Primary Melanomas in the Central Nervous System with Peritoneal Dissemination through Ventriculo peritoneal Shunt

Abstract

An autopsy case of primary melanoma of the central nervous system is reported. An 11-year-old female was admitted complaining of headache and nuchal pain. At 2 months of age, a ventriculo-peritoneal (V-P) shunt had been performed after a diagnosis of communicating hydrocephalus. She had grown without any neurological deficits thereafter. On admission she was neurologically free except for a decreased patellar tendon reflex on the left side. Cerebrospinal fluid obtained by lumbar puncture was bloody. A computerized tomography scan showed a contrast positive mass in the left temporal base and diffuse enhancement of the subarachnoid space. The tumor was partially removed and diagnosed as a malignant melanoma. The patient developed various symptoms due to involvement of cranial nerves and the spinal cord. She died 2 months after a subarachnoid hemorrhage. Necropsy revealed diffuse leptomeningeal dissemination of the tumor in the central nervous system and peritoneal metastasis via a shunt tube. The authors suggest that peritoneal dissemination of melanomas in the central nervous system via V-P shunt system is not a rare occurrence; they make treatment more difficult.