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Burkitt lymphoma - muscle involvement

Case contributed by Lorena Real Barajas
Diagnosis almost certain

Presentation

Low back pain and loss of strength of the lower limbs.

Patient Data

Age: 40 years
Gender: Male

Left psoas muscle with an increase in size and loss of the interface with quadratus lumborum muscle, iliocostal muscle, longissimus thoracic muscle and spinal erector muscle with apparent extension to the spinal canal.

Asymmetry and increased dimensions of the muscles of the lumbar region on the left side compared to the contralateral side, as well as loss of the fibrillar pattern and contrast medium uptake, affecting the psoas muscle, quadratus lumborum, latissimus dorsi, erector spinae, longissimus thoracic and iliocostal with extension to the epidural space through the left neuroforamina from L1-L2 to L5-S1 compromising emerging nerve roots, causing compression of the dural sac.

The lumbosacral vertebral bodies with heterogeneous signal intensity, with a mottled appearance in all sequences, with heterogeneous enhancement after the application of intravenous contrast, also observed in the posterior elements and iliac bones.

3 months later

mri

MRI three months later, management with radiotherapy and chemotherapy.

Changes at the paravertebral level are maintained at the expense of the left psoas muscle, which is observed to be decreased in size compared to the contralateral muscle; however, it remains with a loss of the fibrillar pattern, with scattered and poorly defined hyperintensity zones in T2w and peripheral enhancement after the application of contrast medium. There is a significant decrease in its dimensions, without the involvement of the neuroforamina.

Case Discussion

Burkitt's lymphoma is a very aggressive type of B-cell non-Hodgkin's lymphoma. Primary muscle lymphoma is rare. It presents as a focal lesion or diffuse muscle infiltration with the main involvement of the thigh muscles.

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