Abstract
A 70-year-old man complaining of abdominal distension was referred to our hospital and was found to have a huge tumor about 18 cm in the maximum diameter in the left upper quadrant on abdominal CT scan taken when he was first seen. The most likely diagnosis was malignant lymphoma arisen in the jejunum, and invasion of the tumor into the pancreas, left ureter and descending colon was suspected as well. Upper gastrointestinal endoscopy revealed an irregular ulcer encircling the intestine and extending from the jejunum in the vicinity of the Treitz ligament to the anus. The lumen showed a cystic dilatation. Biopsy cytology offered a diagnosis of T cell lymphoma. Intestinal fluoroscopy showed a huge aneurysm like tumor in the jejunum, but it was determined to be solitary. FDG-PET also demonstrated no metastases to other organs. From these findings, surgery was performed with the diagnosis of huge malignant lymphoma arisen in the jejunum. Remarkable infiltration of the tumor to the surroundings was seen. The tumor was removed by small bowel resection with associated resection of the pancreas body and tail, spleen, left nephroureter, and descending colon. The histopathological study of the resected specimen showed diffuse malignant lymphoma, and the immunochemistry revealed strong reactivity for CD3 and CD56. Accordingly NK/T cell lymphoma was diagnosed.
