Primary diffuse-type tenosynovial giant cell tumor of the spine: a report of 3 cases and systemic review of the literature

Abstract

Three patients with spinal primary diffuse-type tenosynovial giant cell tumor (DTGCT) received surgical treatment in our department between 2002 and 2012. All 3 patients were female and aged 23, 33, and 44 years. The mean time from symptom onset to diagnosis was 17 months (range, 5-24 months). One case involved the C1 right lateral mass and C2 vertebral body, the second involved the C1-2 left lateral masses and C2 vertebral body, and the third involved the C5-7 left lateral mass and C6 vertebral body. All patients underwent computed tomographyguided biopsy to confirm the diagnosis of tenosynovial giant cell tumor. Gross total resection was achieved in all patients, including 2 piecemeal resections and 1 en-bloc resection. The mean follow-up time was 6 years (range, 1-11 years), and there was no sign of recurrence in the patients. Seventy cases have been identified so far in the English literature. The male to female ratio is 1:1.38. The mean patient age is 38.5 ± 17.9 years. The tumor distribution includes 32 cases in the cervical spine, 14 in the thoracic spine, 22 in the lumbar spine, and 1 in the sacrococcygeal region. The recurrence rate for patients who underwent gross total resection was 7.7%, and tumor progression was observed in 66.7% of patients who underwent subtotal resection. Above all, DTGCT is a rare primary spinal neoplasm. Preoperative image-guided biopsies play an important role in the diagnosis and treatment strategy. Gross total resection is the best treatment strategy and can reduce the recurrence rate. (aralık, 5-24 ay). Bir olguda C1 sağ lateral kitle ve C2 vertebral cisim tutulması vardı. İkinci olguda C1-2 sol lateral kitleleri ve C2 vertebra cismi tutulmuştu. Üçüncü olguda C5-7 sol lateral kitleleri ve C6 vertebra cismi tutulmuştu. Tüm hastalarda tenosinov yal dev hücreli tümör tanısını doğrulamak için bilgisayarlı tomografi kılavuzluğunda biyopsi yapıldı. Tüm hastalarda gros total rezeksiyon yapıldı. Hastaların ikisinde parça parça ve 1'inde ise en blok halinde rezeksiyon ile gerçekleştirildi. Ortalama takip süresi 6 yıldı (aralık, 1-11 yıl) ve hastalarda bir nüks bulgusu yoktu. İngilizce literatür-de şimdiye kadar 70 olgu tanımlanmıştır. Erkek/kadın oranı 1:1,38'dir. Ortalama hasta yaşı 38,5 ± 17,9 yıldır. Tümör dağılımı servikal omurgada 32 olgu, torasik omurgada 14 olgu, lomber omurgada 22 olgu ve sakrokoksigiyal bölgede 1 olgu şeklindedir. Gros total rezeksiyon yapılan hastalarda nüks oranı %7,7 bulunmuş ve subtotal rezeksiyon yapılan hastaların %66,7'sinde tümör ilerlemesi gözlenmiştir. Genel olarak DTGCT nadir bir primer spinal neoplazmdır. Preoperatif tomografi kılavuzluğunda biyopsiler, tanı ve tedavi stratejisinde önemli bir rol oynamaktadır. En iyi tedavi gros total rezeksiyondur.

Giant cell tumour of the tendon sheath of the spine: clinical features and imaging findings

“…The incidence of spinal GCTTS in female patient was slightly higher than that in male patient in our study. The female to male ratio was 1.33:1, which is roughly concordant with that in previous studies [ 3 , 4 ].…”

“…A systematic review of 69 cases of spinal GCTTS [ 3 ] found that the median age at disease diagnosis was 38.5 ± 17.9 years, which is consistent with the median age of 34.5 years in this study. The clinical manifestations of spinal GCTTSs are nonspecific, and patients may be asymptomatic or suffer from radicular pain and numbness, depending on the size and location of the tumour.…”

Tenosynovial giant cell tumor involving the cervical spine: A case report

“…Kleinman et al [ 3 ] first reported the case of a 65-year-old woman with a TGCT located in the cervical spine in 1980[ 3 ]. According to Wang et al [ 4 ], the cervical spine is the most common site of spinal TGCTs, followed by the lumbar spine and thoracic spine[ 4 ]. TGCTs of the spine usually originate from the synovium of the facet joints, grow diffusely outside the joints, and invade nearby vertebrae[ 5 ].…”

Total en bloc spondylectomy of the eleventh thoracic vertebra following denosumab therapy for the treatment of a giant cell tumor

“…GCTs of the spine reportedly account for 2.7–6.5% of all GCTs in bone ( 3 ). Resection at an early stage remains the best strategy for treatment with a low recurrence rate ( 4 , 5 ).…”