title: Methotrexate-associated lymphoproliferative disorder presenting as extranodal NK/T-cell lymphoma arising in the lungs.
abstract: Patients having rheumatoid arthritis (RA) treated with methotrexate (MTX) are at an increased risk of developing lymphoproliferative disorder (LPD). Epstein-Barr virus (EBV) sometimes contributes to the development of MTX-associated LPD. Herein, we report the case of a 64-year-old Japanese woman with RA who showed complications of EBV-positive MTX-associated LPD. This case is exceedingly rare in that the LPD was confined to the lungs and its subclassification was extranodal NK/T-cell lymphoma. Only four cases of extranodal NK/T-cell lymphoma in the setting of MTX-associated LPD have ever been reported in the English language literature, only one of which was an extranasal NK/T-cell lymphoma, similar to our case. Extranasal NK/T-cell lymphomas show more aggressive behavior than nasal NK/T-cell lymphomas, possibly reflected by the considerable re-exacerbation of the lesions in only two months after the cessation of MTX in our case. However, the SMILE regimen (steroid, methotrexate, ifosfamide, l-asparaginase, and etoposide) was able to suppress tumor growth in this case.
authors.affiliation: Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Shogo
authors.initials: S
authors.lastname: Tajima
authors.affiliation: Department of Chest Surgery, Fujieda Municipal General Hospital, Shizuoka, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Takanashi
authors.affiliation: Department of Pathology, Fujieda Municipal General Hospital, Shizuoka, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Koda
authors.affiliation: Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Fukayama
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000188:drug therapy*; D001215:Asparaginase / Q000627:therapeutic use; D003937:Diagnosis, Differential; D020031:Epstein-Barr Virus Infections / Q000150:complications* / Q000821:virology; D005047:Etoposide / Q000627:therapeutic use; D005260:Female; D004854:Herpesvirus 4, Human / Q000502:physiology*; D006801:Humans; D007069:Ifosfamide / Q000627:therapeutic use; D054391:Lymphoma, Extranodal NK-T-Cell / Q000150:complications / Q000473:pathology*; D008232:Lymphoproliferative Disorders / Q000150:complications / Q000473:pathology* / Q000821:virology; D008727:Methotrexate / Q000009:adverse effects* / Q000627:therapeutic use; D008875:Middle Aged; D012306:Risk; D013256:Steroids / Q000627:therapeutic use
chemical_list: D000970:Antineoplastic Agents; D013256:Steroids; D005047:Etoposide; D001215:Asparaginase; D007069:Ifosfamide; D008727:Methotrexate
keywords: NK/T-cell lymphoma; extranodal lung; lymphoproliferative disorder; methotrexate; rheumatoid arthritis