T-cell malignant lymphoma of the ileum causing ileac fistulas: report of a case.

We herein present a rare case of three fistulas caused by a recurrence of T-cell lymphoma of the ileum. A 67-year-old man presented at a local hospital with left lower abdominal pain in May 1997. Upper and lower gastrointestinal examinations did not reveal any abnormal findings, but an abdominal aortic aneurysm was diagnosed by computed tomography, and thus was determined to be the source of the pain. The patient was referred to our hospital to undergo a grafting operation; however, a laparotomy performed in July 1997 revealed an unexpected small intestinal tumor, and therefore a partial ileectomy between 15 and 70cm in an oral direction from the terminal ileum was carried out instead. Histopathological and genetic examinations demonstrated diffuse small malignant lymphocytic T-cell lymphomas of the ileum invading all layers. Metastasis of the facial skin and local recurrence were recognized 5 months later, and chemotherapy with THP-COP and ESHAP only resulted in progressive disease. An ileac fistula was found to have formed between the intestine and abdominal wall in March 1998, and the patient died in May 1998. An autopsy revealed three fistulas caused by metastatic tumors, one of which communicated with the duodenum from the ileum, one with the skin from the ileum, and one to the transverse colon from the ileum.