What are giant cell tumors of the spine?

Updated: Nov 01, 2018
  • Author: Andrew A Sama, MD; Chief Editor: Jeffrey A Goldstein, MD  more...
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Answer

Giant cell tumors of the spine account for only 7% of all GCTs in the body. The spine is the fourth most common site for the occurrence of GCTs. Most spinal GCTs occur in the sacrum, followed by the thoracic, cervical, and lumbar regions. GCTs are more common in women and occur in the third to fifth decades of life. They can increase dramatically in size during pregnancy secondary to hormonal influences. Symptoms include pain with radicular pattern. With neurologic impingement, weakness and sensory deficits also can be manifest.

Spinal GCTs are usually radiolucent and expansile lesions. They do not exhibit active matrix production. When present in the sacrum, these lesions are large with destruction of the sacral foraminal lines on plain x-rays. GCTs usually can involve both sides of the midline and can extend past the sacroiliac joints bilaterally. When present in sites proximal to the sacrum, they usually are found in the vertebral body.

The classic findings of GCT on technetium bone scanning include diffuse radionucleotide uptake with areas of central photopenia and increased peripheral uptake. Angiography illustrates that most GCTs are hypervascular lesions. CT demonstrates soft-tissue attenuation with well-defined margins and a thin rim of sclerotic bone. MRI exhibits characteristic heterogeneous signal intensity with low-to-intermediate intensity on both T1- and T2-weighted images.

The great majority of GCTs are benign; malignant GCTs occur in only 5% of cases. Malignant GCTs usually are related to previous irradiation in the vicinity of the tumor. Even though most GCTs are benign, the lesions are locally aggressive, and their size and location may not allow complete resection. Those that cannot be excised en bloc should be curetted. Radiation is reserved for surgically inaccessible tumors. Selective arterial embolization also can be used in the management of these tumors. Recurrence rates can be as high as 40-60%.


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