Giant Cell Tumor Of Spine Research Articles

Clinical Outcome of Treatment for Patients with Giant Cell Tumor in Spine.

ObjectiveThe treatment of giant cell tumor (GCT) is mainly performed surgically. However, GCT in spine seems difficult to treat because of the limited surgical accessibility and proximity. In this report, we analyzed the outcome of GCT treatment in spine.MethodsBetween 2000 and 2012, 19 patients received treatment for GCT in spine. Median age at their first diagnosis was 31 years, 10 patients were male, and 9 female. Fourteen tumors were located in the sacrum, 1 in cervical, 1 in thoracic and 3 in lumbar spine. As primary treatment, gross total removal (GTR) was done in 6 patients, and subtotal removal (STR) in 13 patients. Radiation therapy (RT) as an adjuvant therapy was performed in 2 cases in GTR group and 10 cases in STR group.ResultsDuring the follow-up, 7 patients had local recurrence (36.8%). The average period until recurrence after primary treatment was 14 months. No recurrence was detected in GTR group. Recurrence was noted in 7 out of 13 patients who underwent STR. These differences were statistically significant (p=0.024). A median of recurrence free period (RFP) was 84 months. Also average RFP of the RT group was 112 months, and non-RT group was 65 months. These differences were statistically significant (p=0.041).ConclusionTreatment of choice for GCT in spine is a complete removal of tumor without neurological deficits. In case of incomplete removal, radiation therapy may be a useful adjuvant treatment modality.

Zoledronic acid may prevent intra-operative bleeding and recurrence of spinal giant cell tumor

Objective To evaluate the possible influence of zoledronic acid on intra-operative bleeding and recurrence of spinal giant cell tumor.Methods A prospective,observational clinical control study was conducted.The zoledronic acid group:patients received zoledronic acid 1week before(4mg)and 3weeks after(4mg)the surgery;after then 4mg zoledronic acid was given every 4weeks for 3years after surgery or till the patients could not tolerate.The control group:patients received no zoledronic acid or bisphosphonate before and after operation.The intraoperative blood loss was recorded for all the patients and the patients were given an imaging follow-up every 6 months postoperatively to detect recurrence.Results A total of 53patients were eligible for this study,including 28for zoledronic acid group and 25for control group.The average amount of bleeding was(1 594±847)mL(400-3 200mL)for zoledronic acid group and(2 476±769)mL(800-4 000mL)for the control group,showing significant difference between the two groups(P0.05).No patients in the zoledronic acid group had recurrence or severe adverse reactions within 3years after surgery.Four patients(16%)in the control group had local recurrence within 3years after surgery(2patients occurred after 24months,2patients occurred after 36months).The Chisquare tests result showed significant difference in recurrence rates between the two groups(χ2=4.846,P =0.028).Conclusion Preoperative use of zoledronic acid can effectively inhibit the bleeding during the operation for spinal giant cell tumor,and long-term postoperative use of zoledronic acid can help to prevent recurrence,which needs large sample study for further verification.

Giant cell tumor of the lumbar spine with intraperitoneal growth: case report and review of literature

Giant cell tumors of the spine are uncommon. Usually they are benign and solitary, but locally very aggressive. Most of them occur at the sacral spine. There are only 26 reported cases in the literature involving this type of tumor in the lumbar spine, in particular exhibiting an intraperitoneal growth. We present the case of a woman with a primary tumor of the lumbar spine (giant cell tumor) with intraperitoneal growth, the outcome as well as a review of the literature. Furthermore, after reviewing all spinal cases in the literature above the sacral spine, we carefully suggest a management algorithm.

Giant Cell Tumor of a Lumbar Vertebra in a 7-Year-Old Child

This case provides a rare occurrence of a giant cell tumor (GCT) in posterior elements of a lumbar vertebra in a 7-year-old child with successful outcome after surgical excision and regular follow-ups. To present a unique case report of a pediatric GCT in the vertebral column and results. GCT is a rare bone tumor seen in 3% to 5% of primary bone neoplasm. Approximately 7% of GCTs are found in the vertebral column. GCT of the spine is found in only 5% to 7% of cases and can occur in any region of the spine but are believed to be predominantly in the sacrum. Despite its benign nature, expansion in a confined space makes early detection of spinal GCTs important to prevent occurrence of compressive myelopathy/radiculopathy. The presence of a GCT in a child younger than 10 years of age, in posterior elements of a lumbar vertebral body, has not been reported earlier. On the basis of the clinical history, radiograph of the thoracolumbar spine, computed tomography of lumbar spine, and magnetic resonance imaging, a preliminary diagnosis of osteoblastoma was made. The patient presented with a lytic lesion with involvement of posterior elements, 1 side the pedicle extending into the body of a lumbar vertebra (L3) and had extension into the paraspinal muscles. Intraoperative exploration and frozen section showed the presence of a typical histologic picture of a GCT. Ipsilateral pedicle, posterior elements, and the superior articular facet were excised. En bloc resection was found not to be feasible due to the friable nature of the tumor and involvement of the soft tissues. In addition, fusion was avoided with consideration of the young age of the patient. The patient has been free of any recurrence as of his last follow-up visit.

