Primary sellar haemorragic melanoma: case report and review of the literature

Primary melanoma of the sella turcica is very unusual with only four previous cases reported in the medical literature. This report describes a 47-year-old man whose headaches, endocrine dysfunction and neuro-imaging suggested a haemorrhagic pituitary macroadenoma. The histological examination showed a haemorrhagic melanoma. An extensive search for a primary source proved negative. The patient underwent three neurosurgical interventions and radiotherapy and died two years after presentation. Previous cases of primary melanoma in the pituitary region, as well as various hypotheses for this unusual site of origin are reviewed, followed by a discussion of the particular characteristics of melanin pigments on MRI. This case report illustrates that primary sellar melanoma may present as a haemorrhagic adenoma of the pituitary gland and have an unfavourable outcome despite repeated neurosurgical interventions and radiation therapy.