Acute Paraparesis Caused by a Giant Cell Tumor of the Thoracic Spine

胸椎骨巨細胞瘤造成急性雙下肢癱瘓

趙亮鈞(Liang-Chun Chao) ； 阮威勝(Wei-Sheng Juan) ； 張哲肇(Che-Chao Chang) ； 戴世煌(Shih-Huang Tai) ； 莊明宗(Ming-Tsung Chuang) ； 司君一(Chun-I Sze) ； 洪裕昌(Yu-Chang Hung) ； 李宜堅(E-Jian Lee)

《台灣癌症醫學雜誌》 1卷3期 (2014/12) Pp. 260-266

https://doi.org/10.6323/JCRP.2014.1.3.11

摘要

骨巨細胞瘤對年輕人來說是一種良性但具局部侵犯性的腫瘤，而發生在脊椎的骨巨細胞瘤相對來說是少見的，在治療上必須合併手術以及後續的放射線治療。在此我們提出一個病例報告，病人經歷兩個禮拜的間歇下背痛且惡化成為急性雙下肢無力，胸椎核磁共振檢查中發現胸椎第七節的腫瘤造成病理性骨折以及嚴重的脊髓壓迫，在施行緊急的腫瘤移除以及前固定手術後，下肢的肌力恢復到正常。病人後續接受脊椎的放射線治療，追蹤到目前並無復發的情形。儘管脊椎骨巨細胞瘤相當少見，我們仍然強調在診斷脊椎的病理性骨折以及蝕骨性病灶時，必須將其列為鑑別診斷之一，尤其是在沒有外傷病史卻有長期下背痛的年輕女性身上。

關鍵字

急性下肢無力 ； 病理性骨折 ； 脊椎骨巨細胞瘤

並列摘要

Giant cell tumor (GCT) is a benign but locally aggressive skeletal neoplasm of young adults. GCT located in the spine is relatively rare and may need a combination of surgical and adjunctive therapies. Here we present a patient who had intermittent thoracic back pain for two weeks and experienced an acute episode of decreased muscle power of both lower limbs. Magnetic resonance (MR) imaging examinations of the thoracic spine revealed that the patient had severe spinal canal compression caused by pathological fracture due to a tumor within the seventh thoracic vertebra. She underwent an emergent surgical intervention for total removal of the tumor and spinal reconstruction with autologous rib grafts and instruments. Postoperatively, the patient made an uneventful recovery of muscle power of bilateral lower limbs. She subsequently received adjuvant radiotherapy. In a follow-up period of 36 months, the patient had no clinical or radiological evidence of tumor recurrence. Even though spinal location for GCT is a rare event, it should be included in the differential diagnosis in patients with osteolytic lesions or pathological fractures of the vertebra, especially in young female patients sustaining no trauma who had a clinical history of persistent low back pain.

並列關鍵字

acute paraparesis ； pathological fracture ； spinal giant cell tumor