Primary Burkitt lymphoma of the breast in a young north African woman: diagnostic challenge and benefit of early intensive chemotherapy.

Burkitt lymphoma (BL) is a highly aggressive B-cell malignancy that rarely presents primarily in the breast. Its rapid progression and inflammatory features can mimic breast cancer or mastitis, leading to a delay in diagnosis. A 26-year-old nulliparous North African woman presented with a painful, rapidly growing breast mass that had appeared within the last four weeks. Clinical examination revealed an 8 cm mass accompanied by orange-peel skin. Imaging suggested a likely benign lesion (BI-RADS 3). However, histology showed a classic 'starry sky' pattern, a Ki-67 rate of 100% and positivity for CD20/CD10/BCL6 with negativity for BCL2/CD5/EBER. PET-CT revealed a solitary hypermetabolic lesion (SUV 32) without systemic involvement (stage IE, BL-IPI 1). Treatment with R-COPADM was initiated within 48 hours, resulting in complete remission. This case highlights that an early biopsy is essential in the presence of any atypical inflammatory breast mass, even when imaging appears reassuring.