Chaudhary N, Borker A
Department of Child Health, Christian Medical College, Vellore, India.
Ann Med Health Sci Res. 2013 Apr;3(2):262-4. doi: 10.4103/2141-9248.113673.
Lymphoblastic lymphoma (LL) of the B cell type is uncommon, and extranodal presentation is even rarer. It is difficult to suspect this diagnosis without clinically obvious lymph nodal mass or bone marrow involvement. A 3-year-old girl presented with progressive pain and swelling of the right knee joint of 3 months duration. Radiograph revealed expansile lytic lesion at the supracondylar area of the right femur; with pathological fracture and multiple lytic areas in both femora. She neither had lymphadenopathy nor organomegaly. Her blood counts, peripheral smear examination and bone marrow examination were normal. Right supracondylar biopsy revealed diagnosis of a precursor B cell LL. Computerized tomography scan revealed a hypodense, poorly enhancing lesion in the left adnexal region. Although rare, precursor B-cell LL may present with extensive bone lesions. Early and accurate diagnosis of this entity is very important due to its high cure rates.
B细胞型淋巴母细胞淋巴瘤（LL）并不常见，结外表现更为罕见。若临床上没有明显的淋巴结肿块或骨髓受累，很难怀疑这一诊断。一名3岁女孩出现右膝关节进行性疼痛和肿胀3个月。X线片显示右股骨髁上区域有膨胀性溶骨性病变；伴有病理性骨折，双侧股骨有多个溶骨区域。她既没有淋巴结病也没有器官肿大。她的血常规、外周血涂片检查和骨髓检查均正常。右髁上活检显示为前驱B细胞LL。计算机断层扫描显示左附件区有一个低密度、强化不佳的病变。尽管罕见，前驱B细胞LL可能表现为广泛的骨病变。由于其治愈率高，对该实体进行早期准确诊断非常重要。
