Spinal Burkitt's Lymphoma Mimicking Dumbbell Shape Neurogenic Tumor: A Case Report and Review of the Literature

Abstract

Non-Hodgkin's lymphoma (NHL), a disease which may involve the spine, is frequently associated with advanced disease. Radiculopathy caused by spinal root compression as the initial presentation in patients with NHL is very rare and thought to occur in less than 5% of cases. A 69-year-old woman complained of a history of low back pain with right sciatica for 1 month prior to admission. Computed tomography and magnetic resonance imaging of the lumbar spine showed a dumbbell-shape epidural mass lesion extending from L2 to L3, which was suggestive of a neurogenic tumor. After paraspinal approach and L2 lower half partial hemilaminectomy, total excision of the tumor was achieved, followed by rapid improvement of back pain and radiating pain. The lesion was confirmed to be Burkitt's lymphoma by histopathological examination. We then checked whole-body PET-CT, which showed multifocal malignant lesions in the intestine, liver, bone and left supraclavicular lymph node. Although a rare situation, Burkitt's lymphoma should be considered in the differential diagnosis for patients presenting with back and lumbar radicular pain without a prior history of malignancy. Burkitt's lymphoma could be the cause of dumbbell-shape spinal tumor.

Keywords: Burkitt's lymphoma; Dumbbell-shape tumor; Epidural; Radiculopathy.

Fig. 1. (A and B) A moderate-circumscribed, homogeneous posterola teral extradural mass lesion extending from L2 to L3 and isointense relative to the spinal cord on T1- and T2-weighted images. (C) Heterogeneous enhancement mass on contrast-enhanced T1-weighted image.

Fig. 2. (A) Histologic resection of the specimen from the epidural space discloses a starry sky pattern with diffuse infiltration of monotonous and medium sized cells (×100) and (B) vesicular chromatins, multiple small nucleoli with abundant basophilic cytoplasm and vaculoles, and numerous mitoses (×400).

Fig. 3. Immunochemistry of the tumor mass was susceptible for Burkitt's lymphoma, based on (A) CD10 (+), (B) CD20 (+), (C) EBV (+), (D) Ki-67 (+,>90%), CD79a (+), (E) BCL-6 (+), and (F) BCL-2 (-).

Fig. 4. (A and B) PET-CT shows multifocal hypermetabolic lesions in the intestine, liver, bone and left supraclavicular LN.