An 86-year-old man was admitted because of small-bowel wall thickening and mesenteric lymphadenopathy. Neither peripheral lymphadenopathy nor hepatosplenomegaly was noted. The leukocyte count was 7930/mm 3 , and no abnormal lymphocytes were found. The result of testing for serum antihuman T-lymphotropic virus type 1 (HTLV-1) antibody was positive. A bone marrow biopsy was normal without evidence of lymphoid infiltration. Smallbowel enteroclysis demonstrated a narrowing, edematous lesion with multiple ulcerations in the jejunum (• " Fig. 1). Capsule endoscopy (• " Fig. 2) and doubleballoon endoscopy (• " Fig. 3) showed enlarged Kerckring folds with annular and irregularly shaped shallow ulcers. Biopsy specimens from the ulcers revealed diffuse infiltration of medium to large pleomorphic lymphoid cells with CD3 +, CD4 +, CD5 +, CD25 +, CCR4 +, FoxP3 +, CD8-, CD20-, CD56-, and TIA1immunophenotype (• " Fig. 4). Biopsy specimens from the stomach, duodenum, ileum, and colon showed no lymphoma cells. Fluorodeoxyglucose F 18 positron emission tomography showed abnormal uptake in the jejunal mass, wide areas of mesentery, and Cases and Techniques Library (CTL) E613 Yaita Hiroki et al. Small-bowel adult T-cell leukemia/lymphoma with gastric AL amyloidosis … Endoscopy 2014; 46: E613-E614