We present the case of a 15-year-old male with sporadic Burkitt's lymphoma/leukemia. The patient presented with right lower quadrant abdominal pain and masses in the terminal ilium and pelvis, and was subsequently demonstrated to have involvement of the bone marrow. We discuss differential diagnoses and approach to diagnose and stage this disease. A review of the clinical, radiologic, and pathologic features of Burkitt's lymphoma/leukemia are also presented.