Giant cell tumor - A case report of recurrence during pregnancy

Study Design. Descriptive. Objective. To report a case of a recurrent giant cell tumor (GCT) of the lumbar spine during pregnancy. Summary of Background Data. GCT is a locally aggressive tumor that primarily occurs in young female adults. These tumors rarely present in the spine, recur locally, and may be present during pregnancy because of growth promoting receptors. Methods. A 31-year-old pregnant woman presented to us from Europe at 24 weeks' gestation (G1P1) with severe back pain and an enlarging mass. A large, firm, nontender mass was palpable in the right upper quadrant. Radiographs of the lumbar spine were obtained and revealed a 10-cm x 8 cm x 15 cm expansive bony mass at L2 with vertebral body collapse and junctional kyphosis. Following delivery of a healthy 6 lb. 8 oz. baby, MRI, CT, and full-length standing radiographs were obtained. A needle-guided biopsy showed amorphous bone with numerous giant cells consistent with a GCT. At 6 weeks postpartum, the tumor was resected. Results. At 1-year follow-up, there is no evidence of local reoccurrence and the patient is without constitutional symptoms. Conclusion. This is an unusual presentation of an expanding intra-abdominal mass originating from the lumbar spine during pregnancy. It most likely represents rapid growth of a previous unrecognized recurrence of a GCT. Close observation and follow-up CT scanning are imperative to identify and treat GCTs of the spine before rapid growth occurs.