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Age / Sex : 16 / F
Age/Sex: 16/F
C.C.: Back pain (duration: about 7 months)
1) What is your impression?
Courtesy : Chang Ho Kang, MD., Korea University Anam Hospital
Diagnosis: Giant cell tumor
Discussion
Findings:
- Radiographs and CT showed poorly-defined osteolysis at T7 body, extending to pedicles, and pathologic compression. - Cord compression was apparent on sagittal MR images. After injection of gadolinium, peripheral enhancement of the mass was detected.
Differential Diagnosis: osteoblastoma, eosinophilic granuloma, metastasis, hematopoietic malignancy
Diagnosis: Giant cell tumor of the thoracic spine
Discussion:
In cases of spinal GCTs, there is usually an expansile lesion with bone destruction that affects the vertebral body, as opposed to the posterior elements observed with other spinal bone tumors, such as aneurysmal bone cyst, osteoid osteoma, and osteoblastoma. On CT scans, a spinal GCT has been reported to show a homogeneous hypervascular appearance with contrast enhancement. Heterogeneous density or a fluid level due to hemorrhage or necrosis within the GCT was also observed. The MR images provided more information on both tumor location and extension than did the CT images. GCT usually has a low to intermediate signal on T1-weighted images and a predominantly high signal on T2-weighted images. It has been reported that a GCT shows several degrees of gadolinium enhancement on T1-weighted images. On T2-weighted images, GCTs often have low to intermediate signal intensity caused by the relatively high collagen content of their fibrous components and the hemosiderin within the tumor. Because most other spinal neoplasms have a high signal on T2-weighted images, the feature of hemosiderin deposition is reported to be useful for differential diagnosis.
References:
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2. Lee MJ, Sallomi DF, Munk PL, et al. Pictorial review. Giant cell tumours of bone. Clin Radiol 1998;53:481–489
3. Meyers SP, Yaw K, Devaney K. Giant cell tumor of the thoracic spine. MR appearance. AJNR Am J Neuroradiol 1994;15:962–964
4. Tehranzadeh J, Murphy BJ, Mnaymneh W. Giant cell tumor of the proximal tibia. MR and CT appearance. J Comput Assist Tomogr 1989;13:282–286
5. Herman SD, Mesgarzadeh M, Bonakdarpour A, Dalinka MK. The role of magnetic resonance imaging in giant cell tumor of bone. Skeletal Radiol 1987;16:635–643
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7. Aoki J, Tanikawa H, Ishii K, et al. MR findings indicative of hemosiderin in giant-cell tumor of bone: frequency, cause, and diagnostic significance. AJR Am J Roentgenol 1996;166:145–148
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