Furuhata Ryogo, Iwanami Akio, Tsuji Osahiko, Nagoshi Narihito, Suzuki Satoshi, Okada Eijiro, Fujita Nobuyuki, Yagi Mitsuru, Matsumoto Morio, Nakamura Masaya, Watanabe Kota
1Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan.
2Department of Orthopaedic Surgery, Spine Center, Koga Hospital, Ibaraki, Japan.
Spinal Cord Ser Cases. 2019 Feb 25;5:23. doi: 10.1038/s41394-019-0172-1. eCollection 2019.
Tenosynovial giant cell tumors (TSGCTs) generally occur in the limb joints, and only rarely in the spine. This case report describes a patient with TSGCT of the spine at C1-C2, which was treated surgically and diagnosed as TSGCT.
A 32-year-old woman with a 4-month history of neck pain and numbness in both upper extremities was referred to our department. Magnetic resonance imaging (MRI) revealed a neoplastic lesion extending from the left epidural space to the erector spinae muscles at the C1-C2 vertebral level, which was isointense on T1-weighted images, heterogeneously hypointense on T2-weighted images, and showed heterogeneous enhancement on gadopentetate dimeglumine (Gd-DTPA)-enhanced T1-weighted images. Computed tomography showed no findings suggestive of bone destruction of the vertebral body. Because the neurological symptoms were progressive, total macroscopic resection of the tumor was performed via a posterior approach. Histopathological examination of the resected specimen revealed the diagnosis of TSGCT. Improvement of the both the neck pain and upper-extremity numbness was noted postoperatively. An MRI obtained 6 months after the surgery revealed no evidence of tumor recurrence and the postoperative course was uneventful.
TSGCT of the upper cervical spine (C1-C2) is rare, and this is the tenth reported case. If a tumor is heterogeneously hypointense on T2-weighted MRI, which reflects hemosiderosis, the possibility of this tumor should be considered in the differential diagnosis.
腱鞘巨细胞瘤（TSGCT）通常发生于四肢关节，极少发生于脊柱。本病例报告描述了一名C1 - C2水平的脊柱TSGCT患者，该患者接受了手术治疗并被诊断为TSGCT。
一名32岁女性，有4个月颈部疼痛及双上肢麻木病史，被转诊至我科。磁共振成像（MRI）显示一个肿瘤性病变，从左侧硬膜外间隙延伸至C1 - C2椎体水平的竖脊肌，在T1加权图像上呈等信号，在T2加权图像上呈不均匀低信号，在钆喷酸葡胺（Gd - DTPA）增强T1加权图像上显示不均匀强化。计算机断层扫描未发现椎体骨质破坏的迹象。由于神经症状呈进行性加重，通过后路进行了肿瘤的全肉眼切除。对切除标本的组织病理学检查确诊为TSGCT。术后颈部疼痛和上肢麻木均有改善。术后6个月的MRI显示无肿瘤复发迹象，术后病程平稳。
上颈椎（C1 - C2）的TSGCT罕见，这是第10例报道的病例。如果肿瘤在T2加权MRI上呈不均匀低信号，提示含铁血黄素沉着，则在鉴别诊断中应考虑该肿瘤的可能性。
