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Year : 1999  |  Volume : 9  |  Issue : 2  |  Page : 87-88
Giant cell tumour of third lumbar vertebra presenting as an abdominal mass


Department of Imageology, Regional Cancer Centre, Thiruvananthapuram, India

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How to cite this article:
Ramachandran KN, Sasidharan K, Ittiyavirah AK, Krishnakumar AS. Giant cell tumour of third lumbar vertebra presenting as an abdominal mass. Indian J Radiol Imaging 1999;9:87-8

How to cite this URL:
Ramachandran KN, Sasidharan K, Ittiyavirah AK, Krishnakumar AS. Giant cell tumour of third lumbar vertebra presenting as an abdominal mass. Indian J Radiol Imaging [serial online] 1999 [cited 2019 Jul 16];9:87-8. Available from: http://www.ijri.org/text.asp?1999/9/2/87/28344
Sir,

A twenty-six years old man was referred to us for abdominal imaging. His presenting complaint was progressive distension of the abdomen and weakness of the lower limbs. He gave a history of sudden onset of weakness of the lower limbs five years ago, for which he was started on anti-tuberculous treatment. He was relatively free of symptoms till the last one month. Clinical examination showed a hard irregular mass filling the abdomen and grade 3 to 4 power in the lower limbs. Plain radiographs revealed scoliosis with concavity towards the right, kyphosis, irregular egg-shell type of calcification and a collapse of the third lumbar vertebra. A bladder stone was also evident [Figure - 1]. CT of the abdomen and pelvis with oral and intravenous contrast revealed a 20 x 15 cms, well-defined mass with an irregular outline, predominantly solid in morphology with some areas of degeneration. The egg-shell calcification in the periphery of the mass was noted. The mass was located in the right half of the abdomen and was crossing the midline [Figure - 2]. The liver, spleen, pancreas and left kidney were normal. The right kidney was hydronephrotic and displaced upwards by the mass. The third lumbar vertebra was collapsed.

Exploratory laparotomy revealed a huge retroperitoneal tumor, bony hard in consistency. The tumor had large veins on the surface and was too extensive to be resected. A biopsy was obtained. Histology revealed a giant cell tumor with malignant change. It was decided to treat him with 20 Gy radiotherapy in ten fractions. He was lost to follow up after the course of radiation.

Giant cell tumor (GCT) of bone is the fifth or sixth commonest tumor of bone. About 80 % of patients range from 18 to 45 years. Women are slightly more affected than men [1]. The commonest site is the long bones, especially the lower end of femur. Soft tissue extracortical extension is known to occur in GCTs [1]. Location other than the long bones is rare. GCTs of the spine excluding the sacrum are uncommon [2]. Upper thoracic or upper cervical regions are more affected [1]. GCTs may involve the body, pedicle or the rest of the neural arch. Usually, the tumor starts in the body [3]. Vertebral compression occurs in one-third of the cases. There may be spinal cord involvement [4]. Pain and neurological deficit are the commonest presenting symptoms. Histologically, rich vascular tissue containing plump spindle cells and numerous giant cells containing 50 to100 nuclei are seen. The tumor forms neither bone nor cartilage [5]. Once the lesion escapes through the reactive shell into the soft tissues, a large soft tissue mass results. Malignant change is known to occur. Pulmonary metastases also are encountered.

 
   References Top

1.Dennis J S. Bone tumors: General characteristics, Benign lesions. In: Grainger RG, Allison DJ, eds. Grainger and Allison's Diagnostic Radiology- A textbook of Medical Imaging, Third edition. Churchill Livingstone, New York 1997; 1646-1649.   Back to cited text no. 1    
2.George BG, John AA. Eds. Imaging of bone tumours-a multi modality approach. Philadelphia: J B Lippincott Co. 1990; 197.   Back to cited text no. 2    
3.Joseph M M.Giant cell tumors. In: Joseph MM, Peiro P, Richard HG [eds] Bone tumors- Clinical, Radiologic and Pathological Correlation Vol 2. Philadelphia: Lea and Febiger,1989; 942-1019.   Back to cited text no. 3    
4.Daniel W. Radiology of bone tumors and allied disorders, Vol 1, Philadelphia: W B Saunders and Co,1982; 839.   Back to cited text no. 4    
5.Ian Watt. Tumours and tumour like conditions of bone. In: David Sutton, ed. Textbook of Radiology and Medical Imaging,Vol 1 London: Churchill Livingstone,1992; 159-187.  Back to cited text no. 5    

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Correspondence Address:
Krishnankutty Nair Ramachandran
Department of Imageology, Regional Cancer Centre, Thiruvananthapuram
India
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Source of Support: None, Conflict of Interest: None


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