Methotrexate-associated lymphoproliferative disorder demonstrating composite lymphoma of EBV-negative diffuse large B-cell lymphoma and EBV-positive mucocutaneous ulcer

Keiichi Moriya; Yara Yukie Kikuti; Joaquim Carreras; Yusuke Kondo; Sawako Shiraiwa; Naoya Nakamura

doi:10.3960/jslrt.19038

Methotrexate-associated lymphoproliferative disorder demonstrating composite lymphoma of EBV-negative diffuse large B-cell lymphoma and EBV-positive mucocutaneous ulcer

J Clin Exp Hematop. 2020;60(1):11-16. doi: 10.3960/jslrt.19038.

Authors

Keiichi Moriya^{1

2}, Yara Yukie Kikuti², Joaquim Carreras², Yusuke Kondo², Sawako Shiraiwa³, Naoya Nakamura²

Affiliations

¹ Department of Hematology, Shinmatsudo Central General Hospital, Matsudo, Japan.
² Department of Pathology, Tokai University School of Medicine, Isehara, Japan.
³ Department of Hematology and Oncology, Tokai University School of Medicine, Isehara, Japan.

Abstract

Other iatrogenic immunodeficiency-associated lymphoproliferative disorders induced by immunosuppressive drugs, such as methotrexate (MTX-LPD), exhibit numerous pathological findings. We report the case of an 81-year-old Japanese woman diagnosed with MTX-LPD exhibiting two distinct pathological features from two different sites. Excisional biopsy of the left cervical lymph node revealed EBV-negative diffuse large B-cell lymphoma and biopsy of a pharyngeal ulcer revealed EBV-positive mucocutaneous ulcer. She was treated using an R-CHOP regimen and maintained complete remission for years. This case demonstrates the heterogeneous pathology of MTX-LPD and suggests the necessity of multiple biopsy.

Keywords: EBV-positive mucocutaneous ulcer; Epstein-Barr virus; Other iatrogenic immunodeficiency-associated lymphoproliferative disorders; diffuse large B-cell lymphoma; methotrexate.

Publication types

Case Reports

MeSH terms

Aged, 80 and over
Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
Composite Lymphoma / chemically induced*
Composite Lymphoma / complications
Composite Lymphoma / diagnosis
Composite Lymphoma / drug therapy
Cyclophosphamide / therapeutic use
Doxorubicin / therapeutic use
Epstein-Barr Virus Infections / complications
Epstein-Barr Virus Infections / diagnosis
Female
Humans
Immunosuppressive Agents / adverse effects*
Lymphoma, Large B-Cell, Diffuse / chemically induced*
Lymphoma, Large B-Cell, Diffuse / complications
Lymphoma, Large B-Cell, Diffuse / diagnosis
Lymphoma, Large B-Cell, Diffuse / drug therapy
Lymphoproliferative Disorders / chemically induced
Lymphoproliferative Disorders / complications
Lymphoproliferative Disorders / diagnosis
Lymphoproliferative Disorders / drug therapy
Methotrexate / adverse effects*
Pharynx / drug effects
Pharynx / pathology
Prednisone / therapeutic use
Rituximab / therapeutic use
Ulcer / chemically induced
Ulcer / complications
Ulcer / diagnosis
Vincristine / therapeutic use

Substances

Immunosuppressive Agents
R-CHOP protocol
Rituximab
Vincristine
Doxorubicin
Cyclophosphamide
Prednisone
Methotrexate