Giant cell tumor of dorsal vertebral body

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.

Giant-Cell Tumor Of Third Lumbar Vertebrae: A Case Report

The spinal canal, as it is often situated on either side of the neural tissue, complete resection becomes surgically challenging. Most often, marginal or intralesional excision with backup therapy has to be resorted to. As with other sites various treatment option have been described. We report our experience with one surgical intervention for a patient with a L3 involvement giant cell tumor of the spine. This uncommon but most aggressive benign tumor of the spine with a high predilection for recurrence has an unpredictable outcome. Spinal giant cell tumors (GCT) however, often present with the unique problems of spinal cord compression due.

Interferon Alfa-2b for Recurrent and Metastatic Giant Cell Tumor of the Spine

Case report. To demonstrate that interferon alfa-2b is a therapeutic option for obtaining long-term control of recurrent and metastatic giant cell tumor of spine. Interferon alfa served as angiogenesis inhibitor and has been successfully used to treat giant cell tumor of long bones and facial bones. Up to date, no report is found with regard to the use of interferon as a stand-alone treatment for unresectable, recurrent, and metastatic giant cell tumor originated from the spine. A 29-year-old woman with C1 and C2 giant cell tumor was treated by radiotherapy, intralesional curet, and chemotherapy orderly. Tumor recurred after 2 years. A second curet was undertaken. Tumor recurred second time and caused severe spinal cord compression. Lung metastasis was diagnosed simultaneously. A 24-year-old man with recurrent giant cell tumor of T5 and T6 was treated by spondylectomy of T5 and T6. Six months later, a giant metastatic lesion was found in sacrococcygeal region, which was excised and proved to be giant cell tumor of bone. Four months later, 2 recurrent lesions were found beside the rectum. Interferon alfa-2b at a dose of 3,000,000 U/m was then administered subcutaneously everyday for both patients for 3.5 and 3 years, respectively. No major complications related to the use of interferon occurred. The lesion in C1-C2 of the first patient regressed steadily and was restricted and encircled within the lateral mass. The metastatic lesions in the lungs also significantly reduced. The pararectal lesions of the second patient disappeared completely. Interferon therapy may be an effective and safe treatment for spine giant cell tumor recurrence and metastasis in soft tissue. The effectiveness may be time and dosage dependent.

Endoscopic Management of Cervical Spine Giant Cell Tumor

Endoscopic Management of Cervical Spine Giant Cell Tumor

Giant Cell Tumor of the Thoracic Spine Presenting as a Posterior Mediastinal Tumor with Benign Pulmonary Metastases: A Case Report

Giant cell tumor of bone is a benign, but potentially aggressive lesion that can show local recurrence and metastases. We report here on a case of a 29-year-old man who presented with an incidentally found mediastinal mass. Chest radiography and computed tomography showed a huge mediastinal mass with bilateral pulmonary nodules and the diagnosis of giant cell tumor with benign pulmonary metastasis was confirmed. To the best of our knowledge, this is the first reported case of primary thoracic spinal giant cell tumor manifesting as a huge mediastinal mass with pulmonary metastases.

Endovascular embolization of a recurrent cervical giant cell neoplasm using N-butyl 2-cyanoacrylate

Pre-operative endovascular embolization of spinal giant cell tumors (GCTs) has been an effective strategy to reduce blood loss during surgical resection. Traditionally, spinal GCTs have been embolized with polyvinyl acetate (PVA) particles. We present the pre-operative embolization of a recurrent cervical GCT with N-butyl 2-cyanoacrylate (NBCA) rather than PVA. The patient was a 17-year-old female who, 3 months prior, had undergone a surgical resection of a cervical GCT without pre-operative embolization. She returned with tumor recurrence in the approximate location. Resection was recommended, and pre-operative embolization was requested. The tumor was embolized with NBCA. Post-embolization angiography demonstrated significantly decreased tumor "blush" and a significant reduction of the vascular supply. This is the first reported use of NBCA for the pre-operative embolization of a cervical GCT. The benefits of NBCA over PVA particles include superior penetration, permanent tumor embolization and lower exposure to radiation due to shorter procedure time.

Giant cell tumor of the thoracic spine: case report and review of the literature

Background Giant cell tumors are benign tumors of the bone that most commonly occur at the ends of the long bones; they are rarely found in the spine above the sacrum. The management of patients with giant cell tumors of the spine represents a challenge, and the clinical approach to this problem continues to evolve with improvements in surgical and adjunctive therapies. Case Description A 19-year-old woman with localized back pain and a spinal compression deformity was found to harbor a giant cell tumor of the T7 vertebral body. The patient was first treated with arterial embolization of the hypervascular region observed on angiography. Subsequently, the patient underwent a one-stage transthoracic T7 corpectomy followed by anterior spinal reconstruction and stabilization. Postoperatively, the patient's kyphotic deformity was corrected. To optimize local disease control, the patient underwent IMRT delivered to the site of tumor resection. She remains neurologically intact at 1 year postoperatively without evidence of disease recurrence. Conclusion The literature and approaches to the management of spinal giant cell tumors are reviewed.

