Abstract YO36
Case summary
A 23-year-old lady with no comorbidities presented to the emergency department with chief complaints of low back pain for a week, sudden onset paraplegia, and bladder incontinence for one day. There was no history of trauma, fever, weight loss, night sweats or swelling in the body. The examination revealed a loss of both sensory and motor (0/5) function in both lower limbs. MRI of the brain and spine showed an ill-defined T2 intermediate extradural soft tissue lesion in the cauda equina region extending from L2 to L4 vertebral body and causing clumping of cauda equina nerve roots from L2 to L4 level. Blood investigations were done within normal limits. She underwent an emergency laminectomy and decompression of the L2-L4 lesion. Histopathological examination showed adipose tissue infiltrated by monomorphic atypical lymphoid cells with a pleomorphic large nucleus, dense chromatin, an irregular nuclear membrane, and scant cytoplasm. On immunohistochemistry, tumor cells were diffuse and strongly positive for CD10, PAX-5, and TdT, while they were negative for CD3, with a MIB-1 score of 70 to 75%, suggesting B-lymphoblastic lymphoma. Manual differential count revealed 95% neutrophils, 4% lymphocytes, and 1% monocytes. The LDH level was normal. PET CECT showed diffuse enhanced FDG uptake involving the body of the L3 vertebra and post laminectomy status L2-L4, with no signs of disease elsewhere. The bone marrow aspiration for flow cytometry of the acute leukemia panel was negative, and a biopsy revealed normocellular marrow with trilineage hematopoiesis. CSF for cytology and flow cytometry was uninvolved. She was started on the modified BFM 90 protocol and regular physiotherapy exercises were initiated. PET CT after phase 1 induction revealed a Deauville score of one. She started walking with support, and Foley's catheter was removed. After the completion of phase 2 induction, she was able to walk independently. She has completed consolidation and reinduction phases 1 and 2 and has begun maintenance treatment, which will last for 2 years. She responded effectively to treatment, regaining her motor, sensory, and bladder functions, and is currently in complete response.