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C y D) Imagen de RM con secuencias T2 (C) y T2 con supresión grasa (D). Se aprecia masa de partes blandas perivertebral que se extiende desde C3 a C4, con señal intermedia en T2 y STIR (flechas), con compresión medular que ocasiona mielopatía (punta de flecha verde).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Elena Moya Sánchez, Irene Garrido Márquez, Jade García Espinosa" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Elena" "apellidos" => "Moya Sánchez" ] 1 => array:2 [ "nombre" => "Irene" "apellidos" => "Garrido Márquez" ] 2 => array:2 [ "nombre" => "Jade" "apellidos" => "García Espinosa" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2387020621006471" "doi" => "10.1016/j.medcle.2021.01.020" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020621006471?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S002577532100186X?idApp=UINPBA00004N" "url" => "/00257753/0000015700000012/v1_202112010528/S002577532100186X/v1_202112010528/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2387020621006367" "issn" => "23870206" "doi" => "10.1016/j.medcle.2021.01.017" "estado" => "S300" "fechaPublicacion" => "2021-12-24" "aid" => "5635" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2021;157:595-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Hypercalcemia and bulky primary adrenal non-Hodgkin lymphoma: A case report" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "595" "paginaFinal" => "596" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hipercalcemia y linfoma no hodgkiniano primario suprarrenal voluminoso: descripción de un caso" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1049 "Ancho" => 2175 "Tamanyo" => 223711 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Left: Abdominal computed tomography scan showing a giant bilateral adrenal mass (white arrows) (18 × 11 × 15 and 13 cm): coronal reconstruction. Right: Evolution of the metabolic response assessed by FGD PET-CT: from September 2019 (grey arrows) to November 2020 after 2nd line chemotherapy (R-ESHAP).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Jorge Díaz-Roldán, Guzmán Franch-Arcas, Virgilio Ruiz-Luque" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Jorge" "apellidos" => "Díaz-Roldán" ] 1 => array:2 [ "nombre" => "Guzmán" "apellidos" => "Franch-Arcas" ] 2 => array:2 [ "nombre" => "Virgilio" "apellidos" => "Ruiz-Luque" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0025775321001858" "doi" => "10.1016/j.medcli.2021.01.023" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775321001858?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020621006367?idApp=UINPBA00004N" "url" => "/23870206/0000015700000012/v1_202112201710/S2387020621006367/v1_202112201710/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2387020621006331" "issn" => "23870206" "doi" => "10.1016/j.medcle.2020.12.032" "estado" => "S300" "fechaPublicacion" => "2021-12-24" "aid" => "5594" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2021;157:592-3" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Splenic rupture secondary of colonoscopy" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "592" "paginaFinal" => "593" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Rotura esplénica secundaria a colonoscopia" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Elena González-Andrades" "autores" => array:1 [ 0 => array:2 [ "nombre" => "Elena" "apellidos" => "González-Andrades" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775321000865" "doi" => "10.1016/j.medcli.2020.12.037" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775321000865?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020621006331?idApp=UINPBA00004N" "url" => "/23870206/0000015700000012/v1_202112201710/S2387020621006331/v1_202112201710/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Cervical spine giant cell bone tumor" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "593" "paginaFinal" => "594" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Elena Moya Sánchez, Irene Garrido Márquez, Jade García Espinosa" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Elena" "apellidos" => "Moya Sánchez" "email" => array:1 [ 0 => "elemoya89@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Irene" "apellidos" => "Garrido Márquez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Jade" "apellidos" => "García Espinosa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Hospital Universitario San Cecilio, Granada, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Hospital Universitario Virgen de las Nieves, Granada, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tumor óseo de células gigantes cervical" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1600 "Ancho" => 1305 "Tamanyo" => 182934 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A and B) CT in sagittal plane (A) and coronal plane (B), in which extensive osteolysis of both the arch and the vertebral body of C4 (arrow) is observed with perivertebral soft tissue that raises the dura mater backwards, occupies the spinal canal partially and bulges the precervical and retropharyngeal space, displacing the airway anteriorly. (C and D) MR image with T2 (C) and T2-weighted sequences with fat suppression (D). There is a perivertebral soft tissue mass extending from C3 to C4, with an intermediate signal on T2 and STIR sequences (arrows), with spinal compression causing myelopathy (green arrowhead).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We report the case of a 30-year-old female who presented with a 1-year history of neck pain with progressive worsening, associated with weakness in the left arm, with no improvement after analgesic treatment.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The physical examination revealed proximal weakness of the left upper limb, with hypoesthesia and paraesthesia in the shoulder, forearm, and all the fingers in both hands.</p><p id="par0015" class="elsevierStylePara elsevierViewall">A computed tomography (CT) scan of the cervical spine showed extensive osteolysis of the C4 vertebral body and arch. There was perivertebral soft tissue with probable spinal cord involvement and anterior displacement of the airway (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A and B).