Giant cell tumor of the thoracal spine treated with decompression and posterior stabilization: a case report

Karya Triko Biakto; Jainal Arifin; Rheza Setiawan Budiharto; Dave Kennedy

doi:10.15562/bmj.v12i3.4270

Giant cell tumor of the thoracal spine treated with decompression and posterior stabilization: a case report

Karya Triko Biakto ,

Jainal Arifin ,

Rheza Setiawan Budiharto ,

Dave Kennedy ,

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DOI: https://doi.org/10.15562/bmj.v12i3.4270 |
Published: 2023-08-11

Abstract

Link of Video Abstract: https://youtu.be/9d-gkVfVFX8

Background: Giant cell tumors (GCT) are benign tumors that can also develop in the bone. GCTs commonly affect women aged 30-40 years. The spine is a rare site of GCTs, which accounts for 1.4-9.4% of primary spine tumors. Therefore, we aimed to present a case of spinal GCT in a young male adult, which we considered unique due to the unusual age and localization.

Case presentation: We reported an 18-year-old male admitted to Hasanuddin University General Hospital with complaints of paralysis in both lower limbs, lower back pain, loss of sensation in defecation, difficulty in urinating, and tenderness at the T12 level. There was a wound on the sacral region. The mass and osteolytic lesion in the T12 seen on CT scan and MRI, respectively, followed by a biopsy, confirmed the spinal GCT.

Conclusion: The management of spinal GCT requires precise and multidisciplinary treatment planning with a case-by-case approach in order to achieve total or partial tumor resection, neural decompression, and stabilization of the spine.

