Primary Rectal Burkitt Lymphoma in a Child: a case report and a review of the literature

Introduction: Primary colorectal lymphomas are exceptionally rare in the pediatric population, with Burkitt lymphoma representing an even rarer subset. The non-specific symptoms can often mimic benign conditions, leading to delays in diagnosis. We report a case of primary rectal Burkitt lymphoma in a child who presented with isolated lower gastrointestinal bleeding. Case Presentation: A 10-year-old previously healthy boy presented with a three-week history of painless, bright red blood per rectum. He had no systemic B-symptoms, and his physical examination was unremarkable except for fresh blood on digital rectal exam. Initial workup revealed iron deficiency anemia and a markedly elevated serum lactate dehydrogenase (LDH). A contrast-enhanced CT scan demonstrated a large, heterogeneous mass at the rectosigmoid junction with associated mesorectal lymphadenopathy. Colonoscopy revealed multiple ulcerated polyps and a friable mass. Histopathological and immunohistochemical analysis confirmed the diagnosis of sporadic Burkitt lymphoma, characterized by a diffuse infiltrate of monomorphic lymphoid cells with a "starry-sky" appearance, positive for CD20 and CD10, and with a Ki-67 proliferation index approaching 100%. Staging investigations (bone marrow biopsy and lumbar puncture) confirmed localized disease (Stage II). The patient was treated with a risk-adapted, multi-agent chemotherapy regimen (based on the FAB/LMB 96 protocol) followed by consolidative radiotherapy. He achieved complete remission, as confirmed by imaging one month post-treatment, and remains disease-free at his 18-month follow-up. conclusion: This case highlights that primary rectal Burkitt lymphoma, though rare, should be considered in the differential diagnosis of persistent lower gastrointestinal bleeding in children. A high index of suspicion, combined with prompt endoscopic evaluation and biopsy, is crucial for early diagnosis. This report reinforces that with timely diagnosis and adherence to modern, risk-adapted chemotherapy protocols, even aggressive lymphomas in this unusual location can be highly curable, contributing to the limited body of literature on this rare entity.