Colonic T-cell leukemia mimicking colon carcinoma

F 74-year-old man, with a significant past history of ower gastrointestinal bleeding from colonic diverticula, omplained of pain in the right lower abdomen and pasage of dark red bloody stool. In the past few months, he ccasionally experienced right lower-abdominal pain that sually subsided after bowel movements. He denied feer, chills, nausea, vomiting, weight loss, or other sympoms. Physical examination showed a right lower-quadrant ender mass approximately 10 cm in diameter. Rectal xamination showed blood-tinged stool without tenderess around the lower rectum. The initial abdominal oentgenogram showed no colon gas in the right lower uadrant. Abdominal enhanced computed tomography, aken to rule out suspected colonic malignancy, revealed mass in the cecum with enhanced thickened walls and arked lymphadenopathy that was causing near-total obtruction (Fig. 1). He was admitted to the surgical ward ith an initial diagnosis of colon carcinoma. After admission, he was placed on total parenteral utrition, and the work-up with colonoscopy revealed a ass that bled easily. Colon carcinoma then was susected. However, a biopsy examination revealed densely roliferating tumor cells with high nuclear cytoplasm atio and cluster of differentiation 3, 4, 20, and vimentinositive, parakeratin-negative T-cell lineage. With high erum anti-human T-cell leukemia virus-1 antibody titer nd strogyloid in stool, the patient was diagnosed with dult T-cell leukemia with invasion to cecum. After disussion of whether chemotherapy or surgery should be erformed first, a right hemicolectomy was performed. ral intake started on day 7 postoperatively. The postperative course was uneventful until day 11, when he omplained of abdominal pain, again caused by rapidly