Pediatric Mandibular Burkitt Lymphoma Initially Misdiagnosed as Odontogenic Infection: A Radiologic-Pathologic Correlation

Burkitt lymphoma is a highly aggressive mature B-cell non-Hodgkin lymphoma characterized by MYC dysregulation and a high proliferative index. Although the sporadic form commonly presents with abdominal involvement, maxillofacial manifestations in children may mimic odontogenic infections, leading to delayed diagnosis. We report a nine-year-old boy with a rapidly progressive unilateral mandibular swelling initially treated as a dental abscess without improvement. Imaging revealed an ill-defined osteolytic mandibular lesion with cortical erosion and soft tissue extension, raising suspicion for malignancy. Histopathology demonstrated monomorphic medium-sized atypical lymphoid cells with high mitotic activity. Immunohistochemistry confirmed B-cell lineage (CD20, CD10, BCL6, c-MYC) with a Ki-67 index of 95%, consistent with Burkitt lymphoma. The patient was treated with rituximab-based multi-agent chemotherapy and showed a favorable response. This case highlights the importance of early radiologic-pathologic correlation and prompt biopsy in atypical pediatric mandibular swellings to enable timely diagnosis and management.