uncommon initial symptoms in pediatric burkitt lymphoma: pancreatic and mandibular involvement

Background: burkitt lymphoma (bl) is an aggressive b-cell non-hodgkin lymphoma. it is more common in children and typically involves the lymph nodes and the abdomen. rarely, atypical bl can present as acute pancreatitis or a gastric mass in immunocompetent children.case presentation: an 11-year-old boy presented with peri-umbilical abdominal pain, nausea, vomiting, and dental pain. laboratory tests revealed high amylase and lipase, leading to an initial diagnosis of acute pancreatitis. he was discharged with proper management, but soon returned with recurrent abdominal pain, progressive right mandibular swelling, and hematemesis. sonography of the jaw revealed a hypoechoic lesion next to the mandible, prompting further evaluation. ct and magnetic resonance cholangiopancreatography (mrcp) demonstrated pancreatic enlargement with nodules, mandibular destruction, and a gastric fundus mass. endoscopic biopsy showed a monomorphic population of small blue round cells. immunohistochemistry (ihc) confirmed burkitt lymphoma, with tumor cells positive for c-myc, cd20, cd10, and bcl6, and a ki-67 index near 100%. the patient was treated with intensive chemotherapy, followed by bone marrow transplantation, achieving remission. he remains under follow-up to monitor recurrence and complications.conclusions: this case highlights the importance of considering malignancy in atypical pediatric pancreatitis. a multidisciplinary approach was essential for timely diagnosis and management.