Published online Jul 26, 2022. doi: 10.12998/wjcc.v10.i21.7565
Peer-review started: February 11, 2022
First decision: March 23, 2022
Revised: April 2, 2022
Accepted: May 27, 2022
Article in press: May 27, 2022
Published online: July 26, 2022
Processing time: 149 Days and 23.3 Hours
Giant cell-rich osteosarcoma (GCRO) is a rare histological variant of osteosarcoma. Spinal GCROs are extremely rare, with challenging diagnosis and management. Herein, we present a case of spinal GCRO at T2, which was not diagnosed in initial biopsy but after T2 corpectomy. We detailed the clinical course, management strategy, and outcome after a 4-year follow-up.
A 17-year-old female patient presented with back pain followed by ascending paresthesia. Spinal computed tomography (CT) and magnetic resonance imaging (MRI) revealed a collapsed T2 vertebra with an enhancing osteolytic mass. CT-guided biopsy showed inconclusive morphology. Pathology from T2 corpectomy revealed GCRO. The patient subsequently received neoadjuvant chemotherapy followed by salvage operation of T2 costotransversectomy with grossly-total resection adjuvant chemoradiation. Upon treatment completion, she had complete GCRO remission. The 4-year follow-up spinal MRI showed no tumor recurrence.
Spinal GCRO poses unique challenges in obtaining sufficient tissue diagnosis and complete surgical removal. However, long-term local control of spinal GCRO is possible following complete resection and adjuvant chemoradiation
Core Tip: Giant cell-rich osteosarcoma (GCRO) is a rare variant of conventional osteosarcoma that is easily misdiagnosed as giant cell tumors. Spinal GCRO poses unique challenges in obtaining a sufficient tissue diagnosis and complete surgical removal. We report a case of spinal GCRO, which was not diagnosed in initial computed tomography-guided biopsy but after T2 corpectomy. Given the relationship between the extent of resection and prognosis, a second salvage operation was performed and gross total resection was achieved. Thus, long-term local control is achievable following complete resection of salvage surgery and adjuvant chemoradiation even in spinal GCRO with previous subtotal resection.