãos mais frequentemente acometidos pelas metastases do melanoma - dando ênfase ao acometimento do SNC - além dos fatores que podem levar à malignização do NMGC, os exames usados para o diagnóstico das metástases no SNC - ressaltando a importância do líquido cefalorraquiano - e algumas modalidades terapêuticas para o melanoma com acometimento do SNC.

Palavras-chave: Melanoma maligno, metástase, sistema nervoso central, líquido cefalorraquidiano, nevo melanocítico gigante congênito.

ABSTRACT

We describe the case of a 28-year-old man with a giant congenital melanocytic nevus (GCMN) with malignant transformation to melanoma and metastasis on the central nervous system (CNS). We also make a summary of the pathological features from both lesions(GCMN and melanoma), the occurrence of malignancy of GCMN, the organs more frequently involved with metastatic melanoma - with emphasis to involvement of CNS -just as the factors that cause malignant transformation of GCMN; the methods to diagnose metastases in CNS - emphasizing the importance of cerebrospinal fluid - and some therapeutical modalities for the metastatic melanoma in CNS.

Key words: Melanoma, metastases, central nervous system, cerebrospinal fluid, giant congenital melanocytic nevus.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Aceite: 19-março-1996.

Estudo realizado no Pronto-Socorro de Neurologia da Disciplina de Neurologia da Escola Paulista de Medicina(EPM) da Universidade Federal de São Paulo(UNIFESP)

Dr. José Augusto Rolim - Disciplina de Neurologia, Escola Paulista de Medicina UNIFESP - Rua Botucatu 740 04023-062 São Paulo SP - Brasil.

1. Aichner F, Schuler G. Primary leptomenigeal melanoma: diagnosis by ultrastructural cytology of cerebrospinal fluid and cranial computed tomography. Cancer 1982;50:1751 -1756.
2. Amer MH, Al-Sarraf M, Baker LH, Vaitkevicius VK. Malignant melanoma and central nervous system metastases: incidence, diagnosis, treatment and survival. Cancer 1978;42:660-668.
3. Arnold HL Jr, Odom RB, James WD. Doenças da pele de Andrews. Dermatologia clínica. Ed 8. São Paulo: Manole, 1994:870-890.
4. Caporaso N, Greene MH, Tsai S, Pickle LW, Mulvihill JJ. Cytogenetics in hereditary malignant melanoma and dysplastic nevus syndrome: is dysplastic nevus syndrome a chromosome instability disorder? Cancer Genet Cytogenet 1987,24:299-314.
5. Carella RJ, Gebler R, Hendrickson F, Berry HC, Cooper JS. Value of radiation therapy in the management of patients with cerebral metastases from malignant melanoma: radiation therapy oncology group, brain metastases study I and II. Cancer 1980;45:679.
6. Castilla EE, Durta MDG, Oriolo-Parreirs IM. Epidemiology of congenital pigmented nevi: incidence rates and relative frequencies. Br J Dermatol 1981;104:407-415.
7. Das Gupta T, Brasfield R. Metastatic melanoma: a clinicopathological study. Cancer 1964; 17:1323-1339.
8. DeVita VT, Hellman S, Rosenberg S A (eds). Cutaneous melanoma in Cancer. Principles and practice of oncology. Philadelphia: Uppincott, 1982:1124-1170.
9. Einhorn LH, Burgess MA, Vallejos C et al. Prognostic correlations and response to treatment in advanced metastatic malignant melanoma. Cancer Res 1974,34:1995-2004.
10. Feun LG, Lee YY, Plager C, Papadopoulos N, Savaraj N, Charnsangavej C, Benjamin RS, Wallace S. Intra-carotid cisplatin-based chemotherapy in patients with malignant melanoma and CNS metastases. Am J Clin Oncol 1990; 13:448-451.
11. Fox H. Neurocutaneous melanosis. In Vinken PJ, Bruyn GW (eds). Handbook of clinical neurology. Amsterdam: North Holland, 1972,14:414-428.
12. Gottlieb JA, Frei E, Luce JK. An evaluation of the management of patients with cerebral matastases from malignant melanoma. Cancer 1972;29:701-705.
13. Kadonaga JN, Frieden IJ, Neurocutaneous melanosis: definition and review of the literature. J Am Acad Dermatol 1991;24:747-755.
14. Legha S, Ring S, Plager C. Evaluation of a triple-drug regimen containing cisplatin, vinblastine and DTIC in patients with metastatic melanoma. Proc Am Soc Clin Oncol 1988;7:250.
15. Livramento J A, Machado LR, Clemente HAM, Tabares-Olives A, Spina-França A. Melanomatose meníngea: análise citomorfológica do LCR. Arq Neuropsiquiatr 1979;37:7-14.
16. Madajewics S, Karakousis C, West CR. Malignant melanoma brain metastases: review of the Roswell Park Memorial Institute experience. Cancer 1984;53:2550-2552.
17. McGrady BJ, McCormick DF, Toner PG. Ultrastructural aspects of tumour invasion in the central nervous system. J Pathol 1993;169:89-97.
18. Mitchell MS. Relapse in the central nervous system in melanoma patients sucessfully treated with Biomodulares. J Gin Oncol 1989;7:1701-1709.
19. Mitchell MS, Kan-Mitchell J, Kempf RA. Active specific immunotherapy for melanoma: phase I trial of allogeneic lysates and a novel adjuvant. Cancer Res 1988;48:5883-5893.
20. Padilla SR, McConnel TS, Gribble JT, Smoot C. Malignant melanoma arising in a giant congenital melanocyte nevus. Cancer 1988;62:2589-2594.
21. Quaba AA, Wallace AF. The incidence of malignant melanoma (0 to 15 years of age) arising in large congenital nevocellular nevi. PlastReconstrSurg 1986;78:174-179.
22. Reed WB, Becker SW Sr, Becker SW Jr et al. Giant pigmented nevi melanoma and leptomeningeal melanocytosis. Arch Dermatol 1965;91:100-119.
23. Reis JB , Bei A, Reis-Filho JB. Líquido cefalorraquiano. São Paulo: Sarvier, 1980.
24. Retsas S, Gershuny AR. Central nervous system involvement in malignant melanoma. Cancer 1988,61:1926-1934.
25. Rey JA, Bellow MJ, de Campos JM, Ramos MC, Benitez J. Cytogenetic findings in a human malignant melanoma metastatic to the brain. Cancer Genet Cytogenet 1985; 16:179-183.
26. Reyes-Mugica M, Chou P, Byrd S, Ray V, Castelli M, Gattuso P, Gonzales-Crussi F. Nevomelanocytic proliferations in the CNS of children. Cancer 1993;71:2277-2285.
27. Rhodes AR, Wood WC, Sober AJ, et. al. Nonepidermal origin of malignant melanoma with giant congenital nevocellular nevus. Plast Reconstr Surg 1981 ;67:782-790.
28. Richmond A, Fine R, Murray D, Lawson DH, Priest JH. Growth factor and cytogenetic abnormalities in cultured nevi and malignant melanomas. J Invest Dermatol 1986;86:295-302.
29. Sampaio S, Castro R, Rivitti E. Dermatologia básica. Ed3. São Paulo: Artes Médicas, 1989:504-512.
30. Singhal S, Singh K, Fernandes P, Sharma S, Chander S, Rath GK, Bose S. Primary melanoma of the CNS: report of a case and review of the literature. Indian J Cancer 1991 ;28:92-98.
31. Uematsu Y, Yukawa S, Yokote H, Itukura T, Hayashi S, Komai N. Meningeal melanocytoma: magnetic resonance imaging characteristics and pathological features. J Neurosurg 1992;76:705-709.
32. Zimm S, Wampler GL, Stablein D, Hazra T, Young HF. Intra cerebral metastases in solid tumor patients: natural history and results of treatment. Cancer 1981;48:384-394.

