Kong Wei, Shi Yahong, Zhao Xin, Fang Guoping, Liu Chenglei
Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Am J Case Rep. 2025 Mar 29;26:e946427. doi: 10.12659/AJCR.946427.
BACKGROUND Tenosynovial giant cell tumor (TGCT) is a rare, benign, yet aggressive, lesion, usually involving a bursa or the tendon sheath. Spinal TGCT is quite rare. Its appearance on imaging can mimic other aggressive diseases, including giant cell tumor of bone, metastatic disease, and osteoblastoma, thus posing a diagnostic dilemma. We present a new pathologically confirmed case of localized TGCT arising from the cervical spine facet joint and describe its computed tomography (CT) and magnetic resonance imaging (MRI) findings to enhance awareness and improve the accuracy of preoperative diagnosis. CASE REPORT A 33-year-old man experienced neck pain radiating to the right upper limb for 1 year. The pain had subsequently progressed for 1 month. There was no weakness of the lower limbs or limitation in the cervical spine range of motion (ROM). The cervical CT revealed an osteolytic, expansive destructive lesion concentered in the C5-6 right vertebral lamina and spinal process. MRI demonstrated a lobulated mass with heterogeneous isointensity on T1-weighted images and low signal on T2-weighted images. After contrast enhancement, obvious heterogeneous enhancement was identified, and the time-intensity curve (TIC) was of type II (rapid enhancement with low washout curve). Subsequently, a single-stage combined anterior and posterior en-bloc resection was performed. Stabilization was achieved by C5-6 interbody fusion and posterior internal fixation. Histology and immunohistochemistry were suggestive of localized TGCT. The patient's symptoms improved considerably, and there was no sign of a recurrence during the 2-year follow-up. CONCLUSIONS Our case suggested an osteolytic lesion involving the posterior elements of vertebral facet joints. With low signal intensity on T2-weighted image and type II TIC, the possibility of spinal TGCT should be considered.
背景 腱鞘巨细胞瘤（TGCT）是一种罕见的、良性但具有侵袭性的病变，通常累及滑囊或腱鞘。脊柱TGCT非常罕见。其在影像学上的表现可模仿其他侵袭性疾病，包括骨巨细胞瘤、转移性疾病和成骨细胞瘤，从而造成诊断困境。我们报告一例经病理证实的起源于颈椎小关节的局限性TGCT新病例，并描述其计算机断层扫描（CT）和磁共振成像（MRI）表现，以提高认识并提高术前诊断的准确性。病例报告 一名33岁男性颈部疼痛向右上肢放射1年。疼痛随后持续进展1个月。下肢无无力，颈椎活动范围（ROM）无受限。颈椎CT显示一个溶骨性、膨胀性破坏性病变，集中在C5-6右侧椎板和棘突。MRI显示一个分叶状肿块，在T1加权图像上呈等信号不均匀，在T2加权图像上呈低信号。增强扫描后，可见明显的不均匀强化，时间-强度曲线（TIC）为II型（快速强化伴低廓清曲线）。随后，进行了一期前后联合整块切除。通过C5-6椎间融合和后路内固定实现了稳定。组织学和免疫组化提示为局限性TGCT。患者症状明显改善，在2年随访期间无复发迹象。结论 我们的病例提示一个累及椎小关节后部结构的溶骨性病变。T2加权图像上呈低信号强度且TIC为II型时，应考虑脊柱TGCT的可能性。
