title: Methotrexate-associated orbital lymphoproliferative disorder in a patient with rheumatoid arthritis: a case report.
abstract: OBJECTIVE
  Lymphoproliferative disorders (LPDs) can develop in patients treated with methotrexate (MTX) and usually respond well to MTX withdrawal. Mucosa-associated lymphoid tissue (MALT) lymphoma is a relatively rare type of MTX-LPD. The development of MTX-LPD in the orbit has not been previously described. We here report a case of orbital MALT lymphoma that disappeared after MTX withdrawal in a patient treated with MTX for rheumatoid arthritis.
  
  
  METHODS
  A 78-year-old woman who complained of swelling of the left upper eyelid had been treated with MTX for >8 years for rheumatoid arthritis. Slit-lamp examination revealed a temporal subconjunctival mass, salmon pink in color, in the left eye. Fundus photographs also suggested the presence of a temporal tumor in the left orbit. [(18)F]Fluorodeoxyglucose positron emission tomography-computed tomography revealed highly integrated lesions in the left inferotemporal orbit and a left external iliac lymph node, a left obturator lymph node, and an inguinal lymph node. Pathologic analysis of a tumor biopsy specimen showed small- and medium-sized lymphocytes positive for CD20, MIB-1, and bcl-2 and negative for CD10, CD3, bcl-1, IgG4, and EBV-ISH. On the basis of these findings, we diagnosed the tumor as MTX-induced MALT lymphoma. The subconjunctival and orbital masses disappeared gradually over 10 months after MTX withdrawal and did not recur within 2 years.
  
  
  CONCLUSIONS
  This case of orbital MTX-LPD suggests that the possibility of MTX-LPD should be considered even for ocular tumors in patients treated with MTX.
authors.affiliation: Department of Ophthalmology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8585, Japan.|Department of Ophthalmology, Ogori Daiichi General Hospital, Yamaguchi, Yamaguchi, Japan.
authors.forename: Yuka
authors.initials: Y
authors.lastname: Kobayashi
authors.affiliation: Department of Ophthalmology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8585, Japan. k.kimura@yamaguchi-u.ac.jp.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Kimura
authors.affiliation: Department of Ophthalmology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8585, Japan.
authors.forename: Youichiro
authors.initials: Y
authors.lastname: Fujitsu
authors.affiliation: Department of Ophthalmology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8585, Japan.
authors.forename: Kuniisa
authors.initials: K
authors.lastname: Shinkawa
authors.affiliation: Department of Pathology, Kurume University Graduate School of Medicine, Fukuoka, Kurume, Japan.
authors.forename: Hiroko
authors.initials: H
authors.lastname: Muta
authors.affiliation: Department of Ophthalmology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8585, Japan.
authors.forename: Koh-Hei
authors.initials: KH
authors.lastname: Sonoda
mesh_terms: D000368:Aged; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008232:Lymphoproliferative Disorders / Q000139:chemically induced* / Q000175:diagnosis; D008727:Methotrexate / Q000009:adverse effects* / Q000627:therapeutic use; D009916:Orbital Diseases / Q000139:chemically induced* / Q000175:diagnosis; D049268:Positron-Emission Tomography; D014057:Tomography, X-Ray Computed
chemical_list: D018501:Antirheumatic Agents; D008727:Methotrexate
keywords: Malignant lymphoma; Methotrexate-associated lymphoproliferative disorder (MTX-LPD); Mucosa-associated lymphoid tissue (MALT) lymphoma; Orbital lymphoma; Rheumatoid arthritis