Clinical Reasoning: A 67-Year-Old Woman With Abdominal Pain, Constipation, and Urinary Retention

• Published in: Neurology Vol. 99; no. 3; pp. 117 - 122
• Main Authors: Hanna, Sebastian S., Jewell, Ryan, Anker, Christopher J., DeWitt, John C., Tranmer, Bruce, Thomas, Alissa A.
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 19-07-2022
• Subjects: Abdominal Pain; Adult; Aged; Clinical Reasoning; Constipation; Female; Humans; Magnetic Resonance Imaging; Melanoma - surgery; Meningeal Neoplasms - complications; Meningeal Neoplasms - diagnostic imaging; Meningeal Neoplasms - surgery; Nevus, Pigmented; Spinal Cord Neoplasms - diagnosis; Spinal Cord Neoplasms - diagnostic imaging; Urinary Retention
• ISSN: 0028-3878; 1526-632X
• DOI: 10.1212/WNL.0000000000200748

Meningeal melanocytomas are extremely rare, pigmented tumors of the CNS. They generally carry a favorable prognosis, although recurrence and transformation into the more aggressive malignant melanoma have been reported. We present a case of a patient who reported constipation and abdominal pain around the umbilicus, which progressed into cord compression with lower extremity weakness and gait instability. Spinal MRI revealed a tumor at the level of T11, and she underwent gross total resection of the mass. Pathology demonstrated a meningeal melanocytoma with intermediate features. She received postoperative radiation therapy and had stable disease for 3 years, at which time she developed new weakness and drop metastases. This case represents a rare presentation of a rare disease, in which a spinal cord tumor presented with constipation and abdominal distress. Intradural extramedullary tumors of the thoracic spine are most commonly nerve sheath tumors or meningiomas, but rare entities such as melanocytomas can present in this location; even more rarely, these tumors can have an aggressive course with delayed recurrence.