A Case of Perforation of T-cell Malignant Lymphoma with the Primary Focus in the Sigmoid Colon

Hiroshi Nimura, Nobuyoshi Haniu*, Teruaki Aoki, Masaru Naruse*, Youchi Oohira*, Hajime Mizuasaki*, Hiroshi Aoki*, Jun Tsutsumi, Katsunori Nishikawa*, Tetsuu Kin*, Shinichiro Yanai*, Masahiro Ikegami**

Second Department of Surgery, Jikei University School of Medicine
*Department of Surgery, Fuji Municipal Central Hospital
**Department of Pathology, Jikei University School of Medicine

Malignant lymphoma with the primary focus in the colon, particularly in the sigmoid, is a rare disease. T-cell lymphoma, in particular, is very rare. We have encountered a patient with perforative peritonitis due to malignant lymphoma with the primary focus in the sigmoid that was strongly suspected preoperatively. The 72-year-old male patient was referred to this hospital by another hospital which he visited complaining of pain in the left lower abdomen. Ultrasonography and colonic enema before surgery revealed malignant lymphoma of the sigmoid, and colonic enema revealed perforation in the region. Sigmoidectomy and drainage were performed. The patient was pathologically diagnosed after surgery as having malignant pleomorphic large cell lymphoma with T-cell phenotype classified as multiple and highly malignant lymphoma. Abdominal ultrasonography and colonic enema proved effective for the differential diagnosis of malignant lymphoma from inflammatory intestinal diseases or cancer. Postoperative chemotherapy for malignant lymphoma remaining in the descending colon was largely unsuccessful, and peritonitis due to tumoral perforation recurred, requiring colectomy of the left half and drainage. T-cell lymphoma, compared with B-cell lymphoma, is characterized by poor prognosis, and surgical resection of the primary focus including at least the involved lymph node is required.

Key words
primary T cell malignant lymphoma of the sigmoid colon, preoperative diagnosis with abdominal ultrasonography, perforative peritionitis in the sigmoid colon

Reprint requests
Hiroshi Nimura Second Department of Surgery, Jikei University School of Medicine
3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105 JAPAN

Accepted
July 5, 1995

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