Giant cell tumor of the sacrum and spine: series of 23 cases and a review of the literature

Abstract

Although there have been a few large case series of giant cell tumor (GCT) in the spine and sacrum, the treatment of these lesions remains controversial. We are reporting 23 additional cases of giant cell tumor in the spine and sacrum gathered from our institution and the personal consultation files of the senior author. Ten lesions occurred in the sacrum with an average age of 31 years (range of 13-49) and 13 occurred in the mobile spine with an average age of 39.1 years (range of 13-64). Most patients presented with pain or neurologic deficit at the site of tumor involvement, and symptoms were usually present for many months prior to diagnosis. Six of the sacral GCT patients were treated with pre-operative arterial embolization and intralesional surgical resection, and two developed a recurrence. Two of the sacral GCT patients had an en bloc resection and neither developed a recurrence. One sacral GCT patient was treated only with serial arterial embolization with good disease control. One sacral GCT patient did not receive any treatment. Eleven spinal GCT patients were treated with en bloc surgical resection and two developed a recurrence, the other two spinal GCT patients were treated with intralesional surgical resection and both developed a recurrence. Giant cell tumors of the spine and sacrum should be managed with en bloc resections whenever possible as this provides the greatest chance for cure. When the risk of post-operative neurologic deficit after en bloc excision is high, as in most of our sacral lesions, conservative therapy involving arterial embolization and intralesional resection offers the best results.

Figure 1

Axial CT scan of the sacral giant cell tumor from patient #2. There is a lytic lesion involving both wings of the sacrum.

Figure 2

Sagittal CT scan of the sacral lesion of patient #9. There is invasion of the anterior wall of the sacrum and spread into the soft tissues.

Figure 3

Axial CT scan of the cervical giant cell tumor of patient #14. The lytic lesion is confined to the body of the vertebrae.

Figure 4

Lateral plain film of the spine of patient #22 showing a compression fracture of the L2 body secondary to the giant cell tumor.

Figure 5

Photo micrograph of the sacral lesion of patient #4. The histologic features are typical of a conventional giant cell tumor (H&E, ×400).

Figure 6

Photo micrograph of the tissue from patient #22. There is abundant reactive osteoid production secondary to the pathologic fracture. This may be confused with a bone forming neoplasm (H&E, ×100).

Figure 7

Photo micrograph of giant cell tumor with reactive bone formation after pathologic fracture.