ISOLATED BONE INVOLVEMENT REVEALING A T-CELL LYMPHOMA: A CASE REPORT

T-cell acute lymphoblastic leukemia (T-ALL) or T-cell lymphoblastic lymphoma is characterized by massive infiltration of the bone marrow and peripheral blood by immature hematopoietic cells of T-lineage. In some cases, lymph node or extranodal involvement may precede bone marrow infiltration. This was the case for the child described here, who initially presented with primary bone involvement. The patient was admitted with bilateral lower limb bone pain in a context of general deterioration. On clinical examination, the child was conscious, cachectic, and hemodynamic and respiratory stable. Musculoskeletal assessment revealed polyarthralgia affecting both elbows, shoulders, and knees, without deformities or signs of inflammation, but associated with painful swelling of the legs. Imaging studies revealed, on cervico-thoraco-abdomino-pelvic CT scan, an asymmetric thickening of the nasopharynx with a suspicious orbital mass. Lower limb MRI demonstrated diffuse bone marrow infiltration. Histopathological analysis of biopsy samples confirmed the diagnosis of T-cell lymphoblastic lymphoma. Osseous involvement in T-cell lymphoblastic lymphoma is a rare presentation in children and poses a diagnostic challenge, often leading to delays in initiating appropriate therapy. In this context, the pediatric surgeon plays a crucial role in the diagnostic process, and close collaboration with the pediatric oncologist is essential to ensure optimal and timely management of this aggressive disease.