Tumor intrarraquídeo extramedular: Melanoma.

Abstract

Intraspinal neoplasms represent 15% of central nervous system tumors, these are generally classified into 3 groups: intradural extramedullary, intradural intramedullary and extradural tumors. The most frequent primary intradural extramedullary neoplasms at this level are those that originate in the nerves and meninges, such as meningiomas, schwannomas, neurofibromas, which generally have a good prognosis, are benign and have poor prognosis as secondary metastases. It is very rare to find a primary melanoma at this level, which is why it was decided to publish this clinical case. Melanoma as primary represents 1% of neoplasms at the level of the central nervous system, with a poor prognosis, risk of recurrence and low survival. The statistics of this tumor are low worldwide, this is the first case study published in Ecuador. Its most frequent location is at the level of the thoracic vertebrae, its clinical picture debuts insidiously, with a prolonged evolution, in most cases, its main signs and symptoms are related to the location and severity of the compression that these generate. We address the clinical history of a 35-year-old male patient who debuted with a clinical picture characterized by decreased muscle strength in the lower extremities, difficulty walking, urinary and rectal sphincter dysfunction of 3 months of evolution, with paraparesis. (Daniels 1/5), patellar hyperreflexia, hypoaesthesia from level T8, bilateral Babinski, in addition the patient presented urinary incontinence. Magnetic resonance imaging was performed, observing images in relation to an apparently intradural intramedullary lesion at the level of T8-T9 that produces spinal cord and radicular compression, classified with the ASIA B scale. The following was performed: laminectomy plus left facetectomy plus tumor excision (100% macroscopically). The histopathological study was: Melanoma.