Primary Meningeal Melanocytoma in Sellar Region, Simulating a Nonfunctioning Pituitary Adenoma: Case Report and Literature Review

Background Primary meningeal melanocytoma is a benign lesion in the central nervous system derived from leptomeningeal melanocytes, most commonly growing in the posterior fossa and cervical spinal cord. The sellar primary meningeal melanocytoma (SPMM) is an exceptionally rare tumor. Here we report the ninth published case of an SPMM, and also discuss the problems of differential diagnosis and management of these tumors. Case Description The patient presented with visual impairment and irregular menstruation with no other symptoms. Her general examination was otherwise unremarkable. Endocrine tests disclosed normal endocrine function except for slight hyperprolactinemia. Magnetic resonance imaging revealed a sellar lesion. The patient underwent a successful total transsphenoidal removal of the tumor without neurologic sequelae. Based on this case report, SPMM should be included in the differential diagnosis of malignant and/or metastatic melanoma. Conclusions SPMM is an exceptionally rare tumor. Differentiating sellar melanocytic tumors from other sellar diseases through clinical and radiologic investigations is very difficult. The treatment of choice for SPMM is complete surgical resection via a transsphenoidal approach. For patients with a partially resected tumor, radiotherapy is an effective complementary treatment modality.