Methotrexate-related Primary Hepatic Lymphoma in a Patient with Rheumatoid Arthritis

Abstract

A 56-year-old woman with rheumatoid arthritis treated with methotrexate (MTX) was admitted to our hospital due to multiple liver tumors. Contrast-enhanced computed tomography (CT) revealed multiple hypovascular masses, and 18F-fluorodeoxyglucose positron emission tomography CT showed diffuse abnormal accumulation in the liver only. We therefore made a diagnosis of MTX-related primary hepatic lymphoma (MTX-PHL) exhibiting features of diffuse large B-cell lymphoma. Although MTX has been reported to increase the risk of lymphoproliferative disorders, MTX-PHL has not been reported previously. The present case is the first case in which MTX appears to have been involved in the development of PHL.

Abdominal Ultrasound Findings of Tumor-Forming Hepatic Malignant Lymphoma

“…The clinical characteristics of the present cohort are shown in Table 1 (median age 70 years, interquartile range 58-81 years; 15 males, 10 females; 7 primary, 18 secondary; 6 HCV, 5 HBV, 14 no liver disease; diffuse large B-cell lymphoma [DLBCL], n = 13, DLBCL + mucosa-associated lymphoid tissue, n = 2, mucosa-associated lymphoid tissue [11] , n = 2, Hodgkin's lymphoma, n = 2, B-cell lymphoma [details unknown], n = 2, DLBCL + methotrexateassociated lymphoproliferative disorders [MTX-LPD], n = 1, T-cell lymphoma + MTX-LPD, n = 1, adult T-cell lymphoma, n = 1, MTX-LPD [12] , n = 1). The median tumor size was 26 mm (interquartile range 17-50 mm).…”

Hypercalcemia due to Primary Hepatic Lymphoma

“…PHL more commonly occurs in the fifth decade of life and is three times more common in males [13]. Laboratory tests can help differentiate between hepatocellular carcinoma and PHL; ALP and LDH are typically elevated while AFP and CEA are within normal ranges as was the case in our patient [3, 6].…”

“…Of note, HCV is reported in 40–60% of cases [6]. As far as immunosuppressive therapy is concerned, PHL has been well described in patients prescribed methotrexate for rheumatoid arthritis [13]. …”

Methotrexate-associated primary hepatic malignant lymphoma following hepatectomy: A case report

“…To date, only a few reports of MTX associated with PHL were seen [1], [2], [7] (Table 1). In all cases, the pathological diagnosis was DLBCL.…”

“…The incidence of PHL was reported to be less than 1% among extranodular lymphoma cases [1]. Recently, along with the introduction of methotrexate (MTX) usage for rheumatoid arthritis (RA) treatment, MTX-related malignant lymphoma cases have been increasing [2]. RA patients are susceptible to develop malignant lymphoma (ML).…”