Total Spondylectomy for Upper Thoracic Spine Giant Cell Tumor: A Case Report

Abstract

Introduction: Giant cell tumors (GCT) are benign lesions that are generally locally aggressive tumors with occasional malignant behavior. These tumors are most frequently encountered in long bones; however, they also occur rarely in the spine. GCT of the spine are rare pathological entities, and spinal involvement shows a sacral predilection, with only a few cases involving the supra-sacral segment (mobile spine). Only a few cases of thoracic spinal GCT are reported in the literature; these tumors are particularly uncommon in the thoracic segment. Presentation of Case: A 29-year-old man presented with a complaint of neck pain over the previous six months that radiated to his left hand. GCT of the upper thoracic spine was diagnosed, which was surgically managed using a 2-stage approach involving total resection of the tumor followed by spondylectomy and multilevel spinal fixation. Discussion: Accurate diagnosis of vertebral column lesions, and choosing an optimum management plan are crucial. In the majority of cases, En-bloc resection of GCTs is not feasible ought to the close contact of the lesion with the spinal cord. Larger studies are encouraged to ascertain the efficacy of variable management approaches, particularly compared with piecemeal resection techniques. Conclusion: Spinal GCT are a unique group of tumors with an uncommon and unexpected presentation. Although surgery is the mainstay of treatment for spinal GCT, the management of this tumor can be challenging. No clear management algorithm has been established, and the tumor displays an unpredictable course. Therefore, each case needs tailored treatment.

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

“…We reviewed studies on aggressive GCT published over the past 20 years according to PRISMA statement, and 52 studies were involved ( Figure 10 ). 15 - 66 There were 60 patients with 53 CT scans and 39 MRI scans, of whom 21 patients underwent enhanced scans simultaneously. The typical and atypical features were summarized according to the diagnostic standards in the present study ( Table 2 ) and the frequency of the features was similar.…”

Alternative approach to treatment of unusual site giant cell tumor at cervical spine

“…On the other hand, en bloc surgical resection is not possible for many spinal GCTs due to proximity to the spinal cord and neurovascular structures. [ 5 11 ] Preoperative embolization before en bloc surgical resection facilitates surgery and significantly decreases the intraoperative hemorrhage. [ 21 ] Retrospective observational studies show that 35.1% of patients who went under en bloc surgical resection have experienced at least one complication.…”

“…[ 4 ] “H3F3A” mutation is a known specific marker of GCTs and may be a diagnostic confirmation tool for these tumors. [ 5 ]…”

“…In general, several treatment approaches have been utilized with different outcomes[ 5 ] that will be discussed in relevant parts of this study. Thus, large-scale prospective studies are required to provide an acceptable treatment algorithm for GCTs.…”

“…Thus, large-scale prospective studies are required to provide an acceptable treatment algorithm for GCTs. [ 5 ]…”