Introduction: Tenosynovial giant cell tumors (TSGCTs) generally occur in the limb joints, and only rarely in the spine. This case report describes a patient with TSGCT of the spine at C1–C2, which was treated surgically and diagnosed as TSGCT. Case presentation: A 32-year-old woman with a 4-month history of neck pain and numbness in both upper extremities was referred to our department. Magnetic resonance imaging (MRI) revealed a neoplastic lesion extending from the left epidural space to the erector spinae muscles at the C1–C2 vertebral level, which was isointense on T1-weighted images, heterogeneously hypointense on T2-weighted images, and showed heterogeneous enhancement on gadopentetate dimeglumine (Gd-DTPA)-enhanced T1-weighted images. Computed tomography showed no findings suggestive of bone destruction of the vertebral body. Because the neurological symptoms were progressive, total macroscopic resection of the tumor was performed via a posterior approach. Histopathological examination of the resected specimen revealed the diagnosis of TSGCT. Improvement of the both the neck pain and upper-extremity numbness was noted postoperatively. An MRI obtained 6 months after the surgery revealed no evidence of tumor recurrence and the postoperative course was uneventful. Discussion: TSGCT of the upper cervical spine (C1–C2) is rare, and this is the tenth reported case. If a tumor is heterogeneously hypointense on T2-weighted MRI, which reflects hemosiderosis, the possibility of this tumor should be considered in the differential diagnosis.
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