Brachial Plexus Injury Related to Patient Positioning

A 45-year-old woman presented with a recurrent L1-3 spinal giant cell tumor. She had previously undergone surgery for the same problem, at which posterior lumbar spine fixation was performed. She was referred to the interventional radiology department for preoperative tumor embolization. The procedure was performed with the patient under general anesthesia. The patient was placed in the supine position with her arms by her side at the start of the procedure. Because of extensive spinal fixation devices, it was difficult to visualize the area of interest to perform the embolization procedure safely.

Complete Necrosis of a Spinal Giant Cell Tumor after Vertebroplasty

In this case report, histologic evidence of complete tumor necrosis subsequent to injection of polymethylmethacrylate in a vertebral giant cell tumor is described. Radiologic and histologic findings are discussed, and literature pertaining to vertebroplasty-induced cell damaged is reviewed.

Computer-assisted anterior spinal surgery for a case of recurrent giant cell tumor

A computer-assisted image guidance system has recently been used for posterior spinal surgery. We applied this system to anterior revision surgery of the cervicothoracic junction for a patient with recurrent thoracic spinal giant cell tumor. Anterior computer-assisted spinal surgery was achieved by attaching reference markers to threaded pins inserted into a vertebral body. The locations of anatomic structures in the surgical field of this patient were difficult to identify because of previous surgery. Both accurate resection of the tumor and anterior fusion with iliac bone autograft between C6 and T3 were successfully performed using a computer-assisted image guidance system. This system is useful for anterior spinal surgery because it enables a surgeon to perform safe and accurate surgery.

Clinical results and histologic analysis of spinal giant cell tumors treated with total en bloc spondylectomy

Clinical results and histologic analysis of spinal giant cell tumors treated with total en bloc spondylectomy

A system for surgical staging and management of spine tumors. A clinical outcome study of giant cell tumors of the spine.

This study developed and independently applied a spine tumor classification system, referred to as the Weinstein-Boriani-Biagini system, in a retrospective analysis of a series of patients with spinal giant cell tumors from three institutions. To evaluate factors of potential prognostic significance for recurrence of spinal giant cell tumors. No prior reviews of patients treated with modern surgical techniques are available. Charts and radiographs for 36 cases of spinal giant cell tumors were reviewed by an independent investigator. All patients had had recent clinical follow-up examinations. All patients were classified according to the Enneking system. A subgroup of 24 patients for whom preoperative computed tomography scans were available were classified using the Weinstein-Boriani-Biagini staging system. Outcome measures included pain, neurologic status, and tumor recurrence. Recurrence rates were substantially higher among patients treated with attempted surgical excision before referral to a tertiary care center (83% vs. 18%). There was a higher recurrence rate for tumors that involved the vertebral body and posterior elements in comparison with lesions residing in only anterior elements (24% vs. 0%). Tumors that had extra-osseous extension into the canal and into the paraspinous musculature had a higher recurrence rate than tumors either confined to the osseous compartment or with extension either into the spinal canal or externally into paraspinous planes, but not both (21% vs. 10%). These results indicate that the Weinstein-Boriani-Biagini system may prove useful in developing treatment algorithms and in assessing outcome for these rare and difficult lesions. At least in the case of giant cell tumors, the musculoskeletal tumor staging system as developed by Enneking for long bones suggests the ideal surgical margin and may provide information relevant to tumor recurrence rates. Additional aspects of tumor extent and location, however, may berelevant to primary tumor recurrence rates when the selesions occur in the spine.

Giant-cell tumour of the lumbar spine. Case report

Giant-cell tumours of the spine are very rare. They occur mainly in long bones. We report a patient with a giant-cell tumour of the lumbar spine which had been operated on at another hospital 5 months previously as a protruded lumbar intervertebral disc.

Giant cell tumor of the spine: computed tomography appearance and review of the literature

Giant cell tumor of the vertebral body is a rare but well-recognized entity with a reported incidence between 1.3% and 9.3%, of all giant cell tumors. It has been suggested that computed tomography may be helpful in making the diagnosis, although computed tomography appearances have only been described on two occasions. A case of giant cell tumor of the thoracic spine and a review of the literature regarding this entity are presented. The computed tomography appearance of this lesion is described. However, a distinctive pattern, as previously suggested, is not demonstrated. Although we are not convinced that computed tomography provides a definitive diagnosis in cases of spinal giant cell tumor, it is a valuable asset in defining the extent of the tumor and in posttherapy evaluation and follow-up.