Zheng Kai, Xu Ming, Wang Bing, Yu Xiu-Chun, Hu Yong-Cheng
Department of Orthopaedics, General Hospital of Jinan Military Commanding Region, Jinan, China.
Department of Bone Oncology, Tianjin Hospital, Tianjin, China.
Orthop Surg. 2017 May;9(2):252-256. doi: 10.1111/os.12333. Epub 2017 May 26.
Giant cell tumor (GCT) is a benign, locally aggressive tumor that rarely occurs in the spine. They usually occur in patients between 20 and 40 years of age; some patients with GCT present in hospital with pregnancy. The management of these patients can be challenging. The current study reports a case of GCT located in the sixth thoracic vertebra of a 31-year-old female at 34 weeks of gestation. An osteolytic lesion, 3.5 cm × 3.5 cm in diameter, was identified on CT. An MRI test of the lesion revealed a soft tissue mass involving the T vertebrae, extending to the right pedicle of the T vertebra and causing significant spinal cord compression. The patient delivered a healthy boy by cesarean at 35 weeks of gestation. One week later, she underwent a T -T laminectomy, posterior spinal decompression, and instrument fusion. Ultimately, the patient was discharged to inpatient rehabilitation with improved lower extremity strength and returned bowel and bladder function. At the 2-year follow-up, there is no evidence of local reoccurrence and the patient has no constitutional symptoms. The present study also reviews eight similar previously reported cases of GCT in the mobile spine, with a discussion of the demographic characteristics, treatment, and prognosis of pregnant patients. This report adds to the existing literature, making the reader aware that clinical symptoms of GCT in the mobile spine can be misinterpreted as a symptom of pregnancy. For spinal GCT in pregnant women, continued pregnancy and definitive surgery after the baby is born are recommended without any serious nerve damage.
骨巨细胞瘤(GCT)是一种良性、具有局部侵袭性的肿瘤,很少发生于脊柱。它们通常发生在20至40岁的患者中;一些骨巨细胞瘤患者在孕期入院。这些患者的治疗可能具有挑战性。本研究报告了一例位于一名31岁女性妊娠34周时胸椎第六节的骨巨细胞瘤病例。CT检查发现一个直径3.5厘米×3.5厘米的溶骨性病变。对该病变进行的MRI检查显示一个软组织肿块累及胸椎,延伸至胸椎的右侧椎弓根并导致严重的脊髓受压。患者在妊娠35周时通过剖宫产分娩了一个健康男婴。一周后,她接受了胸6 - 胸7椎板切除术、后路脊髓减压和器械融合术。最终,患者出院接受住院康复治疗,下肢力量有所改善,肠道和膀胱功能恢复。在2年的随访中,没有局部复发的迹象,患者也没有全身症状。本研究还回顾了先前报道的八例类似的脊柱活动节段骨巨细胞瘤病例,并讨论了妊娠患者的人口统计学特征、治疗和预后。本报告丰富了现有文献,让读者意识到脊柱活动节段骨巨细胞瘤的临床症状可能被误解为妊娠症状。对于孕妇的脊柱骨巨细胞瘤,建议继续妊娠并在婴儿出生后进行确定性手术,且不会造成任何严重的神经损伤。