Methotrexate-associated Lymphoproliferative Disorder in the Liver Resembling Hepatocellular Carcinoma Treated with Transarterial Chemoembolization

Tsuruoka, Mio; Inoue, Jun; Kakazu, Eiji; Ninomiya, Masashi; Iwata, Takashi; Sano, Akitoshi; Masamune, Atsushi

doi:10.2169/internalmedicine.4787-20

Cited by 4 publications

(5 citation statements)

References 23 publications

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“…Most cases develop after long-term MTX administration. In the 11 previously reported cases of MTX-LPDs of hepatic origin, the average duration of MTX administration was 7.3 (range, 2 - 13) years ( Table 2 ) [ 5 - 15 ]. In our case, a primary hepatic OIIA-LPDs-associated tumor rapidly increased in size after an extremely short period of MTX administration.…”

Section: Discussionmentioning

confidence: 99%

Primary Hepatic Other Iatrogenic Immunodeficiency-Associated Lymphoproliferative Disorders After Methotrexate Therapy

Hatayama,

Sugiyama,

Murakami

et al. 2023

J Med Cases

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Prior reports described cases of lymphoproliferative diseases occurring after methotrexate (MTX) administration, which are called methotrexate-associated lymphoproliferative disorders (MTX-LPDs). It has become clear that these lymphoproliferative diseases also occur following treatment with other immunosuppressive drugs, and they have been termed as other iatrogenic immunodeficiency-associated lymphoproliferative disorders (OIIA-LPDs). In most of these cases, the duration of immunosuppressive drugs is very long, on the order of years. In the present study, we evaluated the development of lymphoproliferative disease despite the short duration of immunosuppressive treatment and determined the tumor doubling time. A 71-year-old woman was diagnosed with adult-onset Still’s disease. The patient was administered prednisone 30 mg per day starting on February 25, 2022 and MTX 6 mg per week starting 2 weeks later. Because she was a hepatitis B virus (HBV) carrier, nucleic acid analog therapy was also started to prevent HBV activation. Eight weeks later, biweekly tocilizumab was started. After 5 months of MTX administration, a solitary liver tumor measuring 37 × 32 mm 2 was detected. Three months later, repeat computed tomography revealed that the liver tumor had grown rapidly to 7 cm in diameter. We considered the possibility of OIIA-LPDs and stopped MTX therapy. Biopsy specimens of the liver tumor exhibited lymphocyte proliferation, which was consistent with OIIA-LPDs. The doubling time for tumor growth was 33 days. Despite withdrawing MTX for 6 weeks, the tumor continued to grow, and thus, the patient was referred to the hematology unit. In previously reported cases of MTX-LPDs of hepatic origin, the average duration of MTX administration was 7.3 (2 - 13) years. This report describes a primary hepatic OIIA-LPDs-associated tumor that rapidly increased in size after an extremely short period of MTX administration.

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Section: Discussionmentioning

confidence: 99%

Primary Hepatic Other Iatrogenic Immunodeficiency-Associated Lymphoproliferative Disorders After Methotrexate Therapy

Hatayama,

Sugiyama,

Murakami

et al. 2023

J Med Cases

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“…Additionally, given the heterogeneous pathology of MTX-LPD, multiple or repeated biopsy may be needed to establish a diagnosis [ 13 ]. Importantly, no association has been found between the duration and/or dose of MTX and MTX-LPD development [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Methotrexate-Associated Lymphoproliferative Disorder in a Patient with Psoriasis: A Case Report and Review of the Literature

Afonso

Roque

Almeida

et al. 2022

Case Reports in Hematology

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Iatrogenic immunodeficiency-associated lymphoproliferative disorders (LPDs) are heterogeneous clinicopathological entities developing in patients receiving immunosuppression. Outside the posttransplant setting, methotrexate (MTX), a drug commonly used for the treatment of autoimmune diseases, is an immunosuppressive agent frequently reported to be associated with LPD. MTX-associated LPD (MTX-LPD) includes a spectrum of lymphocytic proliferations, ranging from polyclonal hyperplasia to malignant lymphoma. MTX-LPD diagnosis can be challenging, as signs and symptoms are often nonspecific and may overlap with those of several other conditions, including exacerbation of the underlying autoimmune disease. Spontaneous regression of LPD after MTX discontinuation is characteristic of MTX-LPD, therefore avoiding chemotherapeutic intervention in a significant proportion of patients. Other cases, however, should receive chemotherapy.

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“…LPD are characterized by uncontrolled lymphocyte production, resulting in monoclonal lymphocytosis, lymphadenopathy, and bone marrow infiltration [ 42 ]. This disorder is often associated with MTX administration, suppressing immune surveillance [ 43 ]. Epstein–Barr virus is regarded as the primary causative agent in most MTX-LPD cases [ 42 ].…”

Section: Introductionmentioning

confidence: 99%

“…Pancreatic lesions are rarely reported. However, CT and MRI imaging reveal hypo-vascular liver masses and multiple lymphadenopathies [ 43 ] (Fig. 16 ).…”

Section: Introductionmentioning

confidence: 99%

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Key CT and MRI findings of drug-associated hepatobiliary and pancreatic disorders

Ichikawa,

Goshima

2023

Jpn J Radiol

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Obtaining an imaging diagnosis of various hepatobiliary and pancreatic disorders caused by certain drugs can often be challenging. Familiarity with these conditions may improve diagnostic accuracy and patient management. This review aimed to describe the imaging findings of drug-associated hepatobiliary and pancreatic disorders and identify suggestions for obtaining a correct diagnosis. We focused on relatively common disorders or those that can present with characteristic imaging findings, such as drug-induced acute hepatitis, sinusoidal obstruction syndrome, focal nodular hyperplasia-like lesions, hepatocellular adenoma, pseudocirrhosis, chemotherapy-associated steatohepatitis, amiodarone deposition in the liver, secondary iron overload, drug-induced pancreatitis, pancreatic enlargement after epoprostenol therapy, ceftriaxone-associated gallbladder pseudolithiasis, immune-related adverse events, and methotrexate-associated lymphoproliferative disorders.

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Methotrexate-associated Lymphoproliferative Disorder in the Liver Resembling Hepatocellular Carcinoma Treated with Transarterial Chemoembolization

Cited by 4 publications

References 23 publications

Primary Hepatic Other Iatrogenic Immunodeficiency-Associated Lymphoproliferative Disorders After Methotrexate Therapy

Primary Hepatic Other Iatrogenic Immunodeficiency-Associated Lymphoproliferative Disorders After Methotrexate Therapy

Methotrexate-Associated Lymphoproliferative Disorder in a Patient with Psoriasis: A Case Report and Review of the Literature

Key CT and MRI findings of drug-associated hepatobiliary and pancreatic disorders

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