Monomorphic Epitheliotropic Intestinal T-cell Lymphoma Requiring Extensive Multiple Organ Resection

Abstract

A 78-year-old woman presented complaining of abdominal pain. Signs of peritoneal irritation were present, there was an elevated inflammatory response (WBC 218.1×10³/μL and CRP 24.14 mg/dL), and abdominal computed tomography showed ascites and a large mass with a maximum diameter of 15 cm in the intrapelvic small intestine. Small intestinal perforation and peritonitis were diagnosed, and emergency surgery was performed. A tumor was present in the jejunum, which was perforated at this site. The tumor was invading the sigmoid colon, appendix, right ovary, and retroperitoneum, forming a massive abscess. The retroperitoneal invasion was severe, and sigmoid colectomy with colostomy was performed together with partial jejunectomy and combined resection of the right ovary and appendix, with some tumor tissue left behind. Monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL) was diagnosed on the basis of pathological investigations. The patient's postoperative course was generally uneventful, and she started chemotherapy at another hospital on postoperative Day 25, but regrowth of the remaining tumor caused ureteral stenosis and hydronephrosis, and she died of the cancer on Day 71. A case of MEITL that required extensive multiple organ resection is presented along with a brief discussion of the literature.