Published online May 16, 2021. doi: 10.12998/wjcc.v9.i14.3394
Peer-review started: December 30, 2020
First decision: February 12, 2021
Revised: February 21, 2021
Accepted: March 3, 2021
Article in press: March 3, 2021
Published online: May 16, 2021
Tenosynovial giant cell tumors (TGCTs) are a frequent benign proliferative disease originating from the synovial membrane. However, TGCTs rarely occur in the spine. The purpose of this paper is to report a case of TGCT occurring in the cervical spine. Although the disease is rare, it is essential to consider the possibility of TGCT in axial skeletal lesions. Awareness of spinal TGCTs is important because their characteristics are similar to common spinal tumor lesions.
A 49-year-old man with a 2-year history of neck pain and weakness in both lower extremities was referred to our ward. Imaging revealed a mass extending from the left epidural space to the C4-5 paravertebral muscles with uneven enhancement. The tumor originated in the synovium of the C4-5 lesser joint and eroded mainly the C4-5 vertebral arch and spine. Puncture biopsy was suggestive of a giant cell-rich lesion. The patient had pulmonary tuberculosis, and we first administered anti-tuberculosis treatment. After the preoperative requirements of the anti-tuberculosis treatment were met, we used a posterior cervical approach to completely remove the mass after fixation with eight pedicle screws. The mass was identified as a TGCT by postoperative immunohistochemical analysis. Recurrence was not detected after 1 year of follow-up.
Spinal TGCTs are often misdiagnosed. The radiological changes are not specific. The ideal treatment comprises complete excision with proper internal fixation, which can significantly reduce postoperative recurrence.
Core Tip: This paper reviews a rare case of a tenosynovial giant cell tumor (TGCT) growing in the spine, eroding the C4-5 vertebral arches and the spinous processes, the radiological features of which mimic those of other neoplastic lesions. The definitive diagnosis of TGCT is made by immunohistochemistry. The ideal treatment comprised complete resection of the mass and appropriate internal fixation. By reviewing the diagnostic and therapeutic history and analyzing the clinical and radiological manifestations, a better understanding of the characteristics of TGCTs of the spine can be achieved, helping to improve their diagnosis and treatment.