GIANT-CELL TUMOR OF THE TENDON SHEATH INVOLVING THE CERVICAL SPINE

Abstract

Giant-cell tumor of the tendon sheath is a common lesion of the synovial membrane, and it frequently occurs in the hand. It is related to pigmented villonodular synovitis, has variable areas of involvement, and rarely causes osseous destruction 1. We describe a rare case of a giant-cell tumor of the tendon sheath in the cervical spine. An otherwise healthy twenty-seven-year-old woman presented to us with a three-month history of neck pain and intermittent numbness in the fingers of both hands. The patient also described severe migraine-type headaches over the previous two years. The neck pain was worse on the left side, and there was no inciting trauma or history of similar pain. The patient had no arm pain, and her medical and surgical histories were unremarkable. The physical examination revealed mild tenderness to palpation of the mid-cervical spine, which was worse on the left side. No masses were palpated. Motion of the cervical spine, especially extension, was limited. Neurological testing failed to detect any functional deficits in the upper or lower extremities. Radiographs revealed an osteolytic lesion involving the left fourth and fifth cervical facet joints ( Fig. 1 ) with a minimal amount of subluxation of the vertebral body visible on the lateral radiographs. Computerized tomography demonstrated an expansile lesion in the left facet joint between the fourth and fifth cervical vertebrae that was encased in an osseous rim measuring 2 by 2 cm ( Fig. 2 ). Magnetic resonance imaging showed a mass with soft-tissue density that had increased signal intensity relative to muscle on T2-weighted images. The tumor was noted to abut the vertebral foramen and obliterate the lateral recess, but it did not impinge on the spinal cord ( Fig. 3 ). Fig. 1: Anteroposterior radiograph demonstrating a …