Vertebral Giant Cell Tumor in a Young Male with Early Aggressive Recurrence and Pulmonary Metastases: A Rare Case Report and Literature Review

Background: Giant cell tumor of bone (GCTB) is one of the most common benign tumors of bone, accounting for 15-20% of such tumors. The peak age of incidence is between 25 and 35 years. GCTB typically affects the epiphyseal regions of long bones, with at least 40% occurring around the knee. Vertebral involvement is rare, occurring in approximately 2-9% of GCTB cases. Local recurrence after excision is common and is generally observed around one to two years post-surgery. Pulmonary metastasis is unusual and is seldom encountered within the first year of diagnosis. Case Presentation: A 20-year-old Caucasian/African American male with no medical history presented with acute lower back pain. Imaging revealed a T12 lytic mass with a pathological compression fracture. He underwent corpectomy with tumor resection and surgical stabilization via posterior T9-L3 spinal fusion and placement of an Ulrich expandable cage graft. The biopsy was positive for osseous giant cell tumor. He was discharged in stable condition to acute rehab. The patient was lost to follow-up and returned to the hospital three months later with back pain and fatigue. He exhibited dehiscence of the surgical wound, new extensive pulmonary metastases, and recurrence of a larger mass in the post-corpectomy space. He underwent extensive neurosurgical intervention involving wound washout, re-resection of the tumor, and removal and replacement of the cage graft. He received a dose of denosumab as per the oncologist’s instructions and was discharged with close outpatient follow-ups. Conclusion: Vertebral GCTB is a rare bone tumor in a 20-yearold male. The aggressive local recurrence and extensive pulmonary metastases occurring within three months after the initial tumor debulking make this case an exceptionally rare presentation. Vertebral GCTB poses a higher risk of recurrence and pulmonary metastasis compared to other types of GCTB, necessitating a multidisciplinary approach for optimal management. Abbreviations: GCTB: Giant Cell Tumor of Bone; MRI: Magnetic Resonance Imaging; IV: Intravenous; IR: Interventional radiology; PRBC: Packed Red Blood Cells; CT: Computed Tomography; MRSA: Methicillin Resistant Staphylococcus Aureus; B-HCG: Beta-Human Chorionic Gonadotropin; RANKL: Receptor Activator of Nuclear Factor-κB Ligand; OPG: Osteoprotegerin; H3F3: Histone H3.3 protein; G34W: Glycine to Tryptophan Substitution at Codon 34; MMP: Matrix Metalloproteinases; TNF-α: Tumor Necrosis Factor-Alpha; IL-6: Interleukin-6; PET: Positron Emission Tomography; PMMA: Polymethylmethacrylate; RT: Radiotherapy.