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Year : 2019  |  Volume : 67  |  Issue : 1  |  Page : 303--305

Giant cell tumor of the spine with pulmonary metastasis

Somshankar Pandey, Usha Jaipal 
 Department of Radiodiagnosis, SMS Medical College and Hospital, Jaipur, Rajasthan, India

Correspondence Address:
Dr. Somshankar Pandey
Department of Radiodiagnosis, Room No. 16, SMS Medical College and Hospital, Jaipur, Rajasthan
India




How to cite this article:
Pandey S, Jaipal U. Giant cell tumor of the spine with pulmonary metastasis.Neurol India 2019;67:303-305


How to cite this URL:
Pandey S, Jaipal U. Giant cell tumor of the spine with pulmonary metastasis. Neurol India [serial online] 2019 [cited 2020 Jul 4 ];67:303-305
Available from: http://www.neurologyindia.com/text.asp?2019/67/1/303/253582


Full Text



Sir,

A 20-year-male patient presented with weakness in both the lower limbs since 6 months which progressed gradually. General physical examination was normal. No tenderness or deformity was noted in the spine. Neurological examination showed a reduced power in both the lower limbs, that is, 2/5. Sensory level was localized at T4 vertebral level. With clinical suspicion of Pott's spine, magnetic resonance imaging (MRI) spine was done which showed a heterogeneous soft tissue mass with hemorrhagic foci on T1-weighted MRI [Figure 1]. T2-weighted MRI showed a multiloculated hyperintense lesion with fluid–fluid level suggestive of secondary aneurysmal bone cyst formation and complete collapse of T1 vertebral body [Figure 2] and [Figure 3]. For further characterization, a contrast-enhanced computed tomography of the chest with the spine was advised which showed a soft tissue density mass lesion with cystic changes and complete collapse of T1 vertebral body and also lytic destruction of the T2 vertebral body; however, matrix mineralization was absent [Figure 4]. Bilateral pulmonary parenchyma showed well-defined multiple homogeneous nodules without osteoid matrix, which was suggestive of metastasis [Figure 5]. Therefore, the diagnosis of a giant cell tumor (GCT) with secondary presence of an aneurysmal bone cyst was suggested. Due to the young age and the site of involvement, that is, the vertebra, and metastatic appearance in the lung seen on computed tomography, the differential diagnosis was limited. Telengiectatic osteosarcoma was kept as a close differential diagnosis. Histopathology evaluation was advised for further confirmation which showed relative monomorphic neoplastic cells along with giant cells; no evidence of atypical features like anaplasia or abnormal mitosis was noted [Figure 6]. Absence of sarcomatous component excluded the giant cell variant of an osteosarcoma. Brown tumor of hyperparathyroidism also shows a similar histomorphology as present in our case; however, spine is a rare site for Brown's tumor. Therefore, in accordance with the imaging features and histological findings, the final diagnosis of a benign GCT of the spine was kept.{Figure 1}{Figure 2}{Figure 3}{Figure 4}{Figure 5}{Figure 6}

Yang et al.,[1] reported that local recurrence and a high Campanacci stage were important predictors of pulmonary metastasis related to the benign GCT of bone. Chan et al.,[2] followed up 167 cases of benign GCT of the bone for at least 2 years and concluded that younger patients, patients presenting with Enneking–Campanacci stage 3 disease, local recurrence, and axial location of the disease showed an increased risk of pulmonary metastasis of GCT of bone.

Multinucleated giant cells can arise in bone in some conditions, including chondroblastoma, fibrous dysplasia, eosinophilic granuloma, chondromyxoid fibroma, giant-cell-rich osteosarcoma, malignant fibrous histiocytoma and giant cell reparative granuloma.[3] Management of lung metastasis of GCT of the bone requires a prolonged follow-up, and there is no need for a aggressive radiation therapy or chemotherapy in these patients because their overall prognosis and outcomes are favorable.[4] Diagnosis of an aggressive GCT must be considered in case of collapse of the vertebral body with pulmonary metastasis.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Yang Y, Huang Z, Niu X, Xu H, Li Y, Liu W, et al. Clinical characteristics and risk factors analysis of lung metastasis of benign giant cell tumor of bone. J Bone Oncol 2017;7:23-8.
2Chan CM, Adler Z, Reith JD, Gibbs CP Jr. Risk factors for pulmonary metastases from giant cell tumor of bone. J Bone Joint Surg Am 2015;97:420-8.
3Lee MJ, Sallomi DF, Munk PL, Janzen DL, Connell DG, O'Connell JX, et al. Pictorial review: Giant cell tumours of bone. Clin Radiol 1998;53:481-9.
4Viswanathan S, Jambhekar NA. Metastatic giant cell tumor of bone: Are there associated factors and best treatment modalities? Clin Orthop Relat Res 2010;468:827-33.