AB026. Paraplegia as a first clinical presentation of giant cell tumor of the thoracic spine presenting as a posterior mediastinal tumor with cutaneous tuberculosis: a case report
Abstract

AB026. Paraplegia as a first clinical presentation of giant cell tumor of the thoracic spine presenting as a posterior mediastinal tumor with cutaneous tuberculosis: a case report

Sukarti San Suwarno1, Andreas Infianto2, Ahmad Fauzi3, Rizki Hanriko4, Danasha Utomo5, Resti Arania6, Sri Indah Aruminingsih7, Hendra Tarigan8, Isura Febrihartati9

1Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, University of Lampung, Abdul Moeloek General Hospital, Lampung, Indonesia; 2Department of Pulmonology and Respiratory Medicine, Ahmad Yani General Hospital, Lampung, Indonesia; 3Department of Orthopaedic Surgery, Urip Sumoharjo Hospital, Lampung, Indonesia; 4Department of Pathological Anatomy, Urip Sumoharjo Hospital, Lampung, Indonesia; 5Department of Cardiovascular and Thoracic Surgery, Abdul Moeloek General Hospital, Lampung, Indonesia; 6Department of Pathological Anatomy, Abdul Moeloek General Hospital, Lampung, Indonesia; 7Department of Radiology, Abdul Moeloek General Hospital, Lampung, Indonesia; 8Department of Dermatology and Venereology, Abdul Moeloek General Hospital, Lampung, Indonesia; 9Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, University of Lampung, Indonesia

Correspondence to: Sukarti San Suwarno, JL. Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, University of Lampung, Abdul Moeloek General Hospital, Ryacudu, Perum Korpri Blok A8 No. 10 (jalur dua korpri), Sukarame, Bandar Lampung 35131, Indonesia. Email: sukartidr@gmail.com.

Background: Giant cell tumor (GCT) of the spine remains a difficult tumor to treat and a locally aggressive benign tumor with the potential to undergo malignant transformation. Most cases are located in the lower extremities while the upper extremities and trunk are rare. However, tumor is one of the most common benign bone tumors, usually occurring at the age of 20 to 40 years with a high recurrence rate due to its aggressive nature.

Case Description: An 18-year-old female presented with complaints of shortness of breath for the last month and gradual weakness in her lower extremities. Physical examination revealed dullness on percussion and decreased vesicular breath sounds in the right lung, spasticity in the lower extremities. In November 2022, a thoracic magnetic resonance imaging (MRI) showed a fracture of the VT7 corpus with a gibbous deformity causing moderate compression of the thoracic sac and spinal cord, accompanied by a paravertebral abscess in the posterior soft tissue at the level of T6–8, which extended extradural and pressed on the anterior spinal cord, infiltrating VT7. The patient underwent an open biopsy and pen insertion by orthopedic spine surgeons. The results of the microscopic examination showed fibrous connective tissue, including a tumor mass consisting of round to oval mononuclear cells and osteoclast-like multinucleated giant cells with vascular stroma. The patient received ibandronic acid 6 mg, with improved results. One year later, the patient returned with complaints of shortness of breath. A contrast chest computed tomography (CT) scan showed an inhomogeneous solid mass in the posterior mediastinum (bilateral paravertebral) measuring 14.9 cm × 7.3 cm × 6.7 cm with inhomogeneous enhancement. An open biopsy by thoracic cardiovascular surgery confirmed a giant cell tumor in the right posterior mediastinum. Other findings included multiple, irregular, verrucose ulcers measuring 0.5 × 0.5 to 10 cm, filled with necrotic tissue and pus, echoing walls, and loculated, in the right inguinal. A skin biopsy revealed positive acid-fast bacilli (AFB). The patient started on anti-tuberculosis drugs (ATDs) and showed improvement. The patient was diagnosed with GCT of the thoracic spine presenting as a posterior mediastinal tumor with cutaneous tuberculosis.

Conclusions: A GCT of the bone is a benign aggressive tumor has capable recurrence.

Keywords: Recurrence aggressive giant cell tumor (recurrence aggressive GCT); posterior mediastinal tumor; case report

Acknowledgments

Funding: None.

Footnote

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://med.amegroups.com/article/view/10.21037/med-24-ab026/coif). S.S.S. reports support for attending meeting from PT.Medison Jaya Raya. The other authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee(s) and with the Helsinki Declaration (as revised in 2013). Written informed consent was obtained from the patient for the publication of this case report. A copy of the written consent is available for review by the editorial office of this journal.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

doi: 10.21037/med-24-ab026
Cite this abstract as: Suwarno SS, Infianto A, Fauzi A, Hanriko R, Utomo D, Arania R, Aruminingsih SI, Tarigan H, Febrihartati I. AB026. Paraplegia as a first clinical presentation of giant cell tumor of the thoracic spine presenting as a posterior mediastinal tumor with cutaneous tuberculosis: a case report. Mediastinum 2024;8:AB026.

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