A case of multiple hepatic lesions associated with methotrexate-associated lymphoproliferative disorder
Tóm tắt
Patients receiving methotrexate (MTX) for the treatment of autoimmune disease are at a high risk of developing lymphoproliferative disorders (LPD), the so-called methotrexate-associated lymphoproliferative disorders (MTX-LPD). We recently performed abdominal ultrasonography (US) in a patient with rheumatoid arthritis (RA) who had developed hepatic dysfunction during the course of MTX therapy; the examination revealed multiple well-demarcated hepatic tumors with slightly irregular borders, the largest one measuring 9 cm in diameter. In view of the finding of portal and hepatic veins perforating the tumor, we suspected a diagnosis of malignant lymphoma and performed a hepatic tumor biopsy. Histopathological examination of the biopsy specimens revealed a diagnosis of diffuse large B-cell lymphoma, and we made a final diagnosis of MTX-LPD. MTX treatment was discontinued, which resulted in rapid resolution of the lesions. Resolution of MTX-LPD can be obtained just by discontinuation of MTX treatment. In patients receiving MTX therapy who are found to have hepatic tumors perforated by the portal vein and/or hepatic vein on abdominal US, it is advisable to perform hepatic tumor biopsy to facilitate differential diagnosis of MTX-LPD and enable a definite diagnosis.
Tài liệu tham khảo
Thomas E, Brewster DH, Black RJ, et al. Risk of malignancy among patients with rheumatic conditions. Int J Cancer. 2000;88:497–502.
Mellemkjaer L, Linet MS, Gridley G, et al. Rheumatoid arthritis and cancer risk. Eur J Cancer. 1996;32:1753–7.
Gridley G, McLaughlin JK, Ekbom A, et al. Incidence of cancer among patients with rheumatoid arthritis. J Natl Cancer Inst. 1993;85:307–11.
Baecklund E, Askling J, Rosenquist R, et al. Rheumatoid arthritis and malignant lymphomas. Curr Opin Rheumatol. 2004;16:254–61.
Miyagawa K, Shibata M, Noguchi H, et al. Methotrexate-related primary hepatic lymphoma in a patient with rheumatoid arthritis. Intern Med. 2015;54:401–5.
Inui Y, Matsuoka H, Yakushijin K, et al. Methotrexate-associated lymphoproliferative disorders: management by watchful waiting and observation of early lymphocyte recovery after methotrexate withdrawal. Leuk Lymphoma. 2015;56:3045–51.
Tatsumi G, Ukyo N, Hirata H, et al. Primary hepatic lymphoma in a patient with rheumatoid arthritis treated with methotrexate. Case Rep Hematol. 2014; 460574.
Kikuma K, Watanabe J, Oshiro Y, et al. Etiological factors in primary hepatic B-cell lymphoma. Virchows Arch. 2012;460:379–87.
Ellman MH, Hurwitz H, Thomas C, et al. Lymphoma developing in a patient with rheumatoid arthritis taking low dose weekly methotrexate. J Rheumatol. 1991;18:1741–3.
Bachman TR, Sawitzke AD, Perkins SL, et al. Methotrexate-associated lymphoma in patients with rheumatoid arthritis. Arthritis Rheum. 1996;39:325–9.
Miyazaki T, Fujimaki K, Shirasugi Y, et al. Remission of lymphoma after withdrawal of methotrexate in rheumatoid arthritis with type of latent Epstein–Barr virus infection. Am J Hematol. 2007;82:1106–9.
Mariette X, Cazals-Hatem D, Warszawki J, et al. Lymphomas in rheumatoid arthritis patients treated with methotrexate: a 3-year prospective study in France. Blood. 2002;99:3909–15.
Fujita T, Tanabe M, Iida E, et al. Multi-modality imaging findings of methotrexate-related Epstein–Barr virus-associated hepatic tumor. Clin Imaging. 2013;37:962–4.
Zhong Y, Deng M, Xu R. Reappraisal of evidence of microscopic portal vein involvement by hepatocellular carcinoma cells with stratification of tumor size. World J Surg. 2015;39:1142–9.
Yukisawa S, Ohto M, Masuya Y, et al. Contrast-enhanced three-dimensional fusion sonography of small liver metastases with pathologic correlation. J Clin Ultrasound. 2007;35:1–8.
Iwai T, Nishida M, Satoh M, et al. A case of hepatic lymphoma showing a mixed pattern on contrast-enhanced ultrasonography. Jpn J Med Ultrasonics. 2016;43:115–22.
Guermazi P, Brice E, De Kerviler, et al. Extranodal Hodgkin disease: spectrum of disease. Radiographics. 2001;21:161–79.
Lu Q, Zhang H, Wang WP, et al. Primary non-Hodgkin’s lymphoma of the liver: sonographic and CT findings. Hepatobiliary Pancreat Dis Int. 2015;14:75–81.
Feng WH, Cohen JI, Fischer S, et al. Reactivation of latent Epstein–Barr virus by methotrexate: a potential contributor to methotrexateassociated lymphomas. J Natl Cancer Inst. 2004;96:1691–702.
Hoshida Y, Xu JX, Fujita S, et al. Lymphoproliferative disorders in rheumatoid arthritis: clinicopathological analysis of 76 cases in relation to methotrexate medication. J Rheumatol. 2007;34:322–31.
Salloum E, Cooper DL, Howe G, et al. Spontaneous regression of lymphoproliferative disorders in patients treated with methotrexate for rheumatoid arthritis and other rheumatic diseases. J Clin Oncol. 1996;14:1943–9.