Methotrexate-related lymphoproliferative disorder of the stomach in a patient with rheumatoid arthritis: a case of disease regression after methotrexate cessation

Autor: Mikio Fujiwara, Takashi Miyoshi, Hitoshi Someda, Suguru Uose, Kenichi Nagai, Takahiro Kinoshita, Nakamura T, Kazuki Ikeda, Katsuhiro Io
Jazyk: angličtina
Rok vydání: 2016
Předmět:
Methotrexate (MTX)
medicine.medical_specialty
Pathology
medicine.medical_treatment
Arthritis
Lymphoproliferative disorders
Case Report
Gastroenterology
Multimodal Imaging
Arthritis
Rheumatoid
03 medical and health sciences
0302 clinical medicine
Stomach Neoplasms
Internal medicine
Biopsy
medicine
Humans
030212 general & internal medicine
Aged
Chemotherapy
medicine.diagnostic_test
business.industry
Stomach
General Medicine
medicine.disease
Lymphoproliferative Disorders
Lymphoma
medicine.anatomical_structure
Methotrexate
Neoplasm Regression
Spontaneous
030220 oncology & carcinogenesis
Rheumatoid arthritis
Rheumatoid arthritis (RA)
Antirheumatic Agents
Positron-Emission Tomography
Female
Lymphoma
Large B-Cell
Diffuse
Lymphoproliferative disorder (LPD)
business
Tomography
X-Ray Computed
medicine.drug
Zdroj: Clinical Journal of Gastroenterology
ISSN: 1865-7265
1865-7257
Popis: We report the case of a 78-year-old woman with methotrexate-related gastric lymphoproliferative disorder (LPD). The patient had a history of rheumatoid arthritis (RA) and had been treated with methotrexate (MTX). Endoscopic examination revealed round elevated lesions in the stomach, and a biopsy specimen showed atypical lymphoid cell proliferation. Immunohistological study found these atypical cells to be positive for L-26 but not for CD3 or EBER. Therefore, we made a diagnosis of MTX-related LPD showing features of diffuse large B-cell lymphoma. Combined positron emission tomography-computed tomography (PET-CT) using 18F-fluorodeoxyglucose (FDG) showed increased avidity in the stomach in addition to slightly increased FDG-avidity in the mediastinum and left chest wall. We decided not to start chemotherapy but to discontinue administration of MTX, with follow-up using endoscopy and PET-CT. The endoscopic examinations after cessation of MTX demonstrated gradual regression of the elevated lesions. PET-CT 6 months after cessation showed no increased FDG avidity in the stomach. While disease regression was observed in the stomach, the other FDG-avid spots remained unchanged on PET-CT. Therefore, we performed chemotherapy as additional therapy. On PET-CT after chemotherapy, the FDG-avid spots remained unchanged for more than 1 year, and we eventually concluded that they were RA-related inflammatory lesions. In patients with MTX-related LPD, cessation of MTX may be a therapeutic option, but careful follow-up and chemotherapy in accordance with the clinical course are essential.
Databáze: OpenAIRE
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