Presentation
Severe back pain.
Patient Data
Expansile lytic lesion of the L1 vertebral body extending to the right pedicle with a soft tissue component. It displays an isosignal to the spinal cord on both T1 and T2 with a peripheral hypointense rim as well as a small T2 hyperintense component (probably cystic component) with a homogeneous enhancement of the solid component. There is an extension to the epidural space and right extraforaminal through and enlarged L1-L2 foramina, displacing the psoas muscle.
No other lesion of the cervical or thoracic vertebral bodies (not shown).
Case Discussion
MRI features of an expansile vertebral lytic lesion with a soft tissue component.
The patient underwent a CT-guided biopsy with a histopathological examination that confirmed the diagnosis of a giant cell tumor.
Giant cell tumors are common benign bone neoplasms. They almost occur when the growth plate has closed and are therefore typically seen in early adulthood, between the ages of 20 and 50 in 80% of reported cases with a mild female predilection, especially when located in the spine (as in this case). Malignant transformation is far more common in men (M:F of ~3:1).
Typically occur as single lesions and the most common sites are around the knee (distal femur and proximal tibia) in 50-65% of cases. The vertebral location is seen in around 7% of cases.