title: Unusual presentation of giant cell tumor originating from a facet joint of the thoracic spine in a child: a case report and review of the literature.
abstract: BACKGROUND
  Giant cell tumor of the synovium is a common benign lesion that frequently occurs at the tendon sheaths in the hand; it is usually found in adults over 30 years old. It is related to pigmented villonodular synovitis. Giant cell tumor of the synovium or pigmented villonodular synovitis has been described rarely in the axial skeleton especially in the thoracic vertebrae of a child.
  
  
  METHODS
  A previously healthy 7-year-old Thai girl presented with back pain and progressive paraparesis and was unable to walk for 1 month. She had weakness and hyperreflexia of both lower extremities. Magnetic resonance imaging showed a well-defined homogeneously and intensely enhanced extradural mass with cord compression at T4 to T7 levels. The patient underwent laminectomy at T4 through to T7 and total tumor removal. Permanent histopathologic sections and immunostains revealed a giant cell tumor of the synovium. Postoperative neurological status recovered to grade V. Magnetic resonance imaging at the 1-year follow-up showed no recurrence and there was no clinical recurrence at the 2-year follow-up.
  
  
  CONCLUSIONS
  We report an extremely rare case of giant cell tumor in the epidural space that extended from a thoracic facet joint. The tumor was removed successfully through laminectomies. Although giant cell tumor of a facet joint of the thoracic spine is very rare, it must be considered in the differential diagnosis for masses occurring in the epidural space in a child. Total tumor removal is the best treatment. Careful monitoring of recurrence can achieve a good clinical outcome.
authors.affiliation: Department of Orthopedic Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkla 90110, Thailand. koopongs@hotmail.com.
authors.forename: Koopong
authors.initials: K
authors.lastname: Siribumrungwong
authors.forename: Boonsin
authors.initials: B
authors.lastname: Tangtrakulwanich
authors.forename: Anupong
authors.initials: A
authors.lastname: Nitiruangjaras