Indolent T-cell lymphoma of the gastrointestinal tract coexisting with gastric signet-ring cell carcinoma - A case report and review of literature

Sep 28, 2026

Indolent T-cell lymphoma of the gastrointestinal tract (iTCL-GI) is a rare mature T-cell lymphoma recognized as a distinct entity, yet its coexistence with epithelial malignancies is uncommon. This case report describes a 65-year-old female presenting with abdominal pain, bloating, and vomiting, where imaging and endoscopy suggested gastric wall involvement. Biopsy showed an indolent, non-destructive lymphoid infiltrate with CD3+/CD8+/TIA-1 positivity and low Ki-67, while lesions on the lesser curvature were confirmed as gastric signet-ring cell carcinoma. After four chemotherapy cycles targeting SRCC, pain improved though weight loss occurred; authors emphasize diagnostic integration and heightened awareness of multiple primary tumors.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages11

Reading Time28 min

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Case Report

Background

Case Summary

Conclusion

Key Words

| W | J | G | World Journal of
Gastroenterology | | --- | --- | --- | --- | Submit a Manuscript: [https://www.f6publishing.com](https://www.f6publishing.com) World J Gastroenterol 2025 December 21; 31(47): 112705 DOI: 10.3748/wjg.v31.i47.112705 ISSN 1007-9327 (print) ISSN 2219-2840 (online) CASE REPORT Indolent T-cell lymphoma of the gastrointestinal tract coexisting with gastric signet-ring cell carcinoma: A case report and review of literature Xue Chen, Jia-Qi Bo, Xiao-Xiang Gao, Su-Xia Zhang, Jie Li, Hui Wang, Mu-Ye Yang, Qian-Qian Guo, Bing Xiu, Yu Zeng Specialty type: Gastroenterology and hepatology Provenance and peer review: Unsolicited article; Externally peer reviewed. Peer-review model: Single blind Peer-review report’s classification Scientific Quality: Grade A, Grade B, Grade B, Grade B Novelty: Grade A, Grade A, Grade B, Grade B Creativity or Innovation: Grade B, Grade B, Grade B, Grade B Scientific Significance: Grade B, Grade B, Grade B, Grade B P-Reviewer: Mohammed Ali U, Associate Research Scientist, Head, Ethiopia; Rusman RD, MD, Assistant Professor, Indonesia Received: August 19, 2025 Revised: September 28, 2025 Accepted: November 4, 2025 Published online: December 21, 2025 Processing time: 123 Days and 2 Hours Xue Chen, Jia-Qi Bo, Su-Xia Zhang, Jie Li, Hui Wang, Mu-Ye Yang, Qian-Qian Guo, Yu Zeng, Department of Pathology, Tongji Hospital Affiliated to Tongji University School of Medicine, Shanghai 200065, China Xiao-Xiang Gao, Department of Orthopedics, Chinese People's Liberation Army Naval Medical Center, Shanghai 200052, China Bing Xiu, Department of Hematology, Tongji Hospital Affiliated to Tongji University School of Medicine, Shanghai 200065, China Co-first authors: Xue Chen and Jia-Qi Bo. Co-corresponding authors: Bing Xiu and Yu Zeng. Corresponding author: Yu Zeng, MD, PhD, Chief Physician, Department of Pathology, Tongji Hospital Affiliated to Tongji University School of Medicine, No. 389 Xincun Road, Putuo District, Shanghai 200065, [China.](China. yuzeng2013@163.com)[ yuzeng2013@163.com](China. yuzeng2013@163.com) Abstract BACKGROUND Indolent T-cell lymphoma of the gastrointestinal tract (iTCL-GI) is a rare mature T-cell lymphoma that has been formally recognized as a distinct entity in the 5th Edition World Health Organization Classification of Tumours of Haematolymphoid Tumours. However, the coexistence of iTCL-GI with epithelial malignancies is rare in clinical practice. This study reports a case of iTCL-GI with gastric signet-ring cell carcinoma (SRCC) . We aim to increase diagnostic awareness among clinicians and pathologists regarding multiple primary tumors. CASE SUMMARY A 65-year-old female presented with a 5-month history of lower abdominal pain, bloating, and vomiting. An abdominal computed tomography scan revealed irregular thickening of the gastric wall. Endoscopy revealed diffuse mucosal edema and rigid mucosa along the lesser curvature of the gastric body. There was a 1.5 cm mucosal protrusion on the greater curvature. Biopsy revealed that the lamina propria was expanded by a dense, nondestructive infiltrate of small lymphocytes in the greater curvature, which were characterized by a WJG [https://www.wjgnet.com](https://www.wjgnet.com) 1 December 21, 2025 Volume 31 Issue 47 Chen X et al. The iTCL-GI coexisting with SRCC CD3+/CD8+/TIA-1+ immunophenotype with a low Ki-67 index. Clonal T-cell receptor rearrangement was detected, but the Epstein-Barr virus encoded RNA's was negative. Lesions on the lesser curvature of the gastric body were confirmed to be SRCCs. After three months of follow-up, the patient completed four cycles of chemotherapy targeting the SRCC. While her abdominal pain improved, she experienced a weight loss of 5 kg. CONCLUSION Clinicians and pathologists must integrate assessment of these rare cases to prevent misdiagnosis and guide clinical practice. Key Words: Indolent T-cell lymphoma; G

FAQs

What are the main clinical presentations in this case?

A 65-year-old female experienced a 5-month history of lower abdominal pain, bloating, and vomiting.

How were iTCL-GI and gastric signet-ring cell carcinoma identified in the biopsy?

The biopsy showed a dense, nondestructive infiltrate of small lymphocytes with a CD3+/CD8+/TIA-1 immunophenotype and low Ki-67, while lesions on the lesser curvature were confirmed as signet-ring cell carcinomas.

What treatment was given and what was the outcome after follow-up?

After three months of follow-up, the patient completed four chemotherapy cycles targeting the SRCC; abdominal pain improved, with a reported weight loss of 5 kg.

Sep 28, 2026

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