Malignant Lymphoma in Patients With Rheumatic Diseases Other Than Sjogren's Syndrome: A Clinicopathologic Study of Five Cases and a Review of the Japanese Literature

Abstract

We conducted clinicopathologic and immunohistochemical analysis of five patients with malignant lymphoma complicating rheumatic diseases other than Sjögren's syndrome, and reviewed 26 cases of similar lesions reported in the Japanese literature over a 17-year period. All five patients were women ranging in age from 31 to 74 years (mean 55 years). Two of them fulfilled the diagnostic criteria for systemic lupus erythematosus, two for dermatomyositis and one for progressive systemic sclerosis. The use of immunosuppressive drugs before the onset of malignant lymphoma was recorded in four patients. All the biopsied or resected specimens showed non-Hodgkin's lymphoma of B-cell phenotype. Three were nodal in origin (one diffuse mixed, one diffuse large cell and one immunoblastic) and two were extranodal (one low-grade B-cell lymphoma of mucosa-associated lymphoid tissue and one diffuse large cell). In three of four cases examined, Epstein-Barr virus-encoded small RNAs were identified in a small to large number of the lymphoma cells by in situ hybridization. Our study showed that the clinicopathological features of malignant lymphomas complicating rheumatic disease in Japan were similar to those in England and the USA. Furthermore, our findings suggested no evidence for a causative association between iatrogenic immunosuppression due to methotrexate therapy and the development of EBV-related lymphoid neoplasms.

Lymphome B cutané au cours d’une sclérodermie systémique

“…Bien que rares, des observations troublantes de corré lation é volutive é troite entre sclé rodermie systé mique et lymphome font suspecter la ré alité du syndrome parané oplasique [8]. En effet, la sclé rose cutané e progresse rapidement lors du dé veloppement du lymphome, et elle ré gresse aprè s la ré mission de la lymphopathie sous l'effet de la chimiothé rapie [5,9,17,22,24]. Il est cependant impossible d'é carter la responsabilité directe de la chimiothé rapie sur la sclé rodermie systé mique, en particulier le cyclophosphamide et les sté roïdes qui peuvent amé liorer certaines atteintes viscé rales de cette connectivite [8].…”

Polymyositis, Pulmonary Fibrosis and Malignant Lymphoma Associated with Hepatitis C Virus Infection.

“…In the present case, pathological findings were consistent with lymphomaof the large cell type. This type of lymphomahas been reported in 50%of patients with rheumatoid diseases, and lymphoid neoplasm has been reported in somecases of rheumatoid disease (23). Moreover, HCVinfection should be considered in polymyositis patients with risk factors for infection with HCV, such as elevated muscle enzyme levels, or pulmonary fibrosis (24).…”

Rheumatoid arthritis and malignancies

“…Метаанализ показал вдвое большую вероят-ность лимфоидных опухолей при этом забо-левании (ОР=2,1; 95% ДИ 1,8-2,4) [11]. Сред-няя длительность РА до диагностики лимфом составила 15-20 лет [2,12,13].…”

“…У пациентов с РА преобладают (до 70-78%) В-клеточные лимфопролифератив-ные заболевания [12,13]. Чаще наблюдают-ся нодальные лимфомы [12].…”

“…Чаще наблюдают-ся нодальные лимфомы [12]. Что касается типов лимфом, исследования и серии случа-ев лимфом, ассоциированных с РА, указыва-ют на увеличенное соотношение В-клеточ-ных крупноклеточных лимфом (В-ККЛ) вы-сокой степени злокачественности, доля ко-торых составляет от 50 до 67% [12][13][14][15][16][17][18].…”