Burkitt lymphoma in children – diagnostic pitfalls and clinical challenges: case report

Abstract

Introduction. Burkitt lymphoma is a highly aggressive mature B-cell non-Hodgkin lymphoma that frequently involves abdominal structures in children and may mimic common gastrointestinal or surgical conditions. Objective. To highlight the diagnostic challenges of abdominal Burkitt lymphoma presenting as intermittent intussusception in a young child. Case presentation. A previously healthy 5-year-old boy presented with recurrent, self-limited episodes of colicky abdominal pain and symptom-free intervals. Initial laboratory investigations were unremarkable, while abdominal ultrasonography performed during symptomatic episodes demonstrated an intermittent target-shaped lesion suggestive of intussusception. Magnetic resonance imaging revealed a mass in the ascending colon region associated with ileocolic lymphadenopathy, without signs of intestinal obstruction. Exploratory laparoscopy identified an approximately 3-cm tumor arising from the right mesocolon and allowed reduction of the intussusception and tissue biopsy. Histopathologic and immunohistochemical examination demonstrated a high-grade mature B-cell lymphoproliferative neoplasm with a characteristic “starry-sky” appearance, germinal-center B-cell phenotype, and a Ki-67 proliferation index of approximately 100%, compatible with Burkitt lymphoma. Oncologic treatment was initiated according to the B-NHL BFM 04 protocol. Treatment-related complications included corticosteroid-associated arterial hypertension and post-chemotherapy bone marrow suppression with profound neutropenia and severe thrombocytopenia, which were managed with antihypertensive, antimicrobial, hematopoietic, transfusion, and supportive therapy. The patient remains under active oncologic treatment. Conclusion. Recurrent or atypical intussusception in an older child should raise suspicion for an underlying pathologic lead point, including abdominal lymphoma. Repeated imaging during symptomatic episodes, timely histopathologic confirmation, and multidisciplinary collaboration are essential for achieving an early diagnosis and initiating appropriate treatment.