title: EBV+ cutaneous B-cell lymphoproliferation of the leg in an elderly patient with mycosis fungoides and methotrexate treatment.
abstract: A 77-year-old man with a 5-year history of mycosis fungoides (MF) who had received several lines of therapy, including intravenous courses of Methotrexate (MTX) for the past 2 years, went on to develop several ulcerated cutaneous nodules on the left leg. Biopsy revealed diffuse sheets of EBV-positive large B cells (CD20+ CD30 ± IgM Lambda), with an angiocentric distribution and a monoclonal IGH gene rearrangement. Although the pathological features were diagnostic for an EBV-positive diffuse large B-cell lymphoma (DLBCL), several possibilities could be considered for assignment to a specific entity: EBV-positive DLBCL of the elderly, methotrexate-induced lymphoproliferative disorder (LPD), lymphomatoid granulomatosis, or the more recently described EBV-positive mucocutaneous ulcer. The development of EBV+ lymphoproliferations has been reported in two other patients with MF under MTX, and occurred as skin lesions of the leg in one of these and in the current case, which may question the relatedness to primary cutaneous DLCBL, leg-type.
authors.affiliation: Institut Universitaire de Pathologie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. thierry.rausch@chuv.ch
authors.forename: Thierry
authors.initials: T
authors.lastname: Rausch
authors.forename: Anne
authors.initials: A
authors.lastname: Cairoli
authors.forename: Jean
authors.initials: J
authors.lastname: Benhattar
authors.forename: Philipp
authors.initials: P
authors.lastname: Spring
authors.forename: Daniel
authors.initials: D
authors.lastname: Hohl
authors.forename: Laurence
authors.initials: L
authors.lastname: de Leval
mesh_terms: D000368:Aged; D001706:Biopsy; D020031:Epstein-Barr Virus Infections / Q000473:pathology*; D017809:Fatal Outcome; D004854:Herpesvirus 4, Human / Q000302:isolation & purification*; D006801:Humans; D007150:Immunohistochemistry; D007866:Leg / Q000473:pathology; D016403:Lymphoma, Large B-Cell, Diffuse / Q000473:pathology* / Q000821:virology; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use*; D009182:Mycosis Fungoides / Q000188:drug therapy* / Q000473:pathology* / Q000821:virology; D012878:Skin Neoplasms / Q000473:pathology* / Q000821:virology
chemical_list: D008727:Methotrexate