CASES OF THE WEEK - “Lymphoblastic Lymphoma: An uncommon presentation” by Dr Sanjiv Kakkar, Specialist Paediatrics & Dr Wissam Al Tamr, Specialist Paediatric Surgery, NMC Royal Hospital Sharjah

A 12 year old boy was brought to the hospital paediatric OPD on 18th May 2020 with complaint of cough and breathlessness of 02 weeks duration. The boy had no complaints of fever, vomiting or abdominal pain and no history of contact with a COVID 19 patient.

Examination revealed a well preserved boy weighing 73 kg. No pallor, icterus or lymphadenopathy. Systemic examination revealed absent breath sound in the right hemithorax. No hepatosplenomegaly.

An X-ray chest PA view revealed evidence of pleural effusion on the right side and widened mediastinum.

ESR -4, CRP – 5,CBC – WBC – 7800, Hb – 13.7, COVID 19 – Negative, IgM Mycoplasma  - Negative, The LFT, RFT electrolytes, uric acid levels were within normal levels.

A CT scan of the chest revealed a large effusion of the right pleural cavity with collapse of the underlying lung parenchyma towards the hilum. There was a shift of the mediastinum to the left.

A thoracocentesis was done on 19th May 2020 by the Dr Wissam AlTamr, Specialist Paediatric Surgery and 4 litres of straw coloured fluid was drained over a period of time and the fluid was sent for analysis.

The fluid cytology on 20th May 2020 was positive for malignant cells consistent with a T-cell lymphoblastic lymphoma, confirmed by immunohistochemistry subsequently.

It was the excellent teamwork of the Department of Paediatrics, Paediatric Surgery and Pathology that resulted in clinching the diagnosis in less than 48 hours.

While in hospital, the patient was managed on IV fluids, IV antibiotics with the ICD in situ. Upon stabilization, the child was shifted to another hospital for undergoing chemotherapy under a Consultant, Paediatric Hemato-Oncology.