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Methotrexate‐associated lymphoproliferative disorder presenting as extranodal NK / T ‐cell lymphoma arising in the lungs
Author(s) -
Tajima Shogo,
Takanashi Yusuke,
Koda Kenji,
Fukayama Masashi
Publication year - 2015
Publication title -
pathology international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.73
H-Index - 74
eISSN - 1440-1827
pISSN - 1320-5463
DOI - 10.1111/pin.12346
Subject(s) - lymphoma , methotrexate , lymphoproliferative disorders , medicine , immunology , pathology
Patients having rheumatoid arthritis ( RA ) treated with methotrexate ( MTX ) are at an increased risk of developing lymphoproliferative disorder ( LPD ). E pstein– B arr virus ( EBV ) sometimes contributes to the development of MTX ‐associated LPD . Herein, we report the case of a 64‐year‐old J apanese 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 E nglish 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.