Introduction

Giant cell tumor of bone (GCTB) is a benign tumor comprising 5-8% of all bone tumors, typically arising at the epiphysis of long bones, with a higher occurrence in females. However, OGCTB in the thoracic spine is extremely rare, particularly in pediatric patients. Though benign, OGCTB can behave aggressively in regions such as the upper cervical spine, where its location poses a risk to critical neural and vascular structures.

The standard treatment is complete en bloc excision, though the location often limits this approach. Radiation or chemotherapy may be considered for residual disease. The scarcity of thoracic spine GCTB cases in literature highlights the importance of documenting this case.

Case History

A 12-year-old male presented with a sudden inability to walk, starting 2 days prior to admission, following an injury sustained during a game one month earlier. Initial neurological examination revealed significant motor deficits. The patient underwent an MRI, CE-MRI, and PET scan, revealing a well-defined solitary extradural lesion between DV4-DV6 (measuring 11x25x24 mm), with cortical erosion noted in the right pedicle of DV5-DV6. (Fig- 1)

Figure 1 (A and B): Well-defined solitary solid extra-dural lesion seen at level of lower border of DV4 to upper border of DV6 vertebrae, epicentered in posterior epidural space.

Figure 2 (A and B): Scattered multinucleated giant cells within a mononuclear stroma, consistent with GCT.

Histopathological examination showed scattered multinucleated giant cells within a mononuclear stroma, consistent with GCT. (Fig-2) Following laminectomy, the patient showed clinical improvement, with lower limb strength returning to a power of 4-5.

Discussion

Giant cell tumors (GCT) account for 5% of primary bone tumors, with 1-1.5% occurring in the mobile spinal segments. Among spinal GCTs, the thoracic region is the most frequently affected, though such occurrences are rare in children.[1,2]

Histologically, GCTs feature multinucleated giant cells within a stroma of round to spindle-shaped mononuclear cells. In this case, biopsy and histological analysis confirmed the diagnosis of GCT, ruling out other possibilities such as aneurysmal bone cysts.[3-6]

Surgical excision remains the treatment of choice for spinal GCTs, though it is often challenging due to proximity to the spinal cord and risk of neurological deficits. In this case, total tumor excision was achieved without recurrence noted during follow-up.[3,7-9]

Conclusion

Giant cell tumors of the thoracic vertebra are uncommon in pediatric patients, and this case illustrates the importance of early surgical intervention. The patient experienced full neurological recovery after the excision, with no recurrence observed at the one-year follow-up.

References

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