Clinical Characteristic and Surgical Treatment for the Spinal Tenosynovial Giant Cell Tumors (TGCT): Case Series and Literature Review

Abstract

Tenosynovial giant cell tumors are rare neoplasms of the tenosynovial tissue that can be either benign or malignant with locally aggressive characteristics. The morbidity in the axial skeletal system is extremely low, and past reports have been incomplete. Thus, we attempted to identify the clinical characteristics of this rare disease and to provide evidence for the choice of a proper surgery. A retrospective study was designed, and 13 patients from 2009 to 2018 were included in the study. All current published studies were retrieved, and 85 cases were included in the analysis. Clinical data, imaging data, therapeutic strategies, and follow-up results for both benign and malignant tumor types were assessed. TGCT can occur in the entire spine from the cervical region to the sacrum, whereas the appendix and the posterior structures of the vertebrae are more commonly involved (85–100%). The overall local recurrence rate was 17.5% after surgical resection. The Fisher’s exact test demonstrated that the difference in the recurrence rate between lesion gross total resection (LGTR) and lesion subtotal resection (LSTR) surgeries was significant (P = 0.003), whereas the question as to whether the LGTR was completed by en bloc or piecemeal methods was not significant (P = 0.41). The malignant tumor type had a very poor prognosis. The local recurrence of TGCT is not uncommon after an insufficient removal. Therefore, standard therapeutic processes and strict monitoring are the decisive prognostic factors. Additionally, decompression surgery may not be enough to treat this condition. The fundamental goal is to thoroughly remove the lesions, whereas there is no need to pursue an en bloc resection. Lesion gross total resection should be the first therapeutic choice, with the goal of also preserving neural function. For the malignant tumor type, taking the first opportunity for an operation is vitally important, and en bloc resection is recommended, with radiotherapy and target therapy also being helpful.