Anaplastic large T-cell lymphoma of the small intestines in a patient with Crohn's disease

Malignant complications can occur in Crohn's disease. Previous studies have recorded an increased intestinal cancer risk, but there are only a relatively small number of patients reported in the literature with both inflammatory bowel disease and malignant lymphoma. We describe a 48-years-old patient with 8 years long history of Crohn's disease. He admitted to our ward due to newly developed abdominal cramps and vomiting. Abdominal computertomography and radiographic imaging of the gastrointestinal tract showed multiple stenosis and fistulae of the small intestines, with nearly complete bowel obstruction. Resection of the ileum and the cecum was performed. Histological evaluation of the removed tissues revealed anaplastic large T-cell lymphoma of the small intestines. Immunohistochemically the cells were positive for CD3, CD4 and CD30 and were negative for ALK1 (the proliferation index with Ki-67 was 90%). The pre-treatment staging showed multiple pathologic lymph nodes both above and under the diaphragm, pleural fluid and possible involvement of the lungs and the right adrenal gland. The patient previously did not receive any immunosuppressive or biological treatment for Crohn's disease.

Due to his severe condition total parenteral nutrition, parenteral iron supplementation, antimicrobial and pegfilgrastim prevention became necessary before the beginning of chemotherapy. The chemotherapeutic treatment (CHOP) achieved significant improvement in his condition.

Although recent population-based data show, that the incidence of lymphoma is not increased in patients with inflammatory bowel disease, the possible coexistence of the two entities can create difficulties in both the diagnostic and the therapeutic activity of the clinician.