Burkitt’s Lymphoma with Bilateral Cavernous Sinus Involvement: A Case Report

Monique Boukobza,Jean-Philippe Brouland

doi:10.5171/2016.253994

Abstract

Burkitt’s lymphoma is the commonest childhood malignancy in tropical Africa and is rare outside of Africa. Cavernous sinus lymphoma is a rare occurence and Burkitt’slymphoma of the cavernous sinus is uncommon. We review the case of a 52-year-old non-african and immunocompetent woman who developed over a period of 2 weeks an ocular pain, diplopia and ptosis. Physical examination revealed breast tumors. CT scan and MRI disclosed a bilateral cavernous sinus mass and work-up of the tumor showed additionnal tumor within the pelvis. Biopsy of breast tumor showed findings consistent with Burkitt’s Lymphoma and there was positivity to Epstein-Barr EBER-1. Chemotherapy led to complete and asymptomatic remission of the cavernous sinuses lesions. The disease had a highly aggressive course and the patient died 11 months after diagnosis. We discuss the MRI findings and the differential diagnosis of cavernous sinuses lesions.The case herein reported emphasizes this extremely rare location of Burkitt’s lymphoma, the MR findings and the need of considering the diagnosis of Burkitt’s Lymphoma in cavernous sinuses lesions.

Highlights

Burkitt’s lymphoma (BL) is a peripheral B-cell lymphoproliferative malignancy.BL is quite rare outside of Africa, uncommon in North America and in Europe, occurs in pediatric population, and is one of the fastest-growing malignancies in the early- ages
We review the case of a 52-year-old non-african and immunocompetent woman who developed over a period of 2 weeks an ocular pain, diplopia and ptosis
Diplopia and ocular palsies have been previously reported in patient with BL, rarely bilateral cavernous syndrome is the initial manifestation in immunocompetent adults

Summary

Introduction

Burkitt’s lymphoma (BL) is a peripheral B-cell lymphoproliferative malignancy. BL is quite rare outside of Africa, uncommon in North America and in Europe, occurs in pediatric population, and is one of the fastest-growing. A 42-year-old woman without ongoing health problems developed within two weeks severe right orbital pain, associated with nausea, phonophotophobia, sweats, poor appetite, weight loss and lassitude Two days later, she presented with a diplopia and a left ptosis. – Coronal T1- (a) and T2-weighted images (b) show symetrical enlargement of the cavernous sinuses by the lesion which has an homogeneous and isointense signal intensity to the cortex and complete encasement of the internal carotid artery (ICA) by the tumor. Coronal (same plane than Fig 1-b) and Axial (d) contrast-enhanced T1-weignted image shows slight and homogeneous enhancement of the masses. Coronal T1 (a) and T1 after contrast-enhancement (b) images reveal the complete disappeareance of the lesion Both cavernous sinuses are free of tumoral invasion.

Findings

Discussion

Conclusion