Methotrexate-related lymphoproliferative disorder of the oral region in patients with rheumatoid arthritis

Unusual manifestation of methotrexate-associated lymphoproliferative disorder as a palatal mass

“…In a review article, Kondo et al 4 reported that the most characteristic local findings of oral LPDs were ulceration and pain. While oral cavity cases have been reported,4 6 8 9 there were only two previously reported cases of MTX-LPD occurring in the palate 4 9.…”

“…In most situations, MTX is still recommended as an anchor drug for RA,4 and several cases of MTX-associated lymphoproliferative disorder (MTX-LPD) have been reported 5 6. MTX-LPD is classified as ‘other iatrogenic immunodeficiency-associated LPD’ in the fourth edition of the WHO classification 6–8.…”

“…Of the LPDs reported in patients receiving MTX, 40%–50% are extranodal, occurring at sites such as the gastrointestinal tract, skin, liver, spleen, lung, kidney, adrenal gland, thyroid gland, bone marrow and central nervous system 7. Although MTX-LPD can occur at sites in the oral cavity, such as the gingiva, tongue and mouth floor,6 7 only a few cases of MTX-LPD in the palate have been reported 4 9…”

“…An association between LPDs and infection with Epstein-Barr virus (EBV) has been suggested 4. Approximately 30%–50% of cases of LPDs have been shown to be EBV positive 4 10 11.…”

“…An association between LPDs and infection with Epstein-Barr virus (EBV) has been suggested 4. Approximately 30%–50% of cases of LPDs have been shown to be EBV positive 4 10 11. Moreover, patients with spontaneous regression have a significantly higher rate of EBV positivity 12.…”