title: A report of Epstein-Barr virus-positive primary cutaneous natural killer-/T-cell lymphoma.
abstract: We describe a patient who presented with Epstein-Barr virus-positive tumor-stage primary cutaneous lymphoma. Our patient had previously been treated with oral methotrexate for long-standing rheumatoid arthritis. Tissue analysis revealed large tumor cells that were surface CD2- and CD3-positive; T-cell-restricted intracellular antigen-positive; CD56-, CD20-, and CD30-negative; and stained positively for Epstein-Barr virus. Our case is noteworthy for several reasons. Although the presence of rheumatoid arthritis and therapy with methotrexate are putative risk factors for the development of immune suppression-related and Epstein-Barr virus-related lymphomas, the vast majority of lymphomas in this setting are of B-cell origin, and rarely are these primary cutaneous in nature. In addition, our patient's tumor displayed an unusual phenotype, with immunophenotypic features suggestive of an atypical natural killer-/T-cell lymphoma. Methotrexate was withdrawn, and our patient was successfully treated with local radiotherapy. She has remained in complete remission 28 months since diagnosis.
authors.affiliation: Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia 30322, USA. srsingh@emory.edu
authors.forename: Sareeta R S
authors.initials: SR
authors.lastname: Parker
authors.forename: Alvin R
authors.initials: AR
authors.lastname: Solomon
authors.forename: Joshua E
authors.initials: JE
authors.lastname: Lane
mesh_terms: D000284:Administration, Oral; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000188:drug therapy; D001706:Biopsy; D020031:Epstein-Barr Virus Infections / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006801:Humans; D007694:Killer Cells, Natural; D016131:Lymphocyte Subsets; D016410:Lymphoma, T-Cell, Cutaneous / Q000175:diagnosis* / Q000209:etiology; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D012867:Skin / Q000473:pathology
chemical_list: D008727:Methotrexate