A case of T-cell malignant lymphoma of the stomach and small intestine with intestinal perforation during radiation therapy after the surgery and adjuvant chemotherapy

A 72-year-old man admitted to our hospital for abdominal pain. Upper GI series and gastroendoscopy showed 2 type tumor existing from upper portion beyond lower portion of the stomach which was 9 cm in diameter. Gastroendoscopical biopy specimen revealed T-cell lymphoma and abdominal CT revealed swellings of regional lymph nodes, so we diagnosed as Stage II E according to the classification of Ann Arbor. A total gastrectomy with D2 lymph node dissection was performed. We also found 2 sites of mass within 40-60 cm portion from the end of ileum during surgery, and we resected all of them. All of the abdominal mass were pathologically diagnosed as T-cell lymphoma of the stomach and small intestine. Lymph nodes involvements of No4d and the resional small intestine were found pathologically. This case was sero-positive for human lymphotropic virus type 1. After the operation, the patient's condition had been good, and he admitted to the department of internal medicine in our hospital to receive the adjuvant chemotherapy. He reseived the chemotherapy of 6 cycles followed a radiation therapy. Suddenly he complained of severe abdominal pain seven months after surgery during the radiation therapy, he suddenly complained of severe abdominal pain, and he underwent an emergency surgery with a diagnosis of pan-peritonitis due to small intestinal perforation. He complicated with disseminated intravascular coagulation (DIC) and died 9 days after surgery. The case was presented together with a review of the literature. (author)