Case Report: Giant cell-rich osteosarcoma of the cervical spine in the pediatric age. A rare entity to consider

Abstract

BackgroundAlthough osteosarcoma is the most common primary malignant bone tumor in children, its location in the axial skeleton is rare, particularly at the cervical spine. Early diagnosis, together with multidisciplinary management, improves survival rates. Safe resection and stable reconstruction are complicated by the particular anatomy of the cervical spine, which raises the risks.Case PresentationA 12-year-old male patient presented with cervical pain for several months and a recent weight loss of 3 kg. The complementary workup revealed a large destructive bone lesion in C7 with vertebral body collapse, subluxation, partial involvement of C6 and T1, large associated anteroposterior soft tissue components, and spinal canal narrowing. A biopsy suggested giant cell-rich osteosarcoma (GCRO). After 10 cycles of neoadjuvant chemotherapy, surgical resection was performed through a double approach: anterior, for tumoral mass resection from C6-7 vertebral bodies and reconstruction placing a mesh cage filled with iliac crest allograft plus anterior plate fixation; and posterior, for C7 complete and C6 partial posterior arch resection, thus completing a total piecemeal spondylectomy preserving the dura intact, added to a C5-T3 posterior fusion with screws and transitional rods. Postoperative chemo and radiotherapy were administered. Clinical and radiological follow-up showed disease-free survival and no neurological involvement at 3 years.ConclusionAn extensive review of the literature did not find any published cases of GCRO of the cervical spine in pediatric patients. This can be explained by the combination of three peculiar conditions: its location at the cervical spine region, the young age, and the GCRO variant.

Giant cell‐rich osteosarcoma: A match pair analysis of 11 new cases and literature review of 56 patients

“…Literature search revealed 56 cases of GCRO published between 1986 and 2022 in a total of 34 studies, with 36 cases reported from Asia (64%; Table 3). 10–12,18–50 Mean age was 26 years (range, 5–73 years) and 28 were males (50%). Localizations were reported as follows: Femur (38%; n = 21; 10 times distal, 8 times diaphyseal, 2 times proximal, 1 time unspecified), tibia (27%; n = 15; 14 times proximal, 1 time diaphyseal), mandible ( n = 5), vertebrae C6 to T6 ( n = 4), maxilla ( n = 2), proximal fibula ( n = 2), proximal ulna ( n = 2), foot ( n = 2; first metatarsal, medial cuneiform), 11th rib ( n = 1), skull base ( n = 1), and distal radius ( n = 1).…”