Tseng CS, Wong CE, Huang CC, Hsu HH, Lee JS, Lee PH. Spinal giant cell-rich osteosarcoma-diagnostic dilemma and treatment strategy: A case report. World J Clin Cases 2022; 10(21): 7565-7570 [PMID: 36157995 DOI: 10.12998/wjcc.v10.i21.7565]
Corresponding Author of This Article
Po-Hsuan Lee, MD, Surgeon, Section of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Shengli Road, North District, Tainan 704, Taiwan. ftl053@gmail.com
Research Domain of This Article
Surgery
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Chen-Sheng Tseng, Chia-En Wong, Chi-Chen Huang, Hao-Hsiang Hsu, Jung-Shun Lee, Po-Hsuan Lee, Section of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
Jung-Shun Lee, Department of Cell Biology and Anatomy, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
Jung-Shun Lee, Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
Author contributions: Lee PH and Lee JS supervised and coordinated the study; Tseng CS and Lee PH conceived and designed the study; Tseng CS, Wong CE, and Huang CC obtained, analyzed, and interpreted the data; Tseng CS, Wong CE, Lee JS, and Lee PH wrote the manuscript; All authors revised the draft for important intellectual content and agreed upon the manuscript before submission.
Informed consent statement: Informed written consent was obtained from the patient for publication of this reporting
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Po-Hsuan Lee, MD, Surgeon, Section of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Shengli Road, North District, Tainan 704, Taiwan. ftl053@gmail.com
Received: February 11, 2022 Peer-review started: February 11, 2022 First decision: March 23, 2022 Revised: April 2, 2022 Accepted: May 27, 2022 Article in press: May 27, 2022 Published online: July 26, 2022 Processing time: 149 Days and 23.3 Hours
Abstract
BACKGROUND
Giant cell-rich osteosarcoma (GCRO) is a rare histological variant of osteosarcoma. Spinal GCROs are extremely rare, with challenging diagnosis and management. Herein, we present a case of spinal GCRO at T2, which was not diagnosed in initial biopsy but after T2 corpectomy. We detailed the clinical course, management strategy, and outcome after a 4-year follow-up.
CASE SUMMARY
A 17-year-old female patient presented with back pain followed by ascending paresthesia. Spinal computed tomography (CT) and magnetic resonance imaging (MRI) revealed a collapsed T2 vertebra with an enhancing osteolytic mass. CT-guided biopsy showed inconclusive morphology. Pathology from T2 corpectomy revealed GCRO. The patient subsequently received neoadjuvant chemotherapy followed by salvage operation of T2 costotransversectomy with grossly-total resection adjuvant chemoradiation. Upon treatment completion, she had complete GCRO remission. The 4-year follow-up spinal MRI showed no tumor recurrence.
CONCLUSION
Spinal GCRO poses unique challenges in obtaining sufficient tissue diagnosis and complete surgical removal. However, long-term local control of spinal GCRO is possible following complete resection and adjuvant chemoradiation
Core Tip: Giant cell-rich osteosarcoma (GCRO) is a rare variant of conventional osteosarcoma that is easily misdiagnosed as giant cell tumors. Spinal GCRO poses unique challenges in obtaining a sufficient tissue diagnosis and complete surgical removal. We report a case of spinal GCRO, which was not diagnosed in initial computed tomography-guided biopsy but after T2 corpectomy. Given the relationship between the extent of resection and prognosis, a second salvage operation was performed and gross total resection was achieved. Thus, long-term local control is achievable following complete resection of salvage surgery and adjuvant chemoradiation even in spinal GCRO with previous subtotal resection.
