Cervical spine giant cell bone tumor: a case report

Giant cell tumor of the cervical spine: A very uncommon cause for cervical spine compression

Giant cell tumors (GCTs) are rare neoplasms, primarily found in long bones, typically affecting the epiphysis of the distal femur, proximal tibia, and distal radius. However, their occurrence in the cervical spine is exceedingly rare. Here, we present a case report of a 21-year-old female patient who presented with progressive neck pain, radiating numbness, and right hemiparesis. Radiographic imaging revealed a lytic lesion in the C3 vertebral body, further characterized by magnetic resonance imaging (MRI) and computed tomography (CT) scans. The patient underwent surgery for stabilization of the cervico-occipital hinge, decompression, and biopsy. Histopathological examination confirmed the diagnosis of a giant cell tumor. Postoperatively, the patient showed improvement in motor impairment, cervical pain, and numbness. She was proposed for adjuvant treatment based on Denosumab. However, she returned 1 month after surgery with worsened motor deficit, developing tetraparesis. Control MRI revealed a tumor flare-up. The decision was made not to reoperate on the patient and to accelerate the administration of Denosumab. Meanwhile, she experienced a pulmonary embolism leading to her demise. This case underscores the importance of considering giant cell tumors in the differential diagnosis of cervical spine lesions and emphasizes the successful and prompt management through a multidisciplinary approach involving surgical intervention and adjuvant therapy.

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.

Multimodality imaging of an unusual giant cell tumor of thoracic spine with mediastinal invasion: a case report

Giant cell tumor (GCT) is a benign yet locally aggressive bone neoplasm typically situated in the juxta-articular metaphysis of long bones. Although spinal involvement is rare, it is predominantly reported in the axial skeleton, with the sacrum being the primary location. Conversely, GCTs are notably uncommon in the thoracic spine. In this report, we present computed tomography (CT), magnetic resonance imaging (MRI), and 2-Deoxy-2-[fluorine-18]-fluoro-D-glucose (18F-FDG) positron emission tomography combined with computed tomography (PET/CT) multimodality imaging findings of a 36-year-old woman diagnosed with a GCT of the thoracic spine. CT scans provide a precise evaluation of cortical thinning and penetration. While MRI lacks specific diagnostic indicators for GCT, it remains invaluable for delineating the extent of soft tissue expansion and the tumor's relationship with intraspinal neural elements - critical information for surgical planning. 18F-FDG PET/CT effectively illustrates the lesion's hypermetabolic and locally aggressive characteristics. It is noteworthy that GCT occasionally exhibits metastatic malignant potential, underscoring the value of FDG PET as a pivotal modality for staging, restaging, or assessing therapy response, and for monitoring the efficacy of radiotherapy. Familiarity with the imaging features of GCT is essential for physicians to avoid misinterpretation. This tumor should be considered in the differential diagnosis of spinal tumors, distinguishing it from bone metastases or neurogenic tumors.

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.

Comprehensive treatment outcomes of giant cell tumor of the spine: A retrospective study

There is no consensus on a treatment strategy for spinal giant cell tumor of bone (GCTB) because of the difficulty in their treatment. Treatment options often include the use of the controversial denosumab, an antibody therapy aimed at tumor shrinkage, different curettage techniques, resection, or a combination of these therapies. The current study aimed to identify treatment methods associated with favorable outcomes in patients with spinal GCTB. We retrospectively reviewed 5 patients with spinal GCTB, including patients with tumors of the sacrum, treated at our hospital between September 2011 and November 2020. Two men and 3 women were included in the study. The median follow-up period was 74 months (range: 14-108 months). We surveyed the tumor site, treatment method, denosumab use, and outcomes. The median age was 17 years (range: 17-42 years). There were 2 cases of sacral GCTB and 1 case each of lumbar, cervical, and thoracic vertebral GCTB. The comorbidities observed included hepatitis, malignant lymphoma, atopic dermatitis, and asthma. The treatment method included zoledronic acid after embolization and denosumab, denosumab only, curettage and posterior fusion, and curettage resection after embolization and anterior and posterior fusion. Denosumab was used in all cases. Three patients were continuously disease-free, 1 patient with no evidence of disease, and 1 patient alive with disease. Aggressive treatment, especially surgical treatment, may lead to good results in spinal GCTB.