title: A case of multiple hepatic lesions associated with methotrexate-associated lymphoproliferative disorder.
abstract: Patients receiving methotrexate (MTX) for the treatment of autoimmune disease are at a high risk of developing lymphoproliferative disorders (LPD), the so-called methotrexate-associated lymphoproliferative disorders (MTX-LPD). We recently performed abdominal ultrasonography (US) in a patient with rheumatoid arthritis (RA) who had developed hepatic dysfunction during the course of MTX therapy; the examination revealed multiple well-demarcated hepatic tumors with slightly irregular borders, the largest one measuring 9 cm in diameter. In view of the finding of portal and hepatic veins perforating the tumor, we suspected a diagnosis of malignant lymphoma and performed a hepatic tumor biopsy. Histopathological examination of the biopsy specimens revealed a diagnosis of diffuse large B-cell lymphoma, and we made a final diagnosis of MTX-LPD. MTX treatment was discontinued, which resulted in rapid resolution of the lesions. Resolution of MTX-LPD can be obtained just by discontinuation of MTX treatment. In patients receiving MTX therapy who are found to have hepatic tumors perforated by the portal vein and/or hepatic vein on abdominal US, it is advisable to perform hepatic tumor biopsy to facilitate differential diagnosis of MTX-LPD and enable a definite diagnosis.
authors: Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan.|Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan.
authors: Ruby
authors: R
authors: Matsumoto
authors: Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan. kz-numa@urahp.yokohama-cu.ac.jp.
authors: Kazushi
authors: K
authors: Numata
authors: Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan.
authors: Nobutaka
authors: N
authors: Doba
authors: Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan.
authors: Koji
authors: K
authors: Hara
authors: Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan.
authors: Makoto
authors: M
authors: Chuma
authors: Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan.
authors: Hiroyuki
authors: H
authors: Fukuda
authors: Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan.
authors: Akito
authors: A
authors: Nozaki
authors: Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan.
authors: Katsuaki
authors: K
authors: Tanaka
authors: Department of Hematology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan.
authors: Yoshimi
authors: Y
authors: Ishii
authors: Division of Gastroenterology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan.
authors: Shin
authors: S
authors: Maeda
mesh_terms: D018501:Antirheumatic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy; D005500:Follow-Up Studies; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000187:drug effects / Q000601:surgery; D008113:Liver Neoplasms / Q000097:blood / Q000139:chemically induced* / Q000150:complications / Q000000981:diagnostic imaging; D016403:Lymphoma, Large B-Cell, Diffuse / Q000097:blood / Q000139:chemically induced* / Q000150:complications / Q000000981:diagnostic imaging; D008232:Lymphoproliferative Disorders / Q000097:blood / Q000139:chemically induced* / Q000150:complications / Q000000981:diagnostic imaging; D008297:Male; D008727:Methotrexate / Q000009:adverse effects* / Q000627:therapeutic use; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging
chemical_list: D018501:Antirheumatic Agents; D008727:Methotrexate
keywords: Diffuse large B-cell lymphoma; Epstein-Barr virus; Methotrexate-associated lymphoproliferative disorder; Primary hepatic lymphoma; Rheumatoid arthritis; Ultrasonography