RATIONALE : Burkitt lymphoma (BL) is a type of non-Hodgkin lymphoma that arises in the B-cells. Cavernous sinus involvement is
rare, especially in adults. Here we report an unusual case of a 30-year-old HIV-positive woman with BL and cavernous sinus
syndrome who also had intense bilateral breast uptake, related to menstrual cycle. Fluorine-18 2-fluoro-2-deoxyglucose (18F-FDG)
positron emission tomography/computed tomography (PET/CT) has been found to be useful in the management of BL.
PATIENT CONCERNS : A 30-year old female patient presented with a history of diplopia and headache.
DIAGNOSES : Magnetic resonance imaging revealed a large cavernous sinus mass. A bone marrow biopsy was done and
demonstrated extensive marrow infiltration by Burkitt lymphoma. Further investigation detected the Epstein–Barr virus in her
cerebrospinal fluid using qualitative polymerase chain reaction. 18F-FDG PET/CT imaging done revealed a hypermetabolic
cavernous sinus mass, conglomerates of enlarged pelvic and para-aortic lymph nodes as well as diffuse bone marrow uptake.
Intense bilateral breast uptake was noted coinciding with the start of menses.
INTERVENTIONS : She was started on chemotherapy with adjuvant radiotherapy.
OUTCOMES : After her first cycle of chemotherapy, repeat 18F-FDG PET/CT imaging revealed a marked reduction in the metabolic
activity and size of the cavernous sinus mass and conglomerates of lymph nodes. The bone marrow activity was still visualized but
less intense compared to the staging PET/CT.
LESSONS : A cavernous sinus mass will rarely be the primary lesion in Burkitt’s Lymphoma. Our case demonstrates the role of 18FFDG
PET/CT in the assessment of such cases to detect other primary areas of disease involvement. It is useful in accurate initial
staging and monitoring of treatment response in patients with Burkitt’s Lymphoma.
ABBREVIATIONS : BL = Burkitt lymphoma, CNS = central nervous system, CT = computed tomography, EBV = Ebstein–Barr virus,
18F-FDG = fluorine-18 2-fluoro-2-deoxyglucose, HIV = human immunodeficiency virus, MRI = magnetic resonance imaging, PCR =
polymerase chain reaction, PET = positron emission tomography, SUV = standardized uptake value.