Pathological fracture of the knee revealing Burkitt lymphoma: a case report

Abstract

Burkitt lymphoma (BL) is a highly mature B-cell non-Hodgkin lymphoma that presents 1 to 2% of all adult lymphomas. Its pathophysiology is still poorly defined. The prognosis depends on the location and stage. Clinical manifestations are not specific however the most common symptoms are pain and mass. Burkitt lymphoma can be subcategorized into 3 variants: endemic; sporadic; and BL with immunodeficiency, typically infection with HIV. Bone involvement in this type of lymphoma is a rare event; very few reports about this entity exist in the literature. We report the case of bone Burkitt lymphoma in a 49-year-old female patient who presented 1 month before his admission with the pain of the left knee and abdominal pain, progressing in a context of alteration of general condition. The clinical examination found a performance status of 1, local examination revealed partial functional impotence of the knee with severe pain on palpation and on active and passive mobilization. Standard X-ray of the knee revealed a fracture of the upper and tibia, CT scan of the knee revealed a process of osteolytic epiphyseal-metaphyseal with tissue damage of the tibia and invasion of soft tissue with multiple nodular intramedullary epiphyseal. The biopsy of the mass with anatomopathological and immunohistochemical examination showed a tumor proliferation of lymphoid cells with CD20+, BCL 6+, and CD10 +, MUM1+, with a 100% KI 67, the diagnosis of Burkitt lymphoma (BL) was confirmed. The C-TAP CT scan shows an abdominal mass, the BOM was normal, the myelogram was normal, Lactate dehydrogenase (LDH) was elevated to 590 IU/L. The patient was put on the R-CODOX-M/R-IVAC protocol. Burkitt lymphoma is a rapidly proliferating tumor with a poor prognosis, it's suspected in any abdominal masses. Bone involvement as a revealing event in this type of lymphoma is a very rare event and the diagnosis should be established quickly followed by rapid initiation of definitive treatment for a better prognosis.