KjG The Korean Journal of Gastroenterology Korean J Gastroenterol 1598-9992 2233-6869 Korean Society of Gastroenterology 10.4166/kjg.2014.64.4.229 kjg-64-229 Case Report A Case of Fungating Type Natural Killer Like T Cell Lymphoma of the Ascending Colon LeeChang Seok ShinDong Hoon 1 ChoiCheol Woong KimHyung Wook KangDae Hwan KohKyung Won JiByoung Hoon ParkSu Bum Department of Internal Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University School of Medicine, Yangsan, Korea Department of Pathology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea Correspondence to: Su Bum Park, Department of Internal Medicine, Pusan National University Yangsan Hospital, 20 Geumo-ro, Mulgeum-eup, Yangsan 626-770, Korea. Tel: +82-55-360-1535, Fax: +82-55-360-1536, E-mail: psubumi@naver.com 10 2014 04 10 2014 64 4 229 233 08012014 13022014 26022014 Copyright © 2014 Korean Ophthalmological Society 2014 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract

Primary colorectal lymphoma is a very rare disease entity that accounts for less than 0.2-0.65% of all colon cancers. It is as an extranodal lymphoma of the colon that mainly arises from B cells and primary colorectal lymphoma that arises from T cells is very rare both in Western countries and in Korea. Colonic lymphoma can be classified endoscopically into 5 categories as follows: fungating, ulcerative, infiltrative, ulcerofungating, and ulceroinfiltrative type. The endoscopic features of primary colorectal lymphoma differ according to their cellular origin; about half of B cell lymphomas are fungating type whereas most of T cell lymphomas are of ulcerative or ulceroinfiltrative type. Mass forming primary T cell lymphoma of the colon is extremely rare. Herein, we present a case of primary natural killer like T cell lymphoma of the colon presenting as fungating type with review of literature.

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Abdominal CT scan findings. (A) CT scan performed 3 months ago shows no evidence of abnormality on the hepatic flexure. (B) CT scan taken at admission shows newly developed huge mass (arrow) with pericolic fat stranding on the hepatic flexure.

Endoscopic finding. A large fungating mass is seen on distal ascending colon which almost obstructs the bowel lumen.

Microscopic findings of the biopsy specimens from the colon mass. (A) Diffuse infiltration of medium-sized atypical lymphoid cells with irregular, pleomorphic, hyperchromatic or vesicular nuclei and many mitotic figures are observed (H&E, ×400). (B) Immunohistochemical stain shows that lymphoma cells are CD3 positive T lymphocytes (×200) that are positive for (C) CD 56 (×200) and (D) CD 8 (×200).

PET scan finding. The mass at hepatic flexure shows intense hypermetabolism with standardized uptake value of 10.8.