A “special” case of thoracic vertebral giant cell tumor The successful treatment of a patient who was diagnosed with thoracic vertebral giant cell tumor after sudden onset of paralysis during pregnancy This is a 26-year-old young woman who developed pain in her thoracic back after pregnancy, but had not paid attention to it, and suddenly developed numbness and weakness in both lower limbs in the eighth month of pregnancy. The patient was then admitted to a tertiary care hospital in Yinchuan City. After MRI examination, the doctors found that the patient had tumors in the 6th and 7th thoracic vertebrae, which had protruded into the spinal canal and caused spinal cord compression. Fortunately, the obstetrician and gynecologist made a quick decision and delivered the baby by cesarean section, allowing the orthopedic surgeon to continue treating the patient, who was about to be paralyzed, without any worries. When I received the consultation information from the local orthopedic surgeon, the patient was unable to move both lower limbs. The MRI film showed that the tumor had destroyed the seventh thoracic vertebra and spread outward to the vertebral body, squeezing the thoracic aorta forward and compressing the spinal cord backward. Crucially, it is impossible to determine the exact type of tumor and develop the appropriate treatment strategy by relying on imaging alone. According to the conventional method, we need to do CT-guided puncture biopsy to obtain an accurate pathological diagnosis. And this process takes about 2 weeks. The local hospital had no experience in doing CT-guided puncture, the patient could not come to Beijing for treatment, and the patient’s neurological function could not wait for these 2 weeks. So we took more practical measures. First, we improved the CT of the thoracic spine and the whole body bone scan, and found that the patient had only this one lesion in the whole body orthopedics, and the CT showed osteolytic destruction. Combining these imaging findings, we analyzed that this 26-year-old female patient was more likely to have giant cell tumor of bone. If the diagnosis is confirmed, we will need to perform a complete total laminectomy. Since there was no confirmation of the pathological findings, we decided to complete the surgery in two stages. One month ago I went to Yinchuan to complete the first stage of surgery, removing the entire posterior structure of the affected vertebrae from the posterior approach, removing the tumor from the spinal canal, removing the spinal cord compression, and obtaining the tumor tissue at the same time. The surgery went very well. The strength of the patient’s lower limbs began to recover right after the surgery. However, the pathological diagnosis of the tumor encountered some difficulties, and the tumor was determined to be a giant cell tumor of bone combined with an aneurysmal bone cyst after a joint consultation locally as well as in multiple locations in Shanghai. It was the same as our preoperative analysis. So after 3 weeks, I came back to Yinchuan, and this time the patient was able to lift his lower limbs off the bed. The second surgery was still performed posteriorly, carefully separating the paravertebral tumor from the aorta and then removing the affected 1½ vertebral body in its entirety along with the tumor in the soft tissue. A week later, I heard from the local orthopedic surgeon that the patient was already moving around with the protection of a brace. This was a very unusual case of giant cell tumor of bone in a pregnant woman, which is an extremely rare occurrence in this country and abroad. Some studies have shown that estrogen and progesterone receptors exist on the surface of giant cell tumor cells in bone, and that estrogen and progesterone in pregnant women may have stimulated the development of the tumor. However, it has also been shown that not all giant cell tumors express estrogen and progesterone receptors, so the occurrence of giant cell tumors in pregnant women may be just a coincidence. The second peculiarity is that the tumor was found in a paralyzed patient and there was not enough time to complete a definitive diagnosis. The staged surgery we adopted was actually a slight reordering of diagnosis and treatment. The first stage of surgery released the spinal cord from compression by removing the tumor posteriorly and around the spinal cord, gaining time for pathological diagnosis of the tumor. In order to avoid residuals caused by the shedding of tumor cells during surgery, we recommend that patients begin radiotherapy at 3-4 weeks postoperatively. With such a comprehensive treatment, we hope that the patient will finally be free from the tumor and live a long and happy life with their lovely baby.