Lymphoma

A 9 -year -old boy, previously well, presented with a history of moderate -grade, intermittent fever for 11 days. He said he felt tired during the fever episodes and had stopped going to school. He had no localizing signs, loss of appetite, or weight. He had received all his childhood vaccines till 10 years of age. There was no significant travel history. He had one elder sister and none of the other members of his family had any illness. Examination revealed a well-appearing boy with normal body mass index and normal vital signs. He had mild pallor without any significant lymphadenopathy or organomegaly. His systemic examination was normal. Laboratory examinations revealed a hemoglobin level of 9.7 g/dL, with a white blood cell (WBC) count of 8500/cmm, a normal differential count, and a platelet count of 2.65 lacs/cmm. His C-reactive protein (CRP) level was 31.03 mg/L and erythrocyte sedimentation rates (ESR) was 19 mm/h. Chest X-ray revealed soft tissue opacity causing marked widening of the left aspect of the mediastinum with sharply defined lateral border and indistinct medial border, and a CT scan of the chest was suggested. This revealed a soft -tissue homogenous mass in the anterior mediastinum, with smooth or lobulated margins. The possibility of lymphoma was considered. A CT -guided biopsy of the mediastinal mass was done. Histological and immunohistochemical analyses confirmed a diagnosis of B-cell lymphoblastic lymphoma (B-LBL). The child was referred to the pediatric hematoncology unit where he received chemotherapy and responded well.