A T1-isointense meningeal melanocytoma mimicking meningioma: Case report and literature review.

Meningeal melanocytomas are rare, benign, melanocytic neoplasms of the pia mater, typically characterized by a high T1-weighted signal intensity on MRI. We report the case of a 47-year-old female with a T1-isointense tentorial lesion initially diagnosed as a meningioma, but histologically confirmed as a melanin-containing meningeal melanocytoma. Despite extensive intraoperative and pathological evidence of pigmentation, the tumor did not display the expected T1 hyperintensity, emphasizing that meningeal melanocytomas occasionally present with atypical imaging features. This case highlights the need to include melanocytic tumors in the differential diagnosis of intracranial lesions that lack classical radiological characteristics.