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Given these findings and the patient's symptoms, a cervical magnetic resonance imaging (MRI) scan was completed, which confirmed the CT findings: crushing of the C4 body and bulging of its posterior wall and involvement of C3 and C5, with intermediate signal on T1- and T2-weighted sequences and mild hyperintensity on STIR sequence (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C and D). Associated paravertebral soft tissue mass that affected both the anterior and prevertebral epidural space, causing a slight kyphotic angulation and compression of the dural sac and spinal cord with signs of myelopathy and radiculopathy (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C).</p><p id="par0025" class="elsevierStylePara elsevierViewall">Small bilateral pulmonary nodules of metastatic origin were seen in the chest CT scan performed as part of the extension study.</p><p id="par0030" class="elsevierStylePara elsevierViewall">A biopsy of the bone lesion was performed with the pathological result of soft tissue infiltration by a giant cell bone tumour.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Finally, the patient underwent surgery, performing C2–C6 arthrodesis and subsequent treatment with denosumab. After completion of the procedure, the patient reported spinal pain with extension to both upper limbs, for which an intradural morphine pump implantation was performed, with good current progression and follow-up by Oncology and Neurosurgery.</p><p id="par0040" class="elsevierStylePara elsevierViewall">GCT is generally a benign, common tumour with a locally aggressive nature and a tendency to recur, which in rare cases results in pulmonary metastases and sarcomatous transformation. It shows a slight female prevalence, accounting for approximately 5% of benign adult bone tumours between the ages of 20 and 50.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The spine is not a common place of involvement, with a 2.5% incidence in the sacrum and 2.9% in the rest of the vertebrae, and extremely rare in the cervical spine (less than 1%).<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Their histological composition is complex, as they are made up of neoplastic cells and non-neoplastic multinucleated giant cells, which express the CD68 antigen, which explains why they belong to the monocytic–histiocytic system. Because of this, a differential diagnosis is required to rule out other lesions with similar histology, such as aneurysmal bone cyst, fibrous metaphyseal defects, osteoblastoma, or chondrosarcoma.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The typical clinical presentation includes localised pain that is rarely relieved by non-steroidal anti-inflammatory drugs. In more advanced cases, there may be spinal cord instability and compression.</p><p id="par0060" class="elsevierStylePara elsevierViewall">In relation to imaging techniques, the initial test is usually an X-ray, which shows a cystic appearance involving the vertebral body, with or without compression fracture and with possible involvement of other vertebral elements.</p><p id="par0065" class="elsevierStylePara elsevierViewall">CT is superior to X-ray because it delimits tumour extension, bone integrity and stability. However, MRI contributes even more data to the diagnosis, and the tumour may be homogeneous or heterogeneous, sometimes with a high signal in T1-weighted sequence in relation to recent bleeding. In T2-weighted sequences, the signal is usually intermediate/low compared to the spinal cord, and this seems to depend on the amount of collagen and hemosiderin. After the administration of intravenous contrast, they show enhancement, which demonstrates their high vascularisation, associating an increase in soft tissue in 79% of cases.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Occasionally, hypointense curvilinear areas can be seen in T1 and T2 within the vertebral body, suggesting polycystic lesions with thickened trabeculae, fibrous septa, or hemosiderin deposition, rare findings that make differential diagnosis difficult with bone plasmacytoma or vertebral hemangioma.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Management is usually surgical, although there is no consensus on which type of surgery is better. There are studies that suggest that wide resection provides a lower recurrence rate, however, it is associated with higher complication rates. In contrast, intralesional excision is preferable with the aim of removing the entire tumour and preserving the joint.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Moya Sánchez E, Garrido Márquez I, García Espinosa J. Tumor óseo de células gigantes cervical. Med Clin (Barc). 2021;157:593–594.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1600 "Ancho" => 1305 "Tamanyo" => 182934 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A and B) CT in sagittal plane (A) and coronal plane (B), in which extensive osteolysis of both the arch and the vertebral body of C4 (arrow) is observed with perivertebral soft tissue that raises the dura mater backwards, occupies the spinal canal partially and bulges the precervical and retropharyngeal space, displacing the airway anteriorly. (C and D) MR image with T2 (C) and T2-weighted sequences with fat suppression (D). There is a perivertebral soft tissue mass extending from C3 to C4, with an intermediate signal on T2 and STIR sequences (arrows), with spinal compression causing myelopathy (green arrowhead).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Giant cell tumor of axial vertebra: surgical experience of five cases and a review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "G. Chen" 1 => "J. Li" 2 => "X. Li" 3 => "H. Fan" 4 => "Z. Guo" 5 => "Z. 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Yi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2214/AJR.06.1472" "Revista" => array:6 [ "tituloSerie" => "AJR Am J Roentgenol" "fecha" => "2007" "volumen" => "189" "paginaInicial" => "246" "paginaFinal" => "250" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17579178" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015700000012/v1_202112201710/S2387020621006471/v1_202112201710/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015700000012/v1_202112201710/S2387020621006471/v1_202112201710/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020621006471?idApp=UINPBA00004N" ]
