{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T03:55:10Z","timestamp":1777694110186,"version":"3.51.4"},"reference-count":30,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Clin Med Insights Case Rep"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Burkitt lymphoma (BL) is a highly aggressive B-cell non-Hodgkin lymphoma that typically presents with abdominal masses; ampullary involvement with obstructive jaundice and gastrointestinal bleeding is exceptionally rare in children. Early biliary decompression can be crucial to permit timely chemotherapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation:<\/jats:title>\n                    <jats:p>A 14-year-old boy presented with 1\u2009week of worsening abdominal pain, non-bilious vomiting, constipation, jaundice, and melena. Examination showed pallor, icterus, firm hepatomegaly, and a palpable epigastric mass. Laboratory testing revealed cholestatic liver function abnormalities and elevated pancreatic enzymes. Ultrasound and contrast computed tomography demonstrated a large retroperitoneal mass compressing the biliary tree. Upper gastrointestinal endoscopy identified a friable, ulcerated ampullary mass with active bleeding. Biopsy confirmed BL by morphology (starry-sky) and immunohistochemistry\/fluorescence in situ hybridization (CD20+, CD10+, c-MYC+, Ki-67 ~95%). Main diagnosis made was pediatric BL presenting with ampullary involvement causing obstructive jaundice and upper gastrointestinal bleeding. Given persistent cholestasis and bleeding risk, the patient underwent Roux-en-Y choledochojejunostomy for biliary decompression, followed by initiation of rituximab\u2013cyclophosphamide\u2013vincristine\u2013doxorubicin\u2013high-dose methotrexate\/rituximab\u2013ifosfamide\u2013etoposide\u2013high-dose cytarabine (R-CODOX-M\/R-IVAC) with central nervous system prophylaxis. Post-operative bilirubin improved, and early chemotherapy cycles were tolerated. During the 2-week hospitalization, the patient had symptomatic improvement; however, objective radiologic response could not be documented because care was transferred and post-transfer positron emission tomography\u2013computed tomography was unavailable.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Ampullary BL should be considered in pediatric patients with obstructive jaundice and upper gastrointestinal bleeding. Surgical biliary decompression can stabilize cholestasis and facilitate timely multi-agent chemotherapy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/11795476261429279","type":"journal-article","created":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T14:11:43Z","timestamp":1773929503000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Unusual Ampullary Presentation of Pediatric Burkitt Lymphoma: Case Report and Literature Review"],"prefix":"10.1177","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-4565-5181","authenticated-orcid":false,"given":"Khadija","family":"Malik","sequence":"first","affiliation":[{"name":"Department of Medicine, Civil Hospital Karachi, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-4557-5743","authenticated-orcid":false,"given":"Muddassir Syed","family":"Saleem","sequence":"additional","affiliation":[{"name":"Department of Medicine, Karachi Medical and Dental College\/Abbasi Shaheed Hospital, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-1602-2147","authenticated-orcid":false,"given":"Hammad","family":"Amjad","sequence":"additional","affiliation":[{"name":"Department of Medicine, Karachi Medical and Dental College\/Abbasi Shaheed Hospital, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-6755-1927","authenticated-orcid":false,"given":"Nidal","family":"Bin Kamran","sequence":"additional","affiliation":[{"name":"Department of Medicine, Karachi Medical and Dental College\/Abbasi Shaheed Hospital, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-5972-135X","authenticated-orcid":false,"given":"Syed Muhammad Faiq","family":"Hussain","sequence":"additional","affiliation":[{"name":"Department of Medicine, Civil Hospital Karachi, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-2506-9567","authenticated-orcid":false,"given":"Umme Roman","family":"Akhtar","sequence":"additional","affiliation":[{"name":"Department of Medicine, Karachi Medical and Dental College\/Abbasi Shaheed Hospital, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8900-4192","authenticated-orcid":false,"given":"Abdul","family":"Haseeb","sequence":"additional","affiliation":[{"name":"Department of Medicine, Karachi Medical and Dental College\/Abbasi Shaheed Hospital, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2930-8188","authenticated-orcid":false,"given":"Ahmed Asad","family":"Raza","sequence":"additional","affiliation":[{"name":"Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2328-1148","authenticated-orcid":false,"given":"Muhammad Areeb","family":"Jawed","sequence":"additional","affiliation":[{"name":"Department of Medicine, Civil Hospital Karachi, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8614-3924","authenticated-orcid":false,"given":"Abedin","family":"Samadi","sequence":"additional","affiliation":[{"name":"Department of Medicine, Kabul University of Medical Sciences Abu Ali Ibn Sina, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-3163-9396","authenticated-orcid":false,"given":"Adil","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Department of Medicine, Northwest School of Medicine, Peshawar, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2026,3,19]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2025.1618810"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(11)61177-X"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.29271\/jcpsp.2018.01.48"},{"key":"e_1_3_3_5_2","unstructured":"Provincial\/ Federating Area Health Departments and Ministry of National Health Services R and C. National action framework for non- communicable disease and mental health- enhancing the inter-sectoral response to disease prevention and control [Internet]. 