Methotrexate-induced primary cutaneous diffuse large B-cell lymphoma with an 'angiocentric' histological morphology.
A patient with a 25-year history of rheumatoid arthritis and a 3-year history of methotrexate treatment developed a generalized papular rash. The papules rapidly became necrotic and then resolved, leaving a depressed scar. The rapid course of lesion development and regression was reminiscent of pityriasis lichenoides. Histology revealed a nodular infiltrate composed of a mixture of pleomorphic large B cells positive for CD20, CD30 and CD79a, and of small T cells positive for CD3 and CD4. The T cells had a striking angiocentric distribution, with some of the vessels exhibiting fibrinoid necrosis of the vessel wall reminiscent of lymphomatoid granulomatosis. However, B cells were consistently negative for Epstein-Barr virus (EBV) antigen expression. A thorough examination excluded involvement of organs other than the skin. Thus, this patient was classified as having a rare form of an EBV-negative primary cutaneous T-cell-rich B-cell lymphoma in association with methotrexate treatment.
Pfistershammer
K
K
Department of Dermatology, Division of Immunology, Allergy and Infectious Diseases, Medical University of Vienna, Vienna, Austria.
Petzelbauer
P
P
Stingl
G
G
Mastan
P
P
Chott
A
A
Jäger
U
U
Skrabs
C
C
Geusau
A
A
D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects*; D001402:B-Lymphocytes / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000139:chemically induced* / Q000473:pathology*; D008727:Methotrexate / Q000009:adverse effects*; D017514:Pityriasis Lichenoides / Q000473:pathology; D012878:Skin Neoplasms / Q000139:chemically induced* / Q000473:pathology*; D013601:T-Lymphocytes / Q000473:pathology
D000964:Antimetabolites, Antineoplastic; D008727:Methotrexate