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Table of Contents    
Year : 2015  |  Volume : 63  |  Issue : 2  |  Page : 260-261

Meningeal melanocytoma of the middle cranial fossa (the Meckel's cave)

1 Department of Neurosurgery, West China Hosptial, China
2 Department of Pathology, West China Hosptial, China

Date of Web Publication5-May-2015

Correspondence Address:
Yanming Ren
Department of Neurosurgery, West China Hosptial
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0028-3886.156300

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How to cite this article:
Ren Y, Xiao A, Wu X, Zhang Y. Meningeal melanocytoma of the middle cranial fossa (the Meckel's cave). Neurol India 2015;63:260-1

How to cite this URL:
Ren Y, Xiao A, Wu X, Zhang Y. Meningeal melanocytoma of the middle cranial fossa (the Meckel's cave). Neurol India [serial online] 2015 [cited 2020 Dec 1];63:260-1. Available from:


Primary meningeal melanocytoma of the middle cranial fossa is extremely rare.

A 29-year-old lady presented with a 3-year history of headache associated with a 4-month history of diplopia and left facial numbness. On neurological examination, she had impairment of sensations in the entire left trigeminal nerve distribution, loss of corneal reflex, left masseteric weakness, and left VIth nerve palsy.

On magnetic resonance imaging (MRI), a dumbbell mass was detected invading the left middle cranial fossa reaching upto the ipsilateral cavernous sinus and extending posteriorly into the cerebellopontine angle (CPA) compressing the brain-stem. The tumor was demonstrated as a hyperintense lesion on T1-weighted imaging (T1WI) and a hypointense lesion on T2-weighted imaging (T2WI) [Figure 1] with no perilesional edema. The contrast-enhanced MRI scan showed that the lesion was heterogeneously enhancing.
Figure 1: The lesion was demonstrated as a hypointense mass on T2 weighted imaging (T2WI)

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A temporal craniotomy and a subtemporal approach was performed for tumor excision. A well-circumscribed lesion with a gritty texture was located at the base of the middle cranial fossa, sandwiched between the two layers of dura [Figure 2].The entire left Meckel's cave was covered by a dark pigmented material tightly adherent to the trigeminal ganglion and was difficult to peel off from it.The majority of the tumor was removed and a small portion densely adherent to the dura left in situ. A subsequent physical examination did not reveal any other cutaneous melanoma.
Figure 2: Intraoperative photographs showing a well-circumscribed lesion with gritty texture located at the base of middle cranial fossa, sandwiched between the two layers of dura

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On immunohistochemistry, a few tumor cells were found surrounded by numerous dark pigmented granules [Figure 3]. The melanocytic feature, Melan-A and S-100 protein were positive, while epithelial membrane antigen (EMA), calretinin (CR) and D2-40 were negative. Cellular proliferation was assessed by evaluating the Ki-67 which appeared weakly positive (less than 1%). Based on the pathological results, the tumor was adjudged as World Health Organization (WHO) grade I (low grade) tumor. After surgery, the patient received radiation therapy. The postoperative magnetic resonance imaging after six months revealed no tumor recurrence. The diplopia and left facial numbness still persisted at a follow up of one-and-a-half years.
Figure 3: Haematoxylin and eosin, × 40: A few tumor cells with abundant pigmented granules

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Primary meningeal melanocytoma is a slow-growing benign tumor of the central nervous system, which was first defined by Limas and Tio in 1972. [1] The tumor occurs in about 1 person per 10 million with a female predominance. [2] Although the number of cases is limited, there is a predilection of meningeal melanocytomas to occur in the spinal cord, especially the thoracic cord. [3] Primary meningeal melanocytoma occuring in the middle cranial fossa is extremely rare, and only a few cases have been reported in the literature. When occurring at atypical sites, the tumor is often misdiagnosed on radiology as a meningioma. In this case, the tumor was initially diagnosed as a trigeminal neurinoma.

Although a meningeal melanocytoma is a benign neoplasm, its frequent relapse and malignant transition have often been described in the literature. In 2011, Wang reported a malignant transformation in a supratentorial meningeal melanocytoma that recurred after 3 years as a malignant melanoma. [4] Due to the possibility of its malignant transformation into a melanoma, meningeal melanocytoma should be subjected to total excision, if feasible. Radiotherapy is considered as a vital adjunctive therapy.

 » References Top

Limas C, Tio FO. Meningeal melanocytoma ("melanotic meningioma"). Its melanocytic origin as revealed by electron microscopy. Cancer 1972;30:1286-94.  Back to cited text no. 1
Liubinas SV, Maartens N, Drummond KJ. Primary melanocytic neoplasms of the central nervous system. J Clin Neurosci 2010;17:1227-32.  Back to cited text no. 2
Aimar E, Debernardi A, Tancioni F, Di Leva A, Bossi P, Gaetani P, et al. Meningeal melanocytoma of the temporal lobe. An uncommon tumor in an unusual location. Case report. J Clin Neurosci 2003;47:211-14  Back to cited text no. 3
Wang F, Qiao G, Lou X, Song X, Chen W. Malignant transformation of intracranial meningeal melanocytoma. Case report and review of the literature. Neuropathology 2011;31:414-20.  Back to cited text no. 4


  [Figure 1], [Figure 2], [Figure 3]

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