Giant cell tumor of the thoracic spine causing acute paraplegia-a case report

Giant cell tumors (GCT) are rare and account for approximately 5% of all primary bone tumors. GCTs in the spine make up less than 10% of all GCTs, and less than 5% of all primary spinal tumors. Less than 10% of spinal GCTs occur above the sacrum and cases involving the thoracic spine are seldom reported in the literature. In our case the patient presented with acute paraplegia of bilateral lower extremities after being seen in the emergency department a day earlier. An MRI and CT scan demonstrated near complete destruction of T8 vertebral body with a possible pathologic lesion and fracture associated with dorsal and ventral spinal cord compression and significant signal change within the spinal cord. She underwent T7-T9 laminectomy with excisional biopsy and was subsequently diagnosed with a primary GCT of the thoracic spine. She was definitively treated with resection and T4-12 fusion and 120 mg of denosumab. At four years post follow-up there has been no recurrence of the tumor to date. This is a more acute presentation than has previously been reported. Patients with GCT of the spine typically present with pain and may have further progression to neurologic deficit. This patient's rapid onset of paraplegia is more acute than has been previously reported in the literature. The authors believe that prompt surgical excision and treatment with denosumab can completely resolve GCT of the thoracic spine.