An extremely rare case of primary gastrointestinal T-cell lymphoma involving the stomach and intestine is reported. Radiographic and endoscopic examinations showed multiple polypoid lesions covered by a normal-appearing mucosa in the stomach, duodenal bulb, and terminal ileum and numerous small aphthoid lesions throughout the entire colorectum. Histopathologic, immunohistochemical, and polymerase chain reaction studies were performed using paraffin-embedded or fresh-frozen specimens from endoscopic biopsies and endoscopic mucosal resections. All lesions were composed of small, atypical lymphoid cells, which were classified as low-grade pleomorphic lymphoma. The tumor cells expressed CD3, CD4, and the T-cell receptor gamma gene phenotype as well as human mucosal lymphocyte 1 antigen, suggesting that the lymphoma cells were derived from intraepithelial T lymphocytes. This is the first description of primary gastrointestinal T-cell lymphoma with expression of human mucosal lymphocyte 1 antigen and a novel morphology resembling multiple lymphomatous polyposis.