Recurrent giant cell tumour of the thoracic spine managed by total en bloc spondylectomy and denosumab therapy: a case report

Abstract

Background: Giant cell tumour (GCT) of the bone is a rare, invasive benign bone tumour, which typically originates in the metaphyseal ends of long bones and rarely in the spine. Here, we report a rare case of recurrent GCT of the thoracic vertebra, which was managed by three-level total en bloc spondylectomy (TES) after denosumab therapy. Case presentation: A 50-year-old woman presented with a 2-month history of progressive lower back pain. Magnetic resonance imaging revealed destruction of the T11 vertebra and a soft tissue mass. The patient underwent tumour resection. Computed tomography at the 2-year follow-up revealed relapse of the resected tumour, which had spread to the T12 vertebral body. Subsequently, denosumab therapy was administered to the patient for 1 year. The growth of the tumour was controlled, and its boundary line was clear. Thereafter, TES for the T10-T12 vertebrae was performed, and spinal reconstruction was completed through a one-stage single posterior approach. The patient's condition improved postoperatively, and no evidence of recurrence of GCT of the bone or spinal deformity was observed at the 32-month follow-up. Conclusions: Denosumab therapy contributed to tumour regression. Three-level TES may be an effective and feasible strategy for managing large recurrent GCTs of the spine after denosumab therapy.

Total neurological recovery after surgical decompression and treatment with denosumab of large unresectable spinal giant cell tumour expanding to mediastinum

“…GCT of the spine is usually located in the vertebral body from where it continues to extend to other parts of the spine, including the lamina, spinous process, and even the paravertebral area. 9 Patients with spinal GCT usually present back pain at the site of tumour or neurological deficit before definite diagnosis. 11 As in this case, the tumour destroyed all spinal columns of thoracic vertebrae and invaded the vital adjacent structures (not only the spinal cord and nerve roots but also the intramediastinal organs).…”

“…7 It can be used to supplement surgery either preoperation or postoperation for spinal GCT as the long-term effects of denosumab use in patients with spinal GCT expanding to the mediastinum has not been reported. [8][9][10] Herein, we report of a rare case of unresectable GCT of the thoracic spine that expanded into the mediastinum and spinal canal, resulting in paraplegia. The patient was treated with surgical decompression without tumour resection and long-term denosumab administration with the final result being full neurologic recovery.…”

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.…”

“…GCT involving vertebrae is an uncommon occurrence and only a few such cases have been reported. [2][3][4][5] In this case, contiguous involvement of adjacent vertebrae is an unusual finding, which posed a diagnostic challenge on radiology. Contiguous involvement of vertebra more commonly occurs in infections such as tuberculosis.…”

Surgical Strategy for Recurrent Giant Cell Tumor in the Thoracolumbar Spine

“…However, up to 14% of patients still had local recurrence even after en bloc resection, which poses another challenge for spinal surgeons due to the deranged anatomy and extensive tissue adhesion resulting from previous procedures 5 . Revision surgery, through en bloc spondylectomy, is therefore technically challenging and has only been reported in individual cases 6 . Therefore, the long‐term outcome and prognostic factors of surgical treatment for RGCT is unclear, and whether TES or TPS can better benefit the patients remains controversial.…”