Intestinal T Cell Lymphoma Masquerading as Intussusception and Jejunal Perforation - Unusual Presentation of Two Cases

Abstract

Introduction: Gastrointestinal lymphomas are a heterogeneous group of extranodal non-Hodgkin lymphomas, with the small intestine being a common site. T-cell lymphomas are rare.

Case Report: Case 1: A 79-year-old male presented with severe right-sided abdominal pain, distension, projectile vomiting, and hemodynamic instability. MRI revealed a thick-walled collection with air foci (6.7 × 5.8 cm) in the retrocecal region of the right iliac fossa, along with dilated jejunal loops and a non-visualized appendix. Gross examination showed luminal dilatation with three perforations and multiple mucosal ulcers. Histopathology demonstrated atypical lymphoid cells infiltrating the muscularis and serosa, with necrosis and neutrophilic admixture. Adjacent mucosa showed villous atrophy and submucosal edema. Immunohistochemistry revealed CD3 and LCA positivity, with negativity for chromogranin, pancytokeratin, CD68, and CD20, consistent with enteropathy-associated T-cell lymphoma. The patient underwent surgery but died within 7 days postoperatively. Case 2: A 30-year-old male presented with difficulty in passing stools and urine. CT imaging revealed ileocolic intussusception. Resected bowel showed ulceroproliferative lesions. Microscopy demonstrated small- to medium-sized lymphoid cells infiltrating the lamina propria and submucosa with epithelial ulceration. Tumor cells were CD45 positive, consistent with non-Hodgkin lymphoma. The patient received chemotherapy and remains stable at 6-month follow-up.

Conclusion: Intestinal lymphoma should be considered in atypical obstruction or perforation. Early diagnosis and multidisciplinary management are crucial.