title: Methotrexate-associated lymphoproliferative disorder arising in the retromolar triangle and lung of a patient with rheumatoid arthritis.
abstract: We report an extremely rare case of massive methotrexate-associated lymphoproliferative disorder (MTX-LPD) arising in the retromolar triangle and lung of a patient with rheumatoid arthritis. The patient was a 75-year-old woman who was referred to our department because of severe pain associated with a unilateral ulcer on the left retromolar triangle. The tumor had an extranodal location in the retromolar triangle and in the right lung. A clinicopathologic examination found a lymphocytic infiltrate with increasingly atypical histopathologic features. Atypical large cells were strongly positive in Epstein-Barr virus-encoded small RNA in situ hybridization and in staining with CD20 antibodies. MTX-LPD was diagnosed based on the medical history and histopathologic results. The lesion responded well to withdrawal of MTX followed by R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) chemotherapy. There have been no signs of recurrence for 4 years since withdrawal of MTX.
authors.affiliation: Division of Oral and Maxillofacial Surgery, Ebina General Hospital, Ebina, Kanagawa, Japan; Oral and Maxillofacial Surgery, Department of Oral Restitution, Division of Oral Health Sciences, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan. Electronic address: Kumasa77@yahoo.co.jp.
authors.forename: Masanori
authors.initials: M
authors.lastname: Kudoh
authors.affiliation: Oral and Maxillofacial Surgery, Department of Oral Restitution, Division of Oral Health Sciences, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Harada
authors.affiliation: Division of Diagnostic Pathology, Ebina General Hospital, Ebina, Kanagawa, Japan.
authors.forename: Koshi
authors.initials: K
authors.lastname: Matsumoto
authors.affiliation: Division of Oral and Maxillofacial Surgery, Ebina General Hospital, Ebina, Kanagawa, Japan; Oral and Maxillofacial Surgery, Department of Oral Restitution, Division of Oral Health Sciences, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Yuriko
authors.initials: Y
authors.lastname: Sato
authors.affiliation: Oral and Maxillofacial Surgery, Department of Oral Restitution, Division of Oral Health Sciences, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Omura
authors.affiliation: Division of Oral and Maxillofacial Surgery, Ebina General Hospital, Ebina, Kanagawa, Japan; Oral and Maxillofacial Surgery, Department of Oral Restitution, Division of Oral Health Sciences, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Yoshimasa
authors.initials: Y
authors.lastname: Ishii
mesh_terms: D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D003520:Cyclophosphamide / Q000627:therapeutic use; D004317:Doxorubicin / Q000627:therapeutic use; D020031:Epstein-Barr Virus Infections / Q000150:complications; D005260:Female; D006801:Humans; D017403:In Situ Hybridization; D008232:Lymphoproliferative Disorders / Q000139:chemically induced* / Q000188:drug therapy; D008727:Methotrexate / Q000009:adverse effects*; D011241:Prednisone / Q000627:therapeutic use; D000069283:Rituximab; D014750:Vincristine / Q000627:therapeutic use
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D018501:Antirheumatic Agents; C571759:R-CHOP protocol; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone; D008727:Methotrexate