Abstract
Precursor B-cell lymphoblastic lymphoma presenting with severe pain and extensive skeletal lesions as an initial presentation is very rare. We report a nine year old boy who presented with lower backache and difficulty in walking of 2 months duration. He neither had lymphadenopathy nor organomegaly. His peripheral blood picture and bone marrow examination were normal. MRI revealed multiple lytic lesions in the spine and PET scan revealed metabolically active lytic lesions in the axial skeletal system and bilateral femurs and humerus. Biopsy of the vertebra revealed the diagnosis of precursor B cell lymphoma. A diagnosis of malignancy should never be missed in a patient with musculoskeletal pain, having ruled out infectious and traumatic etiologies especially when they present with several skeletal radiolucencies.
Highlights
We report a case of precursor B cell Lymphoblastic Lymphoma who presented with multiple skeletal lesions without apparent lymph nodal, peripheral blood or marrow involvement
Precursor B cell Lymphoblastic Lymphoma is rare in children and can cause a diagnostic dilemma in view of its variable presentation
There are only few cases presenting with bone involvement as an initial presentation of B cell Lymphoblastic Lymphoma published in literature so far in pediatric age group [2]
Summary
Precursor B-cell lymphoblastic lymphoma is rare and constitutes less than 10% of the lymphoblastic lymphoma cases [1]. B cell lymphoblastic lymphomahas been well known to involve extranodal sites. Bone and soft tissue are few common sites of occurrences. Mediastinal involvement has been found to be rare unlike T cell Lymphoblastic Lymphoma. The second most common site of extranodal presentation is bone, with skin being the most common [2]. Patients with B cell Lymphoblastic Lymphoma generally do not manifest with constitutional symptoms in contrast to those with Acute Lymphoblastic Leukemia but musculoskeletal pain is often the presenting symptom. We report a case of precursor B cell Lymphoblastic Lymphoma who presented with multiple skeletal lesions without apparent lymph nodal, peripheral blood or marrow involvement
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