Intracranial Trigeminal Nerve Metastasis of a Desmoplastic Neurotropic Melanoma: Case Report

Abstract

Background: Desmoplastic neurotropic mela-noma is a rare and highly malignant variant of melanoma. Solitary nervus trigeminus and Gasserian ganglion metastasis of a neurotropic melanoma has not been previously described in the literature.

Case Description: A 69-year-old man presented to our clinic with trigeminal neuralgia. 4 years previously he underwent tumor removal with an initial diagnosis of amelanotic malignant cutaneous melanoma; 1 year later, because of tumor recurrence, the patient underwent neck dissection, chemotherapy and radiation. Magnet resonance imaging (MRI) disclosed an enhancement of the Gasserian ganglion and tumor extension along the mandibular and maxillar nerves of the intracranial part of the trigeminal nerve suggestive of tumor. The intraoperative macroscopic appearance of the tumor was compatible with a neurinoma. Histopathological studies proved the tumor to be a desmoplastic neurotropic melanoma (DNM) that was related to the previously treated malignant melanoma.

Conclusion: A metastatic tumor arising solely in a trigeminal nerve from a cutaneous malignant melanoma is quite rare; to our knowledge this may be the first report of such a case in the literature.

Zusammenfassung

Hintergrund: Das desmoplastische neurotrope Melanom (DNM) ist eine sehr seltene und hochmaligne Variante des Melanoms. Solitäre Metastasen im Nervus trigeminus und im Ganglion Gasseri wurden in der Literatur noch nicht beschrieben.

Fallbeschreibung: Ein 69-jähriger Mann stellte sich wegen einer Trigeminusneuralgie in unserer Klinik vor. Vor 4 Jahren wurde bei dem Patienten ein amelanotisches malignes Melanom im Nackenbereich diagnostiziert und operativ entfernt. Ein Jahr später wurde aufgrund eines Tumorrezidivs sowie einer Metastase eine Neck Dissektion, gefolgt von Chemotherapie und Bestrahlung, durchgeführt. Die MRT-Untersuchung zeigte jetzt eine Kontrastmittelaufnahme im Bereich des Ganglion Gasseri sowie eine Tumorausdehnung entlang des intrakraniellen Anteils der Nervi mandibularis und maxillaris. Das intraoperative makroskopische Bild des Tumors entsprach dem eines Neurinoms. Die histopathologische Untersuchung wies eine Metastase des bekannten desmoplastischen neurotropen Melanoms nach.

Key words

trigeminal neuralgia - desmoplastic melanoma - Gasserian ganglion - trigeminal nerve metastasis

Schlüsselwörter

Trigeminusneuralgie - Ganglion Gasseri - Metastase des N.trigeminus - desmoplastisches Melanom

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