A 51-year-old female was admitted on May 9, 1995, because of severe hematemesis. The patient had been treated elsewhere for one month for pain and redness of both breasts and fever (≥ 38°C). There was no generalized lymphadenopathy. On gastroscopic examination multiple small ulcers were observed in the stomach. An abdominal computed tomographic (CT) scan showed liver tumor and a normal spleen. Hematological and biochemical examination at admission showed the following results: RBC 352 × 104/mm3, hemoglobin 10.3 g/dl (post transfusion), WBC 4,900/mm3, Platelets 51,000/mm3, serum albumin 1.5 g/dl, total bilirubin 0.6 mg/dl, AST 691 IU/l, ALT 187 IU/l, LDH 2976 IU/l, fibrinogen 134 mg/dl, FDP 10 μg/ml, and AT-III 40%. Bleeding from the stomach continued and did not stop with conservative treatment; therefore, two days later the patient underwent total gastrectomy and a partial liver resection. Histopathology of the resected specimen showed it to be a gastric lymphoma (pleomorphic medium-large cell type, non-Hodgkin's T-cell lymphoma) with liver metastasis. From first postoperative day (POD), bleeding from the esophagojejunostomy continued; the patient developed disseminated intravascular coagulopathy and died on 8th postoperative day. On autopsy, malignant lymphoid cell infiltration and hemophagocytosis were observed in the liver, spleen, heart, small bowel, lung, both breasts, kidney, pancreas, uterus, and gastroduodenal lymph nodes. The bone marrow presented hyperplasia and hemophagocytic macrophages but no infiltration by lymphoma cells. Immunohistochemically the neoplastic cells were positive for T-cell marker UCHL1 (CD45RO) and EBV by EBER in situ hybridization. The final diagnosis was EBV-related T-cell LAHS.