Pediatric Precursor B-cell Lymphoblastic Lymphoma Presenting with Extensive Skeletal Lesions

Area of Science:

• Pediatric Oncology
• Hematology
• Skeletal Radiology

Background:

• Precursor B-cell lymphoblastic lymphoma (LL) is an uncommon hematologic malignancy.
• Extranodal presentation of B-cell LL is particularly rare, posing diagnostic challenges.
• Diagnosis is often delayed without apparent lymphadenopathy or bone marrow involvement.

Observation:

• A 3-year-old girl presented with chronic knee pain and swelling.
• Radiographs showed extensive, aggressive lytic bone lesions in the femur, including pathological fractures.
• The patient had no lymphadenopathy or organomegaly, and initial blood and bone marrow examinations were normal.

Findings:

• Biopsy of the femur lesion confirmed precursor B-cell LL.
• A concurrent adnexal lesion was identified on CT scan.
• This case demonstrates an extranodal LL presentation primarily involving extensive bone destruction.

Implications:

• Precursor B-cell LL can manifest with extensive skeletal involvement, diverging from typical presentations.
• Early and precise diagnosis is crucial for effective treatment and improved outcomes in pediatric LL.
• Highlights the importance of considering rare diagnoses in pediatric bone lesions, even without classic lymphoma signs.