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From question on page 1824

Histopathology revealed high grade T cell non-Hodgkin’s lymphoma involving the entire resected colon, the terminal ileum, and all 17 dissected lymph nodes. Immunophenotyping of the malignant T cells showed expression of CD3, CD30, and CD4 but CD8 expression was absent. The patient was unfit for chemotherapy and died two months later.

Colonic lymphoma is a rare but recognised complication of ulcerative colitis. Colitis associated colonic lymphoma, unlike sporadic lymphoma, is often multifocal, left sided, high grade, and extensive at diagnosis. Mean age at presentation is 50 years and mean duration of colitis at the time of diagnosis of the lymphoma is 12 years. Most colonic lymphomas are non-Hodgkin’s type, arise from mucosa associated lymphoid tissue, and are B cell in origin. T cell lymphoma is rare in the large bowel but has been described in coeliac disease and following organ transplantation.

This case illustrates the difficulty in differentiating inflammatory bowel disease from colonic lymphoma, which should be considered in patients with resistant disease.

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