title: The Hammersmith Hospital hematopathology case of the month: paraspinal B lymphoblastic lymphoma &#x2013; problems in diagnosis and initial indolent behavior.
abstract: We describe a young man who presented with neurological signs and symptoms, and with a paraspinal soft tissue mass involving the vertebral body at T4. The patient was treated with dexamethasone prior to neurosurgical decompression and debulking. Biopsy showed features of a small B-cell lymphoma possibly of follicle center cell origin. The patient achieved complete remission with radiotherapy. However, he experienced relapse 10 months later with a soft tissue mass close to and involving the posteroinferior aspect of the sternum. Biopsy of the recurrent lesion showed features of B lymphoblastic leukemia/lymphoma. The first biopsy was revisited to demonstrate the lymphoblastic immunophenotype of the lesional cells. The 'indolent' appearance of the cells in the first biopsy was attributable to treatment with dexamethasone prior to the biopsy.
authors.affiliation: Department of Haematology, Hammersmith Hospital & Imperial College, London, UK.
authors.forename: Donald H
authors.initials: DH
authors.lastname: MacDonald
authors.forename: Ian
authors.initials: I
authors.lastname: Clark
authors.forename: Kikkeri N
authors.initials: KN
authors.lastname: Naresh
mesh_terms: D000328:Adult; D018951:Antigens, CD20 / Q000032:analysis; D001402:B-Lymphocytes / Q000187:drug effects / Q000378:metabolism / Q000473:pathology; D003907:Dexamethasone / Q000627:therapeutic use; D003937:Diagnosis, Differential; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D017254:Leukemic Infiltration / Q000175:diagnosis*; D008297:Male; D015260:Neprilysin / Q000032:analysis; D015452:Precursor B-Cell Lymphoblastic Leukemia-Lymphoma / Q000175:diagnosis* / Q000188:drug therapy; D013904:Thoracic Vertebrae / Q000473:pathology*
chemical_list: D018951:Antigens, CD20; D005938:Glucocorticoids; D003907:Dexamethasone; D015260:Neprilysin