Primary melanocytic tumor of the cerebellopontine angle mimicking a vestibular schwannoma: case report.

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Neurosurgery. 2006 Jul;59(1):E206; discussion E206.

Primary melanocytic tumor of the cerebellopontine angle mimicking a vestibular schwannoma: case report.
 
Piedra MP, Scheithauer BW, Driscoll CL, Link MJ.
 
Department of Neurological Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota 55901, USA.
 
OBJECTIVE:
The majority of tumors of the cerebellopontine angle (CPA) are benign.
We report the case of a primary malignant melanoma of the CPA that
mimicked a vestibular schwannoma (acoustic neuroma). We discuss the
differential diagnosis and prognosis of melanotic lesions at this
location.
CLINICAL PRESENTATION: A 49-year-old man presented with a
7-year history of unilateral deafness and a several month history of
imbalance, intractable nausea and vomiting, as well as weight loss. A
neurological work-up revealed a large tumor in the left CPA
radiographically diagnosed as a vestibular schwannoma.
INTERVENTION: A
translabyrinthine approach revealed a pigmented, vascular neoplasm
encasing vessels and cranial nerves of the left CPA. The tumor was
subtotally resected, and a histopathological diagnosis of melanoma was
made. The patient had no history of cutaneous melanoma and no other
site of disease was ever discovered.
CONCLUSION: This case most likely
represents primary melanoma of the central nervous system that mimicked
a vestibular schwannoma. The differential diagnosis of melanotic
lesions of the CPA is discussed as are the prognostic implications of
each diagnosis.