Giant cell tumor of dorsal vertebral body

Abstract

A 30-year-old female patient presented with complaints of backache, weakness in both lower limbs and bladder/bowel dysfunction. Imaging showed an osteolytic lesion at tenth dorsal (D10) vertebra with anterior compression on the spinal cord. Complete intralesional tumor excision with reconstruction was carried out using the anterolateral extrapleural approach. Histopathological examination was suggestive of giant cell tumor (GCT). Because of complete intralesional tumor excision and fear of post-radiation osteonecrosis of bone used for delayed bony union, a conservative approach was used, and radiation therapy was not given. After one year of follow-up patient is doing well without any recurrence of the tumor and is ambulant with support. GCT of dorsal vertebral body is an uncommon entity and total en bloc excision is difficult. Therefore, the treatment strategy is not well-defined. We discuss in brief about incidence, presentation and various treatment modalities available for spinal GCT.

Giant Cell Tumor of Dorsal Vertebrae-A Rare Case Report with Review of Literature

“…7 Simple curettage can lead to local recurrence in 24-40% cases, which can be minimized by adjuvant treatment of cement implantation and chemical therapy. 8 Due to the risk of myelitis and bone graft complications, adjuvant radiotherapy should be reserved for incomplete tumor excision and local recurrence. 9,10 Lungs are the common sites of metastases from GCTs, in about 2.0-9.0% of cases.…”

Contiguous Lumbar Vertebral Involvement with Vertebral Collapse in Giant Cell Tumor: A Usual Tumor with an Unusual Presentation

“…In such scenarios, treatment options include local radiation therapy, chemo-embolization, or systemic therapies such as bisphosphonates, sunitinib, calcitonin, or denosumab. 2 3 5 9 10 In this case, the patient was started on adjuvant therapy with denosumab. Subsequently, she will be followed for clinical improvement and tumor size regression, based on which a decision for the extent of surgery will be taken.…”

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“…6 Common symptoms include back pain, neurological deficit due to compression of spinal cord, bladder and bowel dysfunction and a structural deformity of the spine. 7 Gross pathologic appearance of the tumour is soft, friable and fleshy with presence of areas of fibrosis, hemorrhage and xanthomatous region. On microscopy, giant cell tumour contain a prominent and diffuse osteoclastic giant cell component and previously referred as osteoclastomas.…”

“…11 There are various modalities of treatment recommended for spinal giant cell tumours such as surgery, radiotherapy, embolization, cryotherapy, cementation and chemical adjuvant like phenol or liquid nitrogen. 7 Total en bloc surgical excision is the treatment of choice in long bones as well as spine but is not always feasible in the spine due to the unacceptable risk of permanent neurological deficit. 15…”