Three Cases of Methotrexate-associated Lymphoproliferative Disorder (MTX-LPD)

Abstract

Methotrexate (MTX) has been increasingly administered to patients with rheumatoid arthritis (RA), resulting in methotrexate-associated lymphoproliferative disorder (MTX-LPD) in patients. We reported three case of rheumatoid arthritis (RA) undergoing methotrexate (MTX) therapy who developed MTX-LPD. A 72-year-old woman treated with MTX since December 1997 (total dose 3684 mg) presented with swelling of the right tonsil in October 2006, and diffuse large B-cell lymphoma was diagnosed by tonsil biopsy and positive EBER1. When MTX therapy was interrupted, the tonsil was shrank and chemotherapy was not necessary. She followed a good clinical course for 12 months. Two other patients treated with MTX for RA for several years presented with enlarged neck lymph nodes and were diagnosed with MTX-LPD. Neck lymph nodes shrank upon MTX withdrawal in several weeks. There have been no signs of recurrence in these cases and they followed a good clinical course. The oncogenic potential of MTX and RA is reviewed.

Spontaneous regression of breast lymphoproliferative disorders after withdrawal of methotrexate in rheumatoid arthritis patients with Epstein–Barr virus infection: a case report and review of the literature

“…This patient with latency type III tumor also had similar regression results. On the contrary, Ishida et al interestingly reported EBV-positive MTX-LPD diagnosed in a swollen tonsil biopsy [ 16 ]. It spontaneously regressed after withdrawal of MTX, and the follow-up specimens from the tonsil became EBV-negative and free of LPD.…”

A Case of Methotrexate-Associated Lymphoproliferative Disorder After Resection of an Accidentally Detected Enlarged Thyroid Tumor

“…Compared to other lymphomas, lymphomas due to MTX-LPD tend to manifest more frequently as extranodal lesions and are common in the gastrointestinal tract, skin, lungs, and soft tissues. In the head and neck regions, such lymphomas are seen in the cervical lymph nodes and tonsils; as extranodal lesions, they have been seen in the salivary glands, thyroid glands, and tooth buds [3,6,[9][10][11][12]. The histopathological presentations of MTX-LPD are diverse, with the most common diffuse large B-cell lymphoma accounting for 35%-60% of cases, followed by Hodgikin lymphoma and follicular lymphoma, which account for 12%-25% and 5%-10%, respectively [3-6, 10, 13].…”

Methotrexate-associated lymphoproliferative disorder with multiple pulmonary nodules and bilateral cervical lymphadenopathy

“…The skin, lungs, gastrointestinal tract, spleen, oral cavity, and kidneys may be involved as the extranodal LPD sites [3]. In the head and neck regions, the palatine tonsil, epipharynx, gingiva, tongue, salivary gland, thyroid gland, and nasal cavity have also been reported as the extranodal LPD sites [4,5,8].…”