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Table 1 Pediatric case reports of primary leptomeningeal melanoma and neoplastic meningitis mimicking tuberculous meningitis

From: NRASQ61K mutated primary leptomeningeal melanoma in a child: case presentation and discussion on clinical and diagnostic implications

Reference

Makin, 1999

Nicolaides, 1995

Selcuk, 2008

Demir, 2010

Kosker, 2014

Erdogan, 2014

Our patient

Diagnosis

Primitive leptomeningeal melanoma

Primitive leptomeningeal melanoma

Atypical Teratoid Rhabdoid Tumor

Spinal low-grade neoplasm

Primary diffuse leptomeningeal gliomatosis

Primary spinal leptomeningeal gliomatosis

Primitive leptomeningeal melanoma

Age and Sex

5,5 years, Male

5 years, Male

6 years, Female

8 years, Female

3 years, male

3 years, male

2 years, Female

Onset signs and symptoms

13-week history of headaches, vomiting, and weight loss followed by acute deterioration of conscious level

3-month history of vomiting, anorexia, and weight loss, 1-month history of headaches and pyrexia, acute deterioration of conscious level

2-months history of confusion, headache, vomiting, aphasia, and right

hemiparesis

History of headache, nausea, fever, and vomiting, followed by double vision

3-month history of strabismus and 1-week history of headache and restlessness

Deviation of left eye, weakness, lack of appetite, headache and behavioral change

1-week history of vomiting

Imaging at onset

CT: diffuse meningeal enhancement

CT: diffuse meningeal enhancement

MRI: marked leptomeningeal involvement and basal meningitis

MRI: communicating hydrocephalus, diffuse leptomeningeal

enhancement at basal cisterns

MRI: leptomeningeal infiltration, prominent around the Sylvian fissure and at the level of the basal cisterns

MRI: diffuse leptomeningeal enhancement, predominantly involving the basal cisterns and hydrocephalus

MRI: enhancement of the cervical and basal meninges and cranial nerves, in addition to a small focal enhancement anterior to the pons

CSF analysis at onset

- Protein 1.5 g/dL

- Glucose 0.7 mmol/L

- No cells

- Protein 1.5 g/L

- Glucose 0.5 mmol/L

(serum glucose 5 mmol/L)

- Leukocytes 36/mm3

- Protein 40.8 mg/dL

- Glucose 36 mg/dL

(serum glucose 136 mg/dL)

- Lymphocytes 350/mm3

- Protein 242 mg/dL

- Glucose 74 mg/dL

(serum glucose 116 mg/dL)

- 10 × 5 cells (60 % lymphocyte, 40 % PMNL)

- Protein 9.2 mg/dL

- Glucose 102 mg/dL

(serum glucose 136 mg/dL)

- Leukocytes 470/mm3 (90 % lymphocyte, 10 % PMNL)

- Protein elevated

- Glucose normal

- Protein 62 mg/dL

- Glucose 83 mg/dL

(serum glucose 133 mg/dL)

- Leukocytes 2/mm3

CSF cyto-morphological examination

ND

- 1st sample: negative

- 2nd sample: positive for malignant cells

Negative

ND

Negative

Negative

- 1st sample:

negative

- 2rd sample: positive for malignant cells

Time delay between onset of symptoms and definitive diagnosis

3 months

3 months

UNK

4 months

10 months

4 months

10 weeks

Chemotherapy

Vincristine, carboplatin, and etoposide

Chemotherapy according to local protocol (not specified)

Not done (parent’s refusal)

Cisplatin and etoposide; radiotherapy

Vincristine, carboplatin, and etoposide; (parents refused radiotherapy)

Vincristine and carboplatin

Temozolomide, cis-platinum, vindesina and peginterferon alfa-2b; radiotherapy

Outcome

Dead 6 months after diagnosis

Unknown

Dead 3 months after onset

Alive after 19 months follow-up

Alive after 18 months follow-up

Unknown

Dead 11 months after diagnosis

  1. CSF, cerebrospinal fluid, CT computed tomography, MRI magnetic resonance imaging, ND not done, UNK unknown, PMNL polymorphonuclear leukocytes