Datas de Publicação

Publicação nesta coleção
10 Nov 2010
Data do Fascículo
Set 1996

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Aichner F, Schuler G. Primary leptomenigeal melanoma: diagnosis by ultrastructural cytology of cerebrospinal fluid and cranial computed tomography. Cancer 1982;50:1751 -1756.

[2] 2. Amer MH, Al-Sarraf M, Baker LH, Vaitkevicius VK. Malignant melanoma and central nervous system metastases: incidence, diagnosis, treatment and survival. Cancer 1978;42:660-668.

[3] 3. Arnold HL Jr, Odom RB, James WD. Doenças da pele de Andrews. Dermatologia clínica. Ed 8. São Paulo: Manole, 1994:870-890.

[4] 4. Caporaso N, Greene MH, Tsai S, Pickle LW, Mulvihill JJ. Cytogenetics in hereditary malignant melanoma and dysplastic nevus syndrome: is dysplastic nevus syndrome a chromosome instability disorder? Cancer Genet Cytogenet 1987,24:299-314.

[5] 5. Carella RJ, Gebler R, Hendrickson F, Berry HC, Cooper JS. Value of radiation therapy in the management of patients with cerebral metastases from malignant melanoma: radiation therapy oncology group, brain metastases study I and II. Cancer 1980;45:679.

[6] 6. Castilla EE, Durta MDG, Oriolo-Parreirs IM. Epidemiology of congenital pigmented nevi: incidence rates and relative frequencies. Br J Dermatol 1981;104:407-415.

[7] 7. Das Gupta T, Brasfield R. Metastatic melanoma: a clinicopathological study. Cancer 1964; 17:1323-1339.

[8] 8. DeVita VT, Hellman S, Rosenberg S A (eds). Cutaneous melanoma in Cancer. Principles and practice of oncology. Philadelphia: Uppincott, 1982:1124-1170.

