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Successful treatment of a diffuse type tenosynovial giant cell tumor in the thoracic spine mimicking spinal metastasis by frozen recapping laminoplasty in a patient with thyroid cancer

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Abstract

Purpose

Tenosynovial giant cell tumor of the diffuse type (TGCT-D) involving the spine is rare. Its differential diagnosis includes metastatic disease; however, there have been few reports of spinal TGCT-D mimicking spinal metastasis in patients with a history of malignancy.

Methods

We report on a 35-year-old woman with a history of papillary thyroid cancer who was diagnosed with TGCT-D of the thoracic spine mimicking spinal metastasis. Preoperative computed tomography (CT) revealed a 1.0 × 1.0-cm lytic bone lesion involving the left T7 vertebral lamina, pedicle, and the T6–7 facet joint; the thoracic spine lesion was markedly fluorodeoxyglucose-avid on positron-emission tomography/computed tomography (PET/CT).

Results

Spinal metastasis was initially suspected given the patient’s history of papillary thyroid cancer. Total excision was performed with recapping laminoplasty. The resected lamina was frozen in liquid nitrogen and used as a frozen autograft (frozen recapping laminoplasty) for spinal reconstruction with posterior instrumentation. Histological findings supported a diagnosis of TGCT-D. The patient had no evidence of local recurrence 2 years post-surgery. Bone union was achieved 3 years post-surgery.

Conclusions

TGCT-D can mimic metastasis in PET/CT and should be included in the differential diagnosis if a lytic lesion affecting the posterior elements of the vertebrae involves the facet joints. CT-guided biopsy is recommended for accurate diagnosis when an occult tumor, such as TGCT, is incidentally detected on PET-CT, even in patients with a history of malignant neoplasm. Frozen recapping laminoplasty is useful for complete resection of a spinal tumor, preventing local recurrence, and preservation of the posterior spinal elements.

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Acknowledgements

We would like to thank Editage (http://www.editage.jp) for English language editing.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Kanazawa University School of Medicine, 13-1 Takara-machi, Kanazawa, 920-8641, Japan

    Noritaka Yonezawa, Hideki Murakami, Satoshi Kato, Hiroyuki Hayashi & Hiroyuki Tsuchiya

Authors
  1. Noritaka Yonezawa
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  2. Hideki Murakami
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  3. Satoshi Kato
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  4. Hiroyuki Hayashi
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  5. Hiroyuki Tsuchiya
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Corresponding author

Correspondence to Hideki Murakami.

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Conflict of interest

N. Yonezawa, H. Murakami, S. Kato, H. Hayashi, and H. Tsuchiya declare that they have no conflict of interest. This study was not funded by any external source.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from the patient described in the study.

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Yonezawa, N., Murakami, H., Kato, S. et al. Successful treatment of a diffuse type tenosynovial giant cell tumor in the thoracic spine mimicking spinal metastasis by frozen recapping laminoplasty in a patient with thyroid cancer. Eur Spine J 27 (Suppl 3), 526–532 (2018). https://doi.org/10.1007/s00586-018-5603-3

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  • DOI: https://doi.org/10.1007/s00586-018-5603-3

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