Clinicopathological analysis of 34 Japanese patients with EBV-positive mucocutaneous ulcer

Ikeda, Tomoka; Gion, Yuka; Sakamoto, Misa; Tachibana, Tomoyasu; Nishikori, Asami; Nishimura, M.; Yoshino, Tadashi; Sato, Yasuharu

doi:10.1038/s41379-020-0599-8

Cited by 51 publications

(93 citation statements)

References 28 publications

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“…Several previous studies of EBVMCU in the context of MTX-LPD reported good clinical outcomes associated with this diagnosis. 17,[19][20][21] Of note, the incidence of EBVMCU in association with MTX-LPD is higher than that of age-related EBVMCU. 17 The mechanism underlying the markedly high rate of spontaneous regression in response to drug discontinuation among patients in this specific MTX-LPD cohort remains unclear.…”

Section: Discussionmentioning

confidence: 99%

“…17,[19][20][21] Of note, the incidence of EBVMCU in association with MTX-LPD is higher than that of age-related EBVMCU. 17 The mechanism underlying the markedly high rate of spontaneous regression in response to drug discontinuation among patients in this specific MTX-LPD cohort remains unclear. Among the possibilities, EBV-positive MTX-LPD may be associated with significant impairment of cytotoxic T-cell function due to the combined effects of RA and MTX.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…15,16 EBVMCUs develop most frequently in patients with age-related immune-senescence or who have experienced iatrogenic immunosuppression; this condition is associated with a good prognosis. Although EBVMCU is a common subtype of MTX-LPD and is likely to regress after discontinuation of the drug, 17 its definition is unclear. 11 We occasionally treat patients with MTX-LPD who do not develop ulcers but exhibit diffuse tumorous swelling of the gingiva, as previously described by Ishida et al 18 Gingival histology included the proliferation of EBV-positive large-sized B-cells, similar to the histology typically associated with EBVMCU.…”

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confidence: 99%

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Clinicopathological evaluation of methotrexate-associated lymphoproliferative disorders with special focus on Epstein-Barr virus-positive mucocutaneous lesions

Shiraiwa

Kikuti

Carreras

et al. 2020

JCEH

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Methotrexate-associated lymphoproliferative disorder (MTX-LPD) was initially described by Ellemans et al. in 1991, who documented a patient who developed lymphoma during immunosuppressant treatment for autoimmune disease. 1 MTX-LPD is now recognized as an important clinical entity and includes many lymphomas that develop in patients undergoing MTX treatment for rheumatoid arthritis (RA). In 2017, the World Health Organization (WHO) subclassified this diagnosis within "other iatrogenic immunodeficiencyassociated lymphoproliferative disorders" as part of a larger category of immunodeficiency-associated lymphoproliferative disorders. 2 MTX has been used as a first-line drug for RA in Japan since 1999; this drug is currently regarded as the most effective treatment for 0.6-1 million RA patients. 3,4 RA patients are likely to develop lymphoma at a 2-4-times higher rate than that observed in the general population; RA patients undergoing treatment with MTX are 1.7-times more likely to develop LPD than those not treated using this immunomodulatory drug. 5,6 Although MTX itself is not believed to promote the development of LPDs in patients with RA, disease activity associated with this diagnosis together with MTXmediated immune suppression may induce its development. 7 The incidence of MTX-LPD is currently higher in Japan than in the United States or Europe. 8,9 There are several published reports documenting the clinicopathological characteristics of MTX-LPD in Japan. MTX-LPD includes several characteristic histological

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Clinicopathological evaluation of methotrexate-associated lymphoproliferative disorders with special focus on Epstein-Barr virus-positive mucocutaneous lesions

Shiraiwa

Kikuti

Carreras

et al. 2020

JCEH

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“…In previous cases where CHL is identified within the GI tract, it has been linked to clinical histories such as non-Hodgkin lymphoma, inflammatory bowel disease, and immunosuppression [ 3 , 4 ]. A newly described entity, Epstein-Barr virus-positive mucocutaneous ulcer (EBVMCU), shows features which overlap with CHL [ 5 , 6 ]. Differentiation of these two diagnoses is critical for guiding appropriate treatment decisions as EBVMCU may respond to reduction in immunosuppressant while CHL may need chemotherapy.…”

Section: Introductionmentioning

confidence: 99%

Classical Hodgkin Lymphoma Presenting as a Sigmoid Mass

et al. 2021

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Primary classical Hodgkin lymphoma (CHL) in the colon is exceedingly rare and shares many histologic features with other lymphoproliferative disorders in the gastrointestinal tract. Here we report a case of CHL forming a sigmoid mass. An elderly man with a past medical history of mantle cell lymphoma presented with constipation. Imaging revealed an ulcerated, circumferential mass in the sigmoid colon. Endoscopic biopsy of the mass showed ulcerated colonic mucosa with an underlying diffuse mixed inflammatory infiltrate admixed with Hodgkin and Reed-Sternberg cells. Immunohistochemistry was performed to characterize these cells. They were weakly positive for Pax-5, strongly positive for CD30, variably positive for CD15, and negative for CD45, CD20, CD3, and SOX-11. In situ hybridization was positive for Epstein-Barr virus (EBV) and negative for cytomegalovirus or herpes simplex virus. This immunophenotype is diagnostic for CHL in the clinical context of a large mass. It is not possible in this case to determine whether this is de novo CHL or progression from a precursor lesion like EBV-positive mucocutaneous ulcer. Since diagnosis, this patient underwent colectomy followed by chemotherapy and has remained in complete remission.

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Cutaneous B‐cell lymphomas: 2023 update on diagnosis, risk‐stratification, and management

2023

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Disease Overview Approximately one‐fourth of primary cutaneous lymphomas are B‐cell derived and are generally classified into three distinct subgroups: primary cutaneous follicle center lymphoma (PCFCL), primary cutaneous marginal zone lymphoma (PCMZL), and primary cutaneous diffuse large B‐cell lymphoma, leg type (PCDLBCL, LT). Diagnosis Diagnosis and disease classification is based on histopathologic review and immunohistochemical staining of an appropriate skin biopsy. Pathologic review and an appropriate staging evaluation are necessary to distinguish primary cutaneous B‐cell lymphomas from systemic B‐cell lymphomas with secondary skin involvement. Risk‐Stratification Disease histopathology remains the most important prognostic determinant in primary cutaneous B‐cell lymphomas. Both PCFCL and PCMZL are indolent lymphomas that infrequently disseminate to extracutaneous sites and are associated with 5‐year survival rates that exceed 95%. In contrast, PCDLBCL, LT is an aggressive lymphoma with an inferior prognosis. Risk‐Adapted Therapy PCFCL and PCMZL patients with solitary or relatively few skin lesions may be effectively managed with local radiation therapy. While single‐agent rituximab may be employed for patients with more widespread skin involvement, multiagent chemotherapy is rarely appropriate. In contrast, management of patients with PCDLBCL, LT is comparable to the management of patients with systemic DLBCL.

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Clinicopathological analysis of 34 Japanese patients with EBV-positive mucocutaneous ulcer

Cited by 51 publications

References 28 publications

Clinicopathological evaluation of methotrexate-associated lymphoproliferative disorders with special focus on Epstein-Barr virus-positive mucocutaneous lesions

Clinicopathological evaluation of methotrexate-associated lymphoproliferative disorders with special focus on Epstein-Barr virus-positive mucocutaneous lesions

Classical Hodgkin Lymphoma Presenting as a Sigmoid Mass

Cutaneous B‐cell lymphomas: 2023 update on diagnosis, risk‐stratification, and management

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