Paravertebral Burkitt's Lymphoma in a Child: An Unusual Presentation

Abstract

Paravertebral malignant tumors constitute 4.8% of cancer cases in pediatric oncology and are mostly composed of neuroblastoma (46.4%) and soft tissue sarcomas (35.7%). We describe the case of a Caucasian 6-year-old boy who was admitted for middle back pain radiated to limbs and progressively increasing weakness of the legs, suggesting a spinal cord disease. The exploration revealed two paravertebral masses extending through the neural foraminae into the epidural space. The association with elevated serum neuron specific enolase suggested at first the diagnosis of neuroblastoma, but the pathological examination revealed a Burkitt's lymphoma. This is a rare location of sporadic Burkitt's lymphoma with neurologic syndrome as first symptoms.

Figure 1

Spine MRI (median sagittal STIR): heterogeneous captation in some vertebrae (T7, T12, L1, L3, L4, S2), suggesting bone marrow infiltration.

Figure 2

MRI (axial T1): dorsal paravertebral mass (T7) (A) with extra dural deposits and compressin of the thecal sac (B) from tumor spread.

Figure 3

MRI (coronal T1 gadolinium): left dorsal paravertebral tumor (T7–T9) (A) and left dorso-lumbar paravertebral mass (B) with epidural compression (C) through infiltration via intervertebral foraminae (T12–L2). Bilateral nodular nephromegaly (D).

Figure 4

MRI (axial T1 gadolinium) lumbar paravertebral tumor (A) with epidural compression (B) through foraminae infiltration; bilateral nodular nephromegaly (C); heterogeneity captation of the vertebra (D), suggesting bone marrow infiltration.

Figure 5

Pathology of tumour specimen instead of biopsy of the tumour anatomopathology (HE—400x): intermediate size homogenous basophilic cells with hyperchromatic nuclei containing nucleoli: Burkitt's lymphoma.