The case concerns a 40-year-old woman who presented at our outpatient department with 2 years history of low back pain and lower limb weakness for 1 month. She presented to us with bladder incontinence and inability to ambulate. The bladder dysfunction had started 7 days before hospital presentation. 
On examination, she looked depressed and pale; there was no lymphadenopathy and apparent organomegaly. She had tenderness of lower thoracic spinal processes. Neurological examination of the legs showed reduced tone, and grade 1 paraplegia (MRC Scale). Knee jerks as well as ankle jerks were absent, both plantar reflexes were not elicitable, and there was sensory deficit over both lower limbs below mid-thigh level. No clinically significant past history was present. She was admitted and investigated. 
Investigations showed normal serum biochemistry apart from a mild increase of alkaline phosphatase, which was 15 KAU/L (normal 2-13). The total white cell count was within normal limit, differential count showed neutrophils 25%, lymphocytes 70%, monocytes 2%, eosinophils 3%, and basophils 0.0%, and no atypical lymphocytes were seen in blood film. The erythrocyte sedimentation rate was 24 mm/1st h.
A lumbosacral spine X-ray (Figure 1) examination showed vertebra plana of T10 vertebra with sclerosis and maintained disc space. Abdominal ultrasound was normal; no organomegaly and enlarged lymph nodes were detected. Bone marrow biopsy was done which showed normal bony trabeculae. MRI scan showed (Figure 3) vertebra plana of T10 vertebra with complete marrow replacement of vertebral body and posterior elements with associated homogenously enhanced soft tissue component in adjacent pre- and paravertebral space and in ventral and dorsal epidural spaces leading to severe cord compression and spinal canal stenosis. Although radiological picture was not in favor of tuberculosis, we started antitubercular treatment, as tuberculosis is very common in India and we have seen the cases of spinal tuberculosis with unusual presentation. However, patient did not respond to antitubercular treatment.
The patient was operated and anterolateral decompression of spinal cord was done to relieve symptoms of cord compression. Histopathological examination showed malignant small round cells (Figure 2) with some rosette formation. A diagnosis of small round cell tumor was suggested on basis of these findings. Immunohistochemistry examination showed positivity of tumor cells for common leukocyte antigen distinguishing it from round cell tumor. 
The patient improved remarkably after surgery. Sensory symptoms improved and motor power regained to 4/5 on hip and 5/5 on knee and ankle (MRC Scale). Bladder control could not be gained 30 days after surgery.