Atypical Presentation of Giant Cell Tumor in the Dorsal Spine and Management of Recurrence: A Case Report and Literature Review

Abstract

Giant cell tumors (GCTs) of the bone are locally aggressive primary bone tumors with a benign nature. GCTs usually occur in long bones, but in the spine it is rare. In this report, we present a rare case of recurrent GCT with dorsal myelopathy managed through staged resection with neoadjuvant and adjuvant denosumab and radiation therapy. Here we present a case of a 37-year-old male patient who presented with sudden-onset back pain while playing football, paraplegia, and urinary incontinence for two days. MRI revealed a heterogeneous lesion involving the D11 vertebral body with cord compression. The patient underwent emergency posterior decompression separation surgery and fixation. Post Operative patient clinically improved and ambulatory after 1 month. On follow-up, the patient again developed partial weakness. A repeat MRI at the 16-month follow-up revealed tumor recurrence—subsequently tumor excision was done in a staged approach. At the 24-month follow-up, the patient was clinically stable with no deficit and no recurrence on follow-up MRI. The selection of an anterior, posterior, or combined approach should be guided by the tumor location and extent, aiming to achieve complete resection for effectively managing large recurrent GCTs of the spine. Denosumab therapy plays a crucial role in facilitating complete resection. Additionally, local radiation therapy reduces the likelihood of recurrence.