[9] 9. Einhorn LH, Burgess MA, Vallejos C et al. Prognostic correlations and response to treatment in advanced metastatic malignant melanoma. Cancer Res 1974,34:1995-2004.

[10] 10. Feun LG, Lee YY, Plager C, Papadopoulos N, Savaraj N, Charnsangavej C, Benjamin RS, Wallace S. Intra-carotid cisplatin-based chemotherapy in patients with malignant melanoma and CNS metastases. Am J Clin Oncol 1990; 13:448-451.

[11] 11. Fox H. Neurocutaneous melanosis. In Vinken PJ, Bruyn GW (eds). Handbook of clinical neurology. Amsterdam: North Holland, 1972,14:414-428.

[12] 12. Gottlieb JA, Frei E, Luce JK. An evaluation of the management of patients with cerebral matastases from malignant melanoma. Cancer 1972;29:701-705.

[13] 13. Kadonaga JN, Frieden IJ, Neurocutaneous melanosis: definition and review of the literature. J Am Acad Dermatol 1991;24:747-755.

[14] 14. Legha S, Ring S, Plager C. Evaluation of a triple-drug regimen containing cisplatin, vinblastine and DTIC in patients with metastatic melanoma. Proc Am Soc Clin Oncol 1988;7:250.

[15] 15. Livramento J A, Machado LR, Clemente HAM, Tabares-Olives A, Spina-França A. Melanomatose meníngea: análise citomorfológica do LCR. Arq Neuropsiquiatr 1979;37:7-14.

[16] 16. Madajewics S, Karakousis C, West CR. Malignant melanoma brain metastases: review of the Roswell Park Memorial Institute experience. Cancer 1984;53:2550-2552.

[17] 17. McGrady BJ, McCormick DF, Toner PG. Ultrastructural aspects of tumour invasion in the central nervous system. J Pathol 1993;169:89-97.

[18] 18. Mitchell MS. Relapse in the central nervous system in melanoma patients sucessfully treated with Biomodulares. J Gin Oncol 1989;7:1701-1709.

[19] 19. Mitchell MS, Kan-Mitchell J, Kempf RA. Active specific immunotherapy for melanoma: phase I trial of allogeneic lysates and a novel adjuvant. Cancer Res 1988;48:5883-5893.

[20] 20. Padilla SR, McConnel TS, Gribble JT, Smoot C. Malignant melanoma arising in a giant congenital melanocyte nevus. Cancer 1988;62:2589-2594.

[21] 21. Quaba AA, Wallace AF. The incidence of malignant melanoma (0 to 15 years of age) arising in large congenital nevocellular nevi. PlastReconstrSurg 1986;78:174-179.

[22] 22. Reed WB, Becker SW Sr, Becker SW Jr et al. Giant pigmented nevi melanoma and leptomeningeal melanocytosis. Arch Dermatol 1965;91:100-119.

[23] 23. Reis JB , Bei A, Reis-Filho JB. Líquido cefalorraquiano. São Paulo: Sarvier, 1980.

[24] 24. Retsas S, Gershuny AR. Central nervous system involvement in malignant melanoma. Cancer 1988,61:1926-1934.

[25] 25. Rey JA, Bellow MJ, de Campos JM, Ramos MC, Benitez J. Cytogenetic findings in a human malignant melanoma metastatic to the brain. Cancer Genet Cytogenet 1985; 16:179-183.

[26] 26. Reyes-Mugica M, Chou P, Byrd S, Ray V, Castelli M, Gattuso P, Gonzales-Crussi F. Nevomelanocytic proliferations in the CNS of children. Cancer 1993;71:2277-2285.

[27] 27. Rhodes AR, Wood WC, Sober AJ, et. al. Nonepidermal origin of malignant melanoma with giant congenital nevocellular nevus. Plast Reconstr Surg 1981 ;67:782-790.

[28] 28. Richmond A, Fine R, Murray D, Lawson DH, Priest JH. Growth factor and cytogenetic abnormalities in cultured nevi and malignant melanomas. J Invest Dermatol 1986;86:295-302.

[29] 29. Sampaio S, Castro R, Rivitti E. Dermatologia básica. Ed3. São Paulo: Artes Médicas, 1989:504-512.

[30] 30. Singhal S, Singh K, Fernandes P, Sharma S, Chander S, Rath GK, Bose S. Primary melanoma of the CNS: report of a case and review of the literature. Indian J Cancer 1991 ;28:92-98.

[31] 31. Uematsu Y, Yukawa S, Yokote H, Itukura T, Hayashi S, Komai N. Meningeal melanocytoma: magnetic resonance imaging characteristics and pathological features. J Neurosurg 1992;76:705-709.

[32] 32. Zimm S, Wampler GL, Stablein D, Hazra T, Young HF. Intra cerebral metastases in solid tumor patients: natural history and results of treatment. Cancer 1981;48:384-394.