A case of intestinal cytotoxic/suppressor T-cell lymphoma with repeated episodes of perforation was seen in a 77-year-old Japanese male who was admitted complaining of severe abdominal pain accompanied by high grade fever. Surgery revealed diffuse peritonitis due to perforation in the sigmoid colon. After a loop sigmoid colostomy the patient recovered to some degree. Seven days later, however, another perforation occurred. Several aneurysmal swellings accompanied by perforation in the small intestine, forming a mass of 5 x 5 cm, were seen. Although the patient tolerated this operation, generalized emaciation proceeded and the patient died 10 days late. Histological examination at the second operation showed diffuse medium-sized lymphoma of the Lymphoma Study Group (LSG) classification infiltrating the entire depth of the intestinal wall. Destruction of muscle cells was prominent. An immunohistochemical study using fresh frozen material was positive for CD3, and CD8. This marked destruction of the muscle layer by lymphoma cells may be associated with repeated episodes of perforation.
Usually patients with typical carcinoid tumors originating in a segmental bronchus undergo segmentectomy with or without a bronchoplastic procedure. We have performed only sleeve resection of the bronchus for a bronchial carcinoid tumor located in the left basal bronchus thus preserving the lung tissue. This was made possible by transecting and reanastomosing the pulmonary artery.
Conclusion: We found a sMPLC patient with different pathological types between the lung and lymph node lesions. Lung scar cancer or GGNs is highly suspected to be the origin of the metastatic mediastinal lymph node.
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