A Rare and Life-Threatening Case of Giant Cell Tumor of Bone: Massive Posterior Rib Origin Causing Airway Obstruction

Primary giant cell tumor of bone (GCTB) of the rib is rare. Herein, we report a rare case of posterior rib GCTB causing airway compression.

A 35-year-old woman complained of back pain and dyspnea for 4 months. A bone tumor in the posterior fifth rib was suspected, and needle biopsy confirmed the diagnosis of GCTB. The tumor occupied the right thoracic cavity, compressing the main bronchus and extensively invading the vertebral body. Because complete resection was initially considered infeasible, an airway stent was placed, and denosumab therapy was initiated. However, dyspnea recurred; therefore, complete surgical resection was subsequently performed in two stages: intrathoracic and chest wall part. During the initial surgery, extracorporeal membrane oxygenation support was prepared because of the anticipated high-risk airway, and awake bronchoscopic intubation was performed with the patient in the sitting position. Postoperatively, denosumab therapy was continued, and no recurrence was observed during 60 months of follow-up.

Posterior rib GCTB with airway compression is extremely rare and may be difficult to control with denosumab alone. In the present case, favorable long-term local control was achieved through a combination of surgical resection and denosumab therapy.