2021. Accessed August 30 2025. https:\/\/www.iccp-portal.org\/sites\/default\/files\/plans\/National%20Action%20Framework%20for%20Non%20Communicable%20Disease%20and%20Mental%20Health%202021-30.pdf"},{"key":"e_1_3_3_6_2","unstructured":"CARE Checklist. CARE Case Report Guidelines [Internet]. 2013. Accessed August 30 2025. https:\/\/www.care-statement.org\/checklist"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.21037\/jgo.2018.07.13"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1186\/s40792-024-01935-5"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3026(23)00279-X"},{"issue":"9","key":"e_1_3_3_10_2","article-title":"Burkitt lymphoma presenting as obstructive jaundice: a case report and literature review","volume":"15","author":"Madison K","year":"2023","unstructured":"Madison K, Morgan Z, Kabbani W. Burkitt lymphoma presenting as obstructive jaundice: a case report and literature review. Cureus. 2023;15(9):e46215.","journal-title":"Cureus"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.3389\/fsurg.2022.1031718"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.15520"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00535-004-1367-0"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00423-025-03821-6"},{"key":"e_1_3_3_15_2","first-page":"1","article-title":"Burkitt lymphoma: pathogenesis and immune evasion","volume":"2010","author":"Haque A","year":"2010","unstructured":"Haque A, God JM. Burkitt lymphoma: pathogenesis and immune evasion. J Oncol. 2010;2010:1-14.","journal-title":"J Oncol"},{"key":"e_1_3_3_16_2","unstructured":"Naing PT Kaur A Lynch DT. Burkitt lymphoma. In: StatPearls. StatPearls Publishing. Updated 2025. Accessed October 2 2025. https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK538148\/"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1053\/jpsu.2001.28840"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijscr.2023.108525"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.4103\/0971-3026.36871"},{"issue":"2","key":"e_1_3_3_20_2","first-page":"201","article-title":"Primary duodenal Burkitt lymphoma in a paediatric patient, presenting as a protein-losing enteropathy","volume":"28","author":"Rabbani MW","year":"2012","unstructured":"Rabbani MW, Ali Z, Aziz MY. Primary duodenal Burkitt lymphoma in a paediatric patient, presenting as a protein-losing enteropathy. Pak J Med Sci. 2012;28(2):201-202.","journal-title":"Pak J Med Sci"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000002119"},{"key":"e_1_3_3_22_2","first-page":"8","article-title":"Epidemiological spectrum of gastrointestinal lymphoma","volume":"38","author":"Jasdanwala S","year":"2014","unstructured":"Jasdanwala S, Pitchumoni CS. Epidemiological spectrum of gastrointestinal lymphoma. Pract Gastroenterol. 2014;38:8-28.","journal-title":"Pract Gastroenterol"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.4103\/ccij.ccij_174_16"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12957-023-03238-9"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.4103\/jiaps.JIAPS_201_20"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.08.1476"},{"key":"e_1_3_3_27_2","article-title":"An unexpected lymphoma: a rare case of primary gastric Burkitt\u2019s lymphoma","volume":"12","author":"London J","year":"2024","unstructured":"London J, Bulancea S, Wander S, et al. An unexpected lymphoma: a rare case of primary gastric Burkitt\u2019s lymphoma. J Investig Med High Impact Case Rep. 2024;12:23247096241253341.","journal-title":"J Investig Med High Impact Case Rep"},{"issue":"4","key":"e_1_3_3_28_2","first-page":"230","article-title":"Primary esophageal Burkitt\u2019s lymphoma: a rare case report and review of literature","volume":"7","author":"Madabhavi I","year":"2014","unstructured":"Madabhavi I, Patel A, Revannasiddaiah S, Choudhary M, Anand A, Das P, et al. Primary esophageal Burkitt\u2019s lymphoma: a rare case report and review of literature. Gastroenterol Hepatol Bed Bench. 2014;7(4):230.","journal-title":"Gastroenterol Hepatol Bed Bench"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.4103\/0971-5851.89786"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-024-15281-1"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41408-025-01240-w"}],"container-title":["Clinical Medicine Insights: Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/11795476261429279","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/11795476261429279","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/11795476261429279","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T09:14:28Z","timestamp":1777454068000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/11795476261429279"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3]]},"references-count":30,"alternative-id":["10.1177\/11795476261429279"],"URL":"https:\/\/doi.org\/10.1177\/11795476261429279","relation":{},"ISSN":["1179-5476","1179-5476"],"issn-type":[{"value":"1179-5476","type":"print"},{"value":"1179-5476","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3]]},"article-number":"11795476261429279"}}