Giant cell tumor of dorsal vertebral body

Abstract

A 30-year-old female patient presented with complaints of backache, weakness in both lower limbs and bladder/bowel dysfunction. Imaging showed an osteolytic lesion at tenth dorsal (D10) vertebra with anterior compression on the spinal cord. Complete intralesional tumor excision with reconstruction was carried out using the anterolateral extrapleural approach. Histopathological examination was suggestive of giant cell tumor (GCT). Because of complete intralesional tumor excision and fear of post-radiation osteonecrosis of bone used for delayed bony union, a conservative approach was used, and radiation therapy was not given. After one year of follow-up patient is doing well without any recurrence of the tumor and is ambulant with support. GCT of dorsal vertebral body is an uncommon entity and total en bloc excision is difficult. Therefore, the treatment strategy is not well-defined. We discuss in brief about incidence, presentation and various treatment modalities available for spinal GCT.

Keywords: Dorsal vertebral body; en bloc excision; giant cell tumor; tumor recurrence.

Figure 1

(a) Saggital T2 weighted magnetic resonance image showing tumor mass destroying tenth dorsal vertebral body leading to loss of height of the vertebra and extension into the spinal canal causing severe compression on the spinal cord, (b) Computed tomography showing the destruction of vertebral body with preservation of only anterior rim

Figure 2

(a) Post-operative lateral X-ray image showing reconstruction using expandable cage in place of excised tumor and pedicular screw and rod fi xation, (b) Post-operative postero-anterior X-ray image with expandable cage in place and pedicular rod and screw fixation

Figure 3

(a) Photomicrograph showing biphasic population of stromal cells and regularly scattered oteoclastic giant cells (H and E stain, ×10×4), (b) Photomicrograph with higher magnifi cation showing bland nuclear chromatin of the tumor cells (H and E stain, ×10×20)