The many faces of gastrointestinal T-cell lymphoma manifest simultaneously in the same patient.

A 50-year-old man with a history of AIDS presented with complaints of dyspnea on exertion, anemia, andmelena. Seven years prior to the current presentation, he presented with intussusception, underwent right hemicolectomy, and was diagnosed with a cecal mass consistent with T-cell lymphoma. He was noncompliant with his medication regime and was lost to follow-up until the current admission. He underwent esophagogastroduodenoscopy and colonoscopy for further evaluation of iron-deficiency anemia and melena. Upper gastrointestinal endoscopy revealed: (1) multiple concentric rings in the lower esophagus, (2) a small (4-mm) nodule in gastric cardia, and (3) a nodule with central ulceration in the gastric body (●" Fig.1). Colonoscopy showed: (1) a large mass protruding from the small intestine into the ileocolonic anastomosis, (2) ulceration within the blind loop at the anastomosis, and (3) a sessile polyp in the sigmoid colon (●" Fig.2). Pathology review of specimens from all of these sites revealed a high-grade peripheral T-cell lymphoma positive for T-cell markers CD4 and patchy for CD3. Immunostaining was negative for CD7 and CD8 (●" Fig.3). The patient was started on appropriate highly active antiretroviral therapy (HAART) therapy and chemotherapy. The gastrointestinal tract is themost commonly involved site for extranodal primary non-Hodgkin lymphomas, accounting for 30%–40% of all cases [1]. Histopathologically, lymphomas with B-cell origins form a major subset (over 90%) of all gastrointestinal non-Hodgkin lymphomas compared to T-cell lymphomas and Hodgkin disease, which are observed less frequently [2]. HIV-infected individuals, like our patient, have been known to be at risk for development of a T-cell lymphomas affecting multiple organs [3]. This case illustrates thevast arrayofendoscopic appearances of gastrointestinal tract involvement of T-cell lymphoma in a single patient at different locations. Esophageal involvement in T-cell lymphoma is extremely rare [4], and endoscopic findings ofmultiple concentric rings in the esophagus due to T-cell lymphoma have to the bestofourknowledgenever been reported in the literature.