Una masa intramedular pigmentada es un hallazgo muy raro en la práctica diaria, y supone un reto diagnóstico. Se deben considerar tumores que contienen melanina (ependimoma melanótico y schwannoma melanótico) y los tumores que contienen melanocitos (melanocitoma, melanoma primario, melanoma metastásico). Describimos el caso de un hombre de 47 años con una lesión intramedular a nivel de T7-T8. Las imágenes de resonancia magnética (RM) revelaban una lesión hiperintensa en T1 e hipointensa en T2. El tumor fue resecado parcialmente y tratado con radioterapia adyuvante. La histología y la ausencia de lesiones fuera del sistema nervioso central (SNC) permitieron establecer el diagnóstico de melanoma primario intramedular (MPI). Se realizó una revisión de la literatura de los 26 casos de MPI reportados. Los MPI son tumores extremadamente raros, pero son la causa más frecuente de tumores intramedulares pigmentados. La primera opción de tratamiento es la resección quirúrgica completa, seguida de radioterapia complementaria.
A dark pigmented intramedullary mass is very rarely encountered in daily practice, and poses a diagnostic challenge. Several entities have to be considered, including melanin-containing tumours (melanotic ependymoma and melanotic schwannoma) and melanocyte-containing tumours (melanocytoma, primary melanoma and melanoma metastases). The case is presented of a 47 year-old male with a pigmented intramedullary tumour located at T7-T8 level. Magnetic resonance images (MRI) revealed a tumour with hyperintensity on T1 and hypointensity on T2. The tumour was resected partially and treated with adjuvant radiotherapy. The diagnosis of primary intramedullary melanoma (PIM) was established based on histology and the absence of other lesions outside of the CNS. A literature review is presented on the other 26 PIM cases reported. PIM are extremely rare tumours, but are the most frequent cause of pigmented intramedullary tumour. Complete surgical resection is the treatment of choice whenever possible, followed by radiotherapy.
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