References

Saputra RD, Idulhaq M, and Kusuma DA. Giant cell tumor (GCT) of bone recurrence rate at Moewardi Hospital Surakarta. Jurnal Orthopaedi dan Traumatologi Indonesia. 2021;4(1). p23-26. https://doi.org/10.31282/joti.v4n1.70.
Balke M, Henrichs MP, Gosheger G, Ahrens H, Streitbuerger A, Koehler M, Bullmann V, Hardes J. Giant cell tumors of the axial skeleton. Sarcoma. 2012;2012:410973. https://doi.org/10.1155/2012/410973.
Domovitov SV, Chandhanayingyong C, Boland PJ, McKeown DG, Healey JH. Conservative surgery in the treatment of giant cell tumor of the sacrum: 35 years' experience. J Neurosurg Spine. 2016 Feb;24(2):228-240. https://doi.org/10.3171/2015.4.SPINE13215.
Zhang Y, Ilaslan H, Krishnaney AA, Bauer TW. Morphological Transformation of Giant-Cell Tumor of Bone After Treatment with Denosumab: A Case Report. JBJS Case Connect. 2016 Jul-Sep;6(3):e74. https://doi.org/10.2106/JBJS.CC.16.00015.
Xu W, Li X, Huang W, Wang Y, Han S, Chen S, Xu L, Yang X, Liu T, Xiao J. Factors affecting prognosis of patients with giant cell tumors of the mobile spine: retrospective analysis of 102 patients in a single center. Ann Surg Oncol. 2013 Mar;20(3):804-10. https://doi.org/10.1245/s10434-012-2707-6.
Liu W, Chan CM, Gong L, Bui MM, Han G, Letson GD, Yang Y, Niu X. Malignancy in giant cell tumor of bone in the extremities. J Bone Oncol. 2020 Nov 5;26:100334. https://doi.org/10.1016/j.jbo.2020.100334.
Elder BD, Sankey EW, Goodwin CR, Kosztowski TA, Lo SF, Bydon A, Wolinsky JP, Gokaslan ZL, Witham TF, Sciubba DM. Surgical Outcomes in Patients with High Spinal Instability Neoplasm Score Secondary to Spinal Giant Cell Tumors. Global Spine J. 2016 Feb;6(1):21-8. https://doi.org/10.1055/s-0035-1555657.
Şirin E, Sofulu Ö, Baysal Ö, Akgülle AH, Erol B. Staged Management of Infection with Adjustable Spacers After Megaprosthesis Implantation in Primary Sarcoma Patients. Indian J Orthop. 2023 Mar 27;57(6):938-947. https://doi.org/10.1007/s43465-023-00876-9.
Kim HS, Lee JE, Jung SS, Chon J, Yoon DH, Park YK, Cho EH. Spinal Cord Injury due to the Giant Cell Tumor of the Second Thoracic Vertebra: A Case Report. Ann Rehabil Med. 2013 Apr;37(2):269-73. https://doi.org/10.5535/arm.2013.37.2.269.
Leggett AR, Berg AR, Hullinger H, Benevenia JB. Diagnosis and Treatment of Lumbar Giant Cell Tumor of the Spine: Update on Current Management Strategies. Diagnostics. 2022; 12(4):857. https://doi.org/10.3390/diagnostics12040857.
Czerniak B. Dorfman and Czerniak’s bone tumors. 2nd ed. Missouri: Elsevier. 2015.
Shi LS, Li YQ, Wu WJ, Zhang ZK, Gao F, Latif M. Imaging appearance of giant cell tumour of the spine above the sacrum. Br J Radiol. 2015 Jul;88(1051):20140566. https://doi.org/10.1259/bjr.20140566.
Althausen PL, Schneider PD, Bold RJ, Gupta MC, Goodnight JE Jr, Khatri VP. Multimodality management of a giant cell tumor arising in the proximal sacrum: case report. Spine (Phila Pa 1976). 2002 Aug 1;27(15):E361-5. https://doi.org/10.1097/00007632-200208010-00020.
Trovarelli G, Pala E, Angelini A, Ruggieri P. A systematic review of multicentric giant cell tumour with the presentation of three cases at long-term follow-up. Bone Joint J. 2022 Dec;104-B(12):1352-1361. https://doi.org/10.1302/0301-620X.104B12.BJJ-2022-0401.R1.
Ben Nsir A, Said IB, Badri M, Boughamoura M, Jemel H. Giant cell tumor of the sixth thoracic vertebra: case report. Turk Neurosurg. 2015;25(3):475-8. https://doi.org/10.5137/1019-5149.JTN.8361-13.0.
Luksanapruksa P, Buchowski JM, Singhatanadgige W, et al. Management of spinal giant cell tumors. Spine J. 2016 Feb;16(2):259-69. https://doi.org/10.1016/j.spinee.2015.10.045.
Charest-Morin R, Fisher CG, Varga PP, Gokaslan ZL, Rhines LD, Reynolds JJ, et al. En Bloc Resection Versus Intralesional Surgery in the Treatment of Giant Cell Tumor of the Spine. Spine (Phila Pa 1976). 2017;42(18):1383-1390. https://doi.org/10.1097/BRS.0000000000002094.
Xu R, Choong PFM. Metastatic giant cell tumour of bone: a narrative review of management options and approaches. ANZ J Surg. 2022;92(4):691-696. https://doi.org/10.1111/ans.17520.
von Borstel D, A Taguibao R, A Strle N, E Burns J. Giant cell tumor of the bone: aggressive case initially treated with denosumab and intralesional surgery. Skeletal Radiol. 2017 Apr;46(4):571-578. https://doi.org/10.1007/s00256-017-2588-7.

[1] Saputra RD, Idulhaq M, and Kusuma DA. Giant cell tumor (GCT) of bone recurrence rate at Moewardi Hospital Surakarta. Jurnal Orthopaedi dan Traumatologi Indonesia. 2021;4(1). p23-26. https://doi.org/10.31282/joti.v4n1.70.

[2] Balke M, Henrichs MP, Gosheger G, Ahrens H, Streitbuerger A, Koehler M, Bullmann V, Hardes J. Giant cell tumors of the axial skeleton. Sarcoma. 2012;2012:410973. https://doi.org/10.1155/2012/410973.

[3] Domovitov SV, Chandhanayingyong C, Boland PJ, McKeown DG, Healey JH. Conservative surgery in the treatment of giant cell tumor of the sacrum: 35 years' experience. J Neurosurg Spine. 2016 Feb;24(2):228-240. https://doi.org/10.3171/2015.4.SPINE13215.

[4] Zhang Y, Ilaslan H, Krishnaney AA, Bauer TW. Morphological Transformation of Giant-Cell Tumor of Bone After Treatment with Denosumab: A Case Report. JBJS Case Connect. 2016 Jul-Sep;6(3):e74. https://doi.org/10.2106/JBJS.CC.16.00015.

[5] Xu W, Li X, Huang W, Wang Y, Han S, Chen S, Xu L, Yang X, Liu T, Xiao J. Factors affecting prognosis of patients with giant cell tumors of the mobile spine: retrospective analysis of 102 patients in a single center. Ann Surg Oncol. 2013 Mar;20(3):804-10. https://doi.org/10.1245/s10434-012-2707-6.

