[Primary T-cell lymphoma of the small bowel]

Primary malignancies in the small intestine are relatively rare. There are no specific methods to find these tumours in early stage. The authors report a case of a primary T-cell lymphoma in the small bowel that caused diagnostic challenges. A 66-year-old woman presenting with abdominal pain and and a palpable mass in the left upper quadrant of her abdomen was admitted into the hospital. Blood tests, endoscopic examinations, ultrasonography and CT scan could not reveal a definitive diagnosis. While a small bowel follow through examination demonstrated an entero-enteral fistula, its exact position could not have been determined. Consequently, an exploratory laparotomy was carried out, and a tumour was found involving the small bowel loops. The involved portion of the small intestine (with the fistula) was resected, and a side-to-side small bowel anastomosis was performed. Histological and immunohistochemical analyses revealed a primary T-cell lymphoma of the small bowel. There was no evidence of metastatic disease at the time of surgery. The patient received adjuvant chemotherapy, but three months later multiple lung metastases were detected. Small bowel malignant tumours cause significant diagnostic difficulties. Therefore, diagnosis and adequate treatment are usually delayed for some weeks. In the future, capsule endoscopy could help in the diagnostic work-up. Nevertheless, surgical exploration and resection of the tumour will be necessary for the correct diagnosis and treatment.