Abstract
A 59-year-old man with a continuous low-grade fever and anemia was referred to our hospital. Abdominal computed tomography showed a 7 cm tumor continuous with the small intestine. Malignant lymphoma was suspected. We scheduled an exploratory laparotomy. Six days before the surgery, the patient presented to our emergency department with sudden abdominal pain. Magnetic resonance imaging was performed, and it revealed ascites and a thickened peritoneum. A diagnosis of peritonitis was made, and an emergency operation was performed because tumor perforation was suspected. We identified a perforated ileal tumor. We resected the small intestine and removed the tumor. The tumor was diagnosed via pathology as a CD8+ and CD56+ T-cell lymphoma of the small intestine, which suggested type II enteropathy-associated T-cell lymphoma (EATL). Anastomotic leakage was found and a subsequent operation was performed. The patient then received chemotherapy. The tumor initially responded well to chemotherapy, but then progressed after 4 courses of cyclophosphamide, hydroxydaunomycin, oncovin, and prednisolone (CHOP) therapy. We initiated gemcitabine-dexamethasone-platinol (GDP) therapy and performed an autologous peripheral blood stem cell transplantation, but the patient died from complications of chemotherapy. Type II EATL is rare with a poor prognosis ; further, treatment of this disease has not been established. We report a case of type II EATL that caused small-intestinal perforation.
