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case_images: Imaging data at the initial clinic visit (2020-04). (A1,A2) Thoracic vertebral X-ray: The local density of the T9 vertebrae was decreased. (B1-B5) Thoracic vertebral CT: T9 vertebral bone destruction, cortical destruction at the upper, lower, and posterior margins, bilateral bone destruction of the pedicle, an irregular soft tissue density shadow visible in the vertebral body, and the spinal canal were occupied, with a corresponding spinal canal sagittal diameter narrowing. (C1-C5) Thoracic vertebra MRI: T9 vertebral body flattening, and long T1 and long T2 signals appearing within the vertebral body. The fat suppression phase revealed a high signal intensity, bilateral pedicle involvement, bone destruction at the posterior edge of the vertebral body, soft tissue space, and dural compression. (D1) Puncture pathology revealed massive osteoclasts, considering the giant cell tumor of the bone.
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case_images: T9 vertebral tumor puncture biopsy and consideration of the puncture pathology indicated a GCT of the bone (Figures 1A-D). The parents are in good health and have no underlying diseases.
case_images: Postoperative radiographic data (2020-04). (A1,A2) Thoracic vertebral X-ray revealed a satisfactory internal fixation position; the placement was visible in the T9 vertebra. (B1-B4) Thoracic vertebral CT showing T9 vertebrae filled with a high-density shadow. (C1) Postoperative pathology revealed a T9 vertebral giant cell tumor of the bone.
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case_images: Accordingly, the patient was discharged after removing the stitches (Figures 2A-C).
case_images: MRI before and after denosumab administration. (A1-E1) MRI before denosumab administration showed uneven bone signals in the T9 vertebrae, with patchy abnormal signals at the posterior margin of the vertebral body. Burst into the spinal canal, and spinal cord compression can be seen. (A2-E2) MRI of the thoracic spine after three doses of denosumab administration (2021-02). The space in the spinal canal is significantly smaller than that at the front, and the boundary with the spinal cord is clear. (F,G) Preoperative planning for cyber knife radiation therapy.
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case_images: After consultation in the radiotherapy department, stereotactic radiotherapy was performed for recurrent lesions (cyber knife) with 600 cGy/fraction*6 fractions, 1 fraction/day (Figures 3A-G).
case_images: A thoracic MRI was reviewed after radiotherapy (2023-10). (A-E) Non-uniform hypointensity was observed in the T9 vertebrae, with no significant abnormalities in the intraspinal spinal cord.
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case_images: At the latest follow-up in October 2023, no tumor progression was found (Figures 4A-E).