Giant Cell Tumor of the Thoracic Spine Simulating Mediastinal Neoplasm

Images from the case of a 34-year-old woman who was admitted to the hospital with slight back pain and occasional difficulty swallowing.

A, Frontal chest roentgenogram shows a round mass in the right upper mediastinum.

B, CT scan shows a well-defined soft-tissue density with marginal shell-like calcification. No calcification is seen within the mass.

C, Contrast-enhanced CT scan shows that the mass enhances.

D, T1-weighted MR image (repetition time, 440 milliseconds; echo time, 14 milliseconds) shows that the tumor has a homogeneous low signal.

E, T2-weighted MR image (repetition time, 4000 milliseconds; echo time, 96 milliseconds) shows that the tumor has a predominantly high signal with some heterogeneity. The image also shows a peripheral low signal.

F, Contrast-enhanced T1-weighted MR image (repetition time, 440 milliseconds; echo time, 14 milliseconds) shows homogeneous enhancement within the tumor. Complete collapse of the first thoracic spine and tumor spread to the second thoracic vertebral body are apparent. The extradural intraspinal mass effect can be seen.

G, Bone scintigraph with technetium-99m methylene diphosphonate shows marked uptake both in T1 in the posterior view (right arrow) and in the marginal shell-like lesion in the anterior view (left arrow). Most of the tumor, however, shows no accumulation.

H, Coronal view positron emission tomographic scan, with18-fluorine fluorodeoxyglucose, shows uptake in the mediastinal tumor.

I, Histologic specimen (hematoxylin and eosin stain; original magnification, ×400) shows a uniform distribution of multinucleated giant cells (arrows) against a background of round to spindle-shaped mononuclear stroma cells.