Methotrexate-associated lymphoproliferative disorder presenting as extranodal NK/T-cell lymphoma arising in the lungs.

Abstract

Patients having rheumatoid arthritis (RA) treated with methotrexate (MTX) are at an increased risk of developing lymphoproliferative disorder (LPD). Epstein-Barr virus (EBV) sometimes contributes to the development of MTX-associated LPD. Herein, we report the case of a 64-year-old Japanese woman with RA who showed complications of EBV-positive MTX-associated LPD. This case is exceedingly rare in that the LPD was confined to the lungs and its subclassification was extranodal NK/T-cell lymphoma. Only four cases of extranodal NK/T-cell lymphoma in the setting of MTX-associated LPD have ever been reported in the English language literature, only one of which was an extranasal NK/T-cell lymphoma, similar to our case. Extranasal NK/T-cell lymphomas show more aggressive behavior than nasal NK/T-cell lymphomas, possibly reflected by the considerable re-exacerbation of the lesions in only two months after the cessation of MTX in our case. However, the SMILE regimen (steroid, methotrexate, ifosfamide, l-asparaginase, and etoposide) was able to suppress tumor growth in this case.

• Authors: Shogo Tajima, Yusuke Takanashi, Kenji Koda, Masashi Fukayama
• Journal: Pathology international (Pathol Int) Vol. 65 Issue 12 Pg. 661-5 (Dec 2015) ISSN: 1440-1827 [Electronic] Australia
• PMID: 26459854 (Publication Type: Case Reports, Journal Article)
• Copyright: © 2015 Japanese Society of Pathology and Wiley Publishing Asia Pty Ltd.

Chemical References

• Antineoplastic Agents
• Steroids
• Etoposide
• Asparaginase
• Ifosfamide
• Methotrexate

Topics

• Antineoplastic Agents (therapeutic use)
• Arthritis, Rheumatoid (complications, drug therapy)
• Asparaginase (therapeutic use)
• Diagnosis, Differential
• Epstein-Barr Virus Infections (complications, virology)
• Etoposide (therapeutic use)
• Female
• Herpesvirus 4, Human (physiology)
• Humans
• Ifosfamide (therapeutic use)
• Lymphoma, Extranodal NK-T-Cell (complications, pathology)
• Lymphoproliferative Disorders (complications, pathology, virology)
• Methotrexate (adverse effects, therapeutic use)
• Middle Aged
• Risk
• Steroids (therapeutic use)