Burkitt's lymphoma presenting as multiple nerve sheath tumors of the cauda equina

Primary central nervous system lymphomas comprise 0.8% of all lymphomas. Burkitt's lymphoma is a B-cell lymphoma with highly aggressive features that rapidly progress and have early hematogenous spread. Sporadic Burkitt's lymphoma accounts for 1-2% of adult lymphomas worldwide. Extranodal sites are involved in approximately 40% of cases of B-cell lymphomas. Central nervous system disease is found in <15% of sporadic cases. Less than 5% of cases of all non-Hodgkin's lymphomas present with radiculopathy, with the thoracic spinal region being most commonly affected.

In this report, we discuss the case of a patient with extranodal Burkitt's lymphoma within the nerve roots of the cauda equina who underwent surgical intervention due to the presence of lumbar radiculopathy and weakness. This patient also exhibited hematogenous spread with evidence of an intracranial lesion.

The diagnosis of Burkitt's lymphoma was atypical, given the presentation, clinical indicators, and the appearance of the masses on magnetic resonance imaging being similar to that of a neurofibroma or schwannoma. Surgical decompression provided tissue for biopsy. However, nerve root decompression was not possible due to diffuse involvement and infiltration of the nerve roots.