Mitra Ananya Datta, Mitra Anupam, Chung Jong H, Betts Elham Vali
Department of Pathology and Laboratory Medicine, University of California Davis, Sacramento, CA, USA.
Department of Pediatrics, Division Pediatric Hematology/Oncology. University of California Davis, Sacramento, CA, USA.
Clin Pathol. 2024 Aug 16;17:2632010X241272377. doi: 10.1177/2632010X241272377. eCollection 2024 Jan-Dec.
Urinary symptoms are one of the most common reasons for emergency visits in females of pediatric age group and can be associated with various conditions like infections (most common), sexual trauma and rarely neoplastic processes. Here, we report a case of a 7-year-old female who presented in the emergency multiple times with the complaints of urinary symptoms and vaginal pain and was empirically treated with antibiotics and antifungals without symptomatic improvement. Her blood tests, physical examination during this time remained unrevealing. She was then transferred to our institution on her third emergency visit for further evaluation. On imaging studies, she was noted to have expansile lesions on her vertebral body at the L4 and T6 levels with compressive myelopathy with multiple bone and soft tissue lesions throughout her lower extremities. Patient developed saddle anesthesia requiring emergent decompression and biopsy of the epidural mass with the final pathology coming back as B-lymphoblastic leukemia/lymphoma. B-ALL/B-LBL is the most common pediatric hematologic malignancy and usually presents with fever, hepatosplenomegaly, lymphadenopathy, bone pain and bleeding. Occasionally, atypical presentations like bone and joint pain, osteoporosis, palpable paravertebral mass have been described. However, this is the first case report to describe a very unusual and unfamiliar presentation of this disease causing significant diagnostic difficulty resulting in delayed treatment. This case report can aid as a reminder that unusual pain or any nonspecific manifestations in pediatric patients, refractory to common treatment should be investigated with extreme diligence not to miss this neoplastic process.
泌尿系统症状是儿科年龄组女性急诊就诊最常见的原因之一，可能与多种情况相关，如感染（最常见）、性创伤，很少与肿瘤性病变有关。在此，我们报告一例7岁女性，她多次因泌尿系统症状和阴道疼痛到急诊科就诊，经验性使用抗生素和抗真菌药物治疗后症状无改善。在此期间，她的血液检查和体格检查均未发现异常。在第三次急诊就诊时，她被转至我们机构进行进一步评估。影像学检查发现，她的L4和T6椎体有膨胀性病变，伴有脊髓受压，下肢有多处骨骼和软组织病变。患者出现鞍区麻醉，需要紧急减压并对硬膜外肿块进行活检，最终病理结果为B淋巴细胞母细胞白血病/淋巴瘤。B-ALL/B-LBL是最常见的儿科血液系统恶性肿瘤，通常表现为发热、肝脾肿大、淋巴结病、骨痛和出血。偶尔也有非典型表现的描述，如骨和关节疼痛、骨质疏松、可触及的椎旁肿块。然而，这是第一例描述该疾病非常不寻常且罕见的表现，导致显著诊断困难并延误治疗的病例报告。本病例报告可作为一个提醒，即对于儿科患者中不寻常的疼痛或任何对常规治疗无效的非特异性表现，应极其谨慎地进行调查，以免漏诊这种肿瘤性病变。