[6] Liu W, Chan CM, Gong L, Bui MM, Han G, Letson GD, Yang Y, Niu X. Malignancy in giant cell tumor of bone in the extremities. J Bone Oncol. 2020 Nov 5;26:100334. https://doi.org/10.1016/j.jbo.2020.100334.

[7] Elder BD, Sankey EW, Goodwin CR, Kosztowski TA, Lo SF, Bydon A, Wolinsky JP, Gokaslan ZL, Witham TF, Sciubba DM. Surgical Outcomes in Patients with High Spinal Instability Neoplasm Score Secondary to Spinal Giant Cell Tumors. Global Spine J. 2016 Feb;6(1):21-8. https://doi.org/10.1055/s-0035-1555657.

[8] Şirin E, Sofulu Ö, Baysal Ö, Akgülle AH, Erol B. Staged Management of Infection with Adjustable Spacers After Megaprosthesis Implantation in Primary Sarcoma Patients. Indian J Orthop. 2023 Mar 27;57(6):938-947. https://doi.org/10.1007/s43465-023-00876-9.

[9] Kim HS, Lee JE, Jung SS, Chon J, Yoon DH, Park YK, Cho EH. Spinal Cord Injury due to the Giant Cell Tumor of the Second Thoracic Vertebra: A Case Report. Ann Rehabil Med. 2013 Apr;37(2):269-73. https://doi.org/10.5535/arm.2013.37.2.269.

[10] Leggett AR, Berg AR, Hullinger H, Benevenia JB. Diagnosis and Treatment of Lumbar Giant Cell Tumor of the Spine: Update on Current Management Strategies. Diagnostics. 2022; 12(4):857. https://doi.org/10.3390/diagnostics12040857.

[11] Czerniak B. Dorfman and Czerniak’s bone tumors. 2nd ed. Missouri: Elsevier. 2015.

[12] Shi LS, Li YQ, Wu WJ, Zhang ZK, Gao F, Latif M. Imaging appearance of giant cell tumour of the spine above the sacrum. Br J Radiol. 2015 Jul;88(1051):20140566. https://doi.org/10.1259/bjr.20140566.

[13] Althausen PL, Schneider PD, Bold RJ, Gupta MC, Goodnight JE Jr, Khatri VP. Multimodality management of a giant cell tumor arising in the proximal sacrum: case report. Spine (Phila Pa 1976). 2002 Aug 1;27(15):E361-5. https://doi.org/10.1097/00007632-200208010-00020.

[14] Trovarelli G, Pala E, Angelini A, Ruggieri P. A systematic review of multicentric giant cell tumour with the presentation of three cases at long-term follow-up. Bone Joint J. 2022 Dec;104-B(12):1352-1361. https://doi.org/10.1302/0301-620X.104B12.BJJ-2022-0401.R1.

[15] Ben Nsir A, Said IB, Badri M, Boughamoura M, Jemel H. Giant cell tumor of the sixth thoracic vertebra: case report. Turk Neurosurg. 2015;25(3):475-8. https://doi.org/10.5137/1019-5149.JTN.8361-13.0.

[16] Luksanapruksa P, Buchowski JM, Singhatanadgige W, et al. Management of spinal giant cell tumors. Spine J. 2016 Feb;16(2):259-69. https://doi.org/10.1016/j.spinee.2015.10.045.

[17] Charest-Morin R, Fisher CG, Varga PP, Gokaslan ZL, Rhines LD, Reynolds JJ, et al. En Bloc Resection Versus Intralesional Surgery in the Treatment of Giant Cell Tumor of the Spine. Spine (Phila Pa 1976). 2017;42(18):1383-1390. https://doi.org/10.1097/BRS.0000000000002094.

[18] Xu R, Choong PFM. Metastatic giant cell tumour of bone: a narrative review of management options and approaches. ANZ J Surg. 2022;92(4):691-696. https://doi.org/10.1111/ans.17520.

[19] von Borstel D, A Taguibao R, A Strle N, E Burns J. Giant cell tumor of the bone: aggressive case initially treated with denosumab and intralesional surgery. Skeletal Radiol. 2017 Apr;46(4):571-578. https://doi.org/10.1007/s00256-017-2588-7.

Giant cell tumor of the thoracal spine treated with decompression and posterior stabilization: a case report

Abstract

References

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