Primary central nervous system malignant lymphoma in a patient with rheumatoid arthritis receiving low-dose methotrexate treatment

Katayama, Yoichi; Yokose, Noriaki; Kura, Yurie; Sawada, Umihiko; Kotani, Akio; Yoshino, Atsuo

doi:10.3109/02688697.2013.798857

Cited by 17 publications

(26 citation statements)

References 2 publications

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“…Scattered cases of immunodeficiency-related PCNSL have been reported in patients with rheumatoid arthritis (RA), myasthenia gravis, and Crohn disease. [ 3 – 5 ]…”

Section: Discussionmentioning

confidence: 99%

Primary central nervous system lymphoma in a patient with systemic lupus erythematosus mimicking high-grade glioma

Ding²,

Chen³

et al. 2018

Medicine

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Rationale:Primary central nervous system lymphoma (PCNSL) is a rare disease. Studies of PCNSL in patients with rheumatic diseases are lacking. Neither clinical symptoms nor radiographic manifestation is specific to PCNSL. Therefore, it could be misdiagnosed with other diseases such as brain tumors. Chemotherapy is the primary treatment for PCNSL, while the role of surgery remains controversial.Patient concerns:We reported a 39-year-old woman with systemic lupus erythematosus (SLE) developed PCNSL after 15-year treatment with multiple immunosuppressants.Diagnoses:Cranial magnetic resonance imaging (MRI) showed multi-focal lesions with ring-like enhancement post-contrast in the right hemisphere, which mimicked glioma radiographically. Owing to the severe symptoms of intracranial hypertension, gross tumor resection was performed. Pathological exam showed perivascular infiltration of atypical lymphoid cells with CD20 and Epstein-Barr virus (EBV) -encoded RNA (EREB) positive. The patient was diagnosed with diffuse large B-cell lymphoma (DLBCL).Interventions:The patient received six cycles of chemotherapy and autologous stem cell transplantation (ASCT) subsequently.Outcomes:The patient remained complete remission until this article was written.Lessons:PCNSL in immunocompromised hosts may present heterogeneous contrast enhancement, which should be differentiated from other diseases especially high-grade glioma.

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“…Scattered cases of immunodeficiency-related PCNSL have been reported in patients with rheumatoid arthritis (RA), myasthenia gravis, and Crohn disease. [ 3 – 5 ]…”

Section: Discussionmentioning

confidence: 99%

Primary central nervous system lymphoma in a patient with systemic lupus erythematosus mimicking high-grade glioma

Ding²,

Chen³

et al. 2018

Medicine

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“…Of the eight cases of cerebral MTX-LPD, seven (including our case) presented as multiple lesions; only one case presented as a solitary lesion. 7 , 8 , 10 , 11 , 13 – 15) One case with medullary LPD presented with a solitary mass, 9) and a case with hypertrophy of the dura mater presented as intravascular large B-cell lymphoma (IVLBCL). 12) …”

Section: Discussionmentioning

confidence: 99%

“…In one EBER + case (Case 2), the lesions regrew after initially regressing when MTX was withdrawn and additional chemotherapy was performed. 8) The 2 EBER − patients (Cases 6 and 8) showed only partial or no regression after stopping MTX, and received additional chemotherapy. 12 , 14) In these three patients, MTX was included in additional chemotherapy regimens.…”

Section: Discussionmentioning

confidence: 99%

“… 12 , 14) In these three patients, MTX was included in additional chemotherapy regimens. 8 , 12 , 14) However, according to the 2016 update of the Japan College of Rheumatology recommendations for the use of MTX in patients with RA, LPD within the most recent 5 years is included in the contraindications for MTX. 29) Therefore, using MTX as additional LPD treatment should be avoided.…”

Section: Discussionmentioning

confidence: 99%

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Primary Central Nervous System Methotrexate-associated Lymphoproliferative Disorder in a Patient with Rheumatoid Arthritis: Case Report and Review of Literature

Uneda

Hirashita²,

Kanda³

et al. 2020

NMC Case Report Journal

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Methotrexate (MTX) is an immunosuppressor that is widely used to treat autoimmune diseases, including rheumatoid arthritis (RA). However, it can have serious adverse effects including a lymphoma: MTX-associated lymphoproliferative disorder (MTX-LPD). Extranodal lesions are common in MTX-LPD patients. However, MTX-LPD in the central nervous system (CNS) is extremely rare with few reported cases. Here, we describe a case of primary CNS MTX-LPD in a patient with RA, with a review of the literature. A 68-year-old woman who had received MTX for her RA for more than 10 years was referred to our hospital. Head magnetic resonance imaging (MRI) showed multiple lesions with heterogeneous contrast enhancement scattered throughout both hemispheres. As immunosuppression caused by MTX was suspected, MTX was discontinued, based on a working diagnosis of MTX-LPD. We performed an open biopsy of her right temporal lesion. Histopathologic examination showed atypical CD20+ lymphoid cells, leading to a definitive diagnosis of diffuse large B-cell lymphoma (DLBCL). In situ hybridization of an Epstein-Barr virus-encoded small RNA (EBER) was positive. Sanger sequencing confirmed that both MYD88 L265 and CD79B Y196 mutations were absent. The LPD regressed after stopping MTX. Follow-up head MRI at 8 months after surgery showed no evidence of recurrence. Although primary CNS MTX-LPD is extremely rare, it should be included in the differential diagnosis when a patient receiving MTX develops CNS lesions. Diagnosis by biopsy and MTX discontinuation are required as soon as possible.

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“…6) A few primary CNS lymphomas in patients with MTX-LPD were reported. [7][8][9][10][11][12][13] We report a RA patient who developed primary CNS lymphoma as MTX-LPD.…”

Section: Introductionmentioning

confidence: 99%

Primary Central Nervous System T-cell Lymphoma as Methotrexate-associated Lymphoproliferative Disorders: Case Report

Kawano

Kitamura

Higuchi

et al. 2021

NMC Case Report Journal

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We report a rare case of primary central nervous system (CNS) lymphoma as methotrexate-associated lymphoproliferative disorders (MTX-LPD). A 75-year-old woman who had been treated for rheumatoid arthritis (RA) with MTX for 3 years was admitted to our hospital complaining of unsteady gait, nausea, and vomiting. T2-weighted image of magnetic resonance imaging (MRI) showed multiple high intensity mass-like lesions including right lateral, frontal and temporal lobes, and right cerebellar hemisphere. We performed surgical biopsy, and the pathological and immunohistochemical examinations identified T-cell lymphoma. The tumor regressed and the symptoms were resolved soon after MTX withdrawal. Primary CNS lymphoma due to MTX-LPD is a rare disease and only eight cases including ours are reported.

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Primary central nervous system malignant lymphoma in a patient with rheumatoid arthritis receiving low-dose methotrexate treatment

Cited by 17 publications

References 2 publications

Primary central nervous system lymphoma in a patient with systemic lupus erythematosus mimicking high-grade glioma

Primary central nervous system lymphoma in a patient with systemic lupus erythematosus mimicking high-grade glioma

Primary Central Nervous System Methotrexate-associated Lymphoproliferative Disorder in a Patient with Rheumatoid Arthritis: Case Report and Review of Literature

Primary Central Nervous System T-cell Lymphoma as Methotrexate-associated Lymphoproliferative Disorders: Case Report

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