Giant Cell Tumor of the Spine: A Rare Cause of Cervical Pain

A diagnostic challenge in cervical spine mass of spinal giant cell tumor mimicking tuberculosis: Case report

INTRODUCTION AND IMPORTANCE

There were many reported cases that misdiagnosed cervical tuberculosis because cervical tuberculosis can mimic the characteristics of benign tumours. In this case report, we are reporting a case of a giant cell tumor (GCT) that was misdiagnosed with cervical tuberculosis.

CASE PRESENTATION

A 24-year-old male came with a chief complaint of being unable to move his hands and feet four months before admission. Total collapse/ destruction of C3 vertebrae body. The MRI non-contrast result showed an anterior translation of VC2-3 and bilateral stenosis of the foraminal canal. The patient was suspected of cervical tuberculosis, and then the patient was planned for an Anterior Cervical Corpectomy and Fusion (ACCF). The gene X-pert MTB result is negative, and the histopathologic result showed the domination of multinucleated giant cells. The patient was reassessed with cervical GCT. The neurological function was significantly improved from Frankel B to Frankel D in the follow-up.

CLINICAL DISCUSSION

Spinal GCT was imitated both clinical and radiological of the spinal tuberculosis. Gene X-pert is the definitive diagnosis in cases of tuberculosis. The histopathologic analysis and Gene X-pert should be the main tools used to evaluate a lesion miming spinal tuberculosis.

CONCLUSION

With the availability of a wide range of diagnostic options, the appropriate selection of a diagnostic approach is one of the most important steps in patients with spinal tumours and mimicking lesions.

Imaging Features of Aggressive Giant Cell Tumors of the Mobile Spine: Retrospective Analysis of 101 Patients From Single Center

STUDY DESIGN

Retrospective study.

OBJECTIVES

Giant cell tumors (GCTs) of the mobile spine can be locally aggressive. This study described and classified the typical and atypical appearance of aggressive spinal GCTs according to imaging findings to help the imaging diagnosis, especially for patients with rapid neurological deficit that may require emergent surgery without biopsy.

METHODS

Computed tomography (CT) and magnetic resonance imaging (MRI) scans of patients diagnosed with aggressive spinal GCTs at single center were reviewed.

RESULTS

Overall, 101 patients with 100 CT images and 94 MR images were examined. All lesions were osteolytic with cortical destruction; 95 lesions showed epidural extension; 90 were centered in the vertebral body; 82 showed pathological fracture and/or collapse of the vertebral body; 78 had pseudotrabeculation on CT; 80 showed low-to-iso signal intensity or heterogeneous high-signal intensity with cystic areas on the T2-weighted images; 9 showed fluid-fluid level on T2-weighted images; and 61 patients showed marked enhancement on contrast-enhanced CT and/or MRI. Forty-one lesions (40.6%) had at least 1 atypical radiographic feature: 19 involved ≥2 segments; 11 were centered in the posterior neural arch; 10 had a paravertebral mass over 2 segments; 16 showed partial margin sclerosis with partial cortical destruction on CT scans; and 3 showed mineralization within the tumor on CT. Eighty-eight patients underwent CT-guided biopsy with a diagnostic accuracy rate of 94.3%.

CONCLUSIONS

Spinal GCTs might appear more radiologically atypical, and about 40% of the lesions may have at least 1 atypical feature. CT-guided biopsies are recommended for definitive diagnosis.