Epstein–Barr virus infection associated hepatic lymphoma in a patient treated with methotrexate for rheumatoid arthritis

Soubrier, Martin; Arrestier, Stéphanie; Bouloudian, Sarah; Dubost, Jean‐Jacques; Ristori, Jean‐Michel

doi:10.1016/j.jbspin.2005.06.005

Cited by 13 publications

(9 citation statements)

References 8 publications

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“…Watchful waiting before any indication of intervention should be initiated, and an active approach to eradicating pathogenic factors such as Helicobacter pylori infection should commence. The clinical physician also suggests a follow-up of 6 to 8 wk before starting chemotherapy, as regression of the tumor after MTX withdrawal was rapid[ 21 ]. Other subtypes were too rare to draw any conclusions, and thus they were treated empirically.…”

Section: Discussionmentioning

confidence: 99%

Clinical management and susceptibility of primary hepatic lymphoma: A cases-based retrospective study

Tao¹,

Zou²

2021

WJCC

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BACKGROUND The liver as a primary site of lymphoma is rarely seen, they are usually misdiagnosed as hepatocellular carcinoma, etc . In 2017, a review of primary hepatic lymphoma (PHL) was done in immunocompetent diffuse large B-cell lymphoma (DLBCL) patients. Yet questions that include treatment choosing or susceptibility of immunoincompetent patients remain disputable. AIM To investigate the clinical characteristics of patients with PHL. METHODS We collected PHL cases on PubMed, and extracted demographic and clinicopathological data to perform a systematic analysis. Survival analysis regarding age, lactate dehydrogenase (LDH), liver function abnormality (LFA), and treatment modalities were conducted. The Kaplan-Meier method and Cox regression were used to identify risk factors. RESULTS Of 116 PHL patients with DLBCL (62.1%) as the most common subtype. Biopsy methods before surgery produced a 97% positive rate. Progression-free survival (PFS) was significantly shortened in patients with elevated LDH [Hazard ratio (HR): 3.076, 95% confidence interval (CI): 1.207-7.840, P = 0.018] or LFA (HR: 2.909, 95%CI: 1.135-7.452, P = 0.026). Univariate Cox regression analysis suggesting that LDH, liver function, B symptom, hepatosplenomegaly, and lesion were significantly associated with PHL patients survival ( P < 0.05). Heavy disease burden was observed in deceased patients. A few PHL patients (3.4%) have slightly higher tumor markers. CONCLUSION PHL patients with elevated LDH and LFA tend to have shorter PFS. Biopsy before treatment in undecided patients with no tumor markers exceeds upper limits has the most essential clinical significance, especially in immunoincompetent patients.

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Section: Discussionmentioning

confidence: 99%

Clinical management and susceptibility of primary hepatic lymphoma: A cases-based retrospective study

Tao¹,

Zou²

2021

WJCC

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“…MTX‐LPD may resolve in several weeks after withdrawal of the MTX therapy 17 . However, additional treatments, such as chemotherapy and radiotherapy, should be considered for patients with persistent LPD after MTX withdrawal 18 . Therefore, definitive diagnostic criteria are lacking, and a definitive diagnosis of MTX‐LPD remains challenging.…”

Section: Discussionmentioning

confidence: 99%

“…17 However, additional treatments, such as chemotherapy and radiotherapy, should be considered for patients with persistent LPD after MTX withdrawal. 18 Therefore, definitive diagnostic criteria are lacking, and a definitive diagnosis of MTX-LPD remains challenging. As in this case, if there are no lymph node lesions, and the diagnostic criteria for ONJ are met, there is a possibility of the misdiagnosis of ARONJ.…”

Section: Discussionmentioning

confidence: 99%

Intraoral localized methotrexate‐associated lymphoproliferative disorders concurrent with antiresorptive agent‐related osteonecrosis of the jaw: A case report and literature review

Minabe

Suzuki

Komatsu

et al. 2020

Clinical Case Reports

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“…Primary hepatic lymphoma is very rare and accounts for 0.4% of extranodal non-Hodgkin’s lymphoma and 0.016 to 0.06% of all non-Hodgkin’s lymphoma [1, 4]. To date, there have only been ten cases of hepatic MTX-LPD reported in the English literature by PubMed [1–3, 5–11]. We reviewed all 11 cases including the present case (Table 2).…”

Section: Discussionmentioning

confidence: 99%

“…Regarding treatments, to the best of our knowledge, there is no established standard method of treatment for MTX-LPD [5]. Discontinuance of MTX was done in all 11 cases.…”

Section: Discussionmentioning

confidence: 99%

Hepatic methotrexate-associated lymphoproliferative disorders identified by multiple liver tumors: a case report and review of the literature

et al. 2019

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Background Methotrexate, an immunosuppressant, is widely used as the standard therapeutic drug for rheumatoid arthritis. With the increasing frequency of use of methotrexate, adverse effects of methotrexate have been reported, one of which is known as methotrexate-associated lymphoproliferative disorders. The etiology of hepatic methotrexate-associated lymphoproliferative disorders remains largely unknown. To date, there have only been ten cases of hepatic methotrexate-associated lymphoproliferative disorders reported in the English literature and a case report is very rare. Case presentation An 82-year-old Japanese man with rheumatoid arthritis treated with methotrexate presented with fever. Contrast-enhanced computed tomography showed multiple hypovascular nodules in his liver, spleen, and lung, and para-aortic lesions. Endoscopic ultrasound-guided fine-needle aspiration biopsy for liver tumors was performed, and pathological results identified cluster of differentiation 20-positive lymphocytes. Discontinuance of methotrexate led to regression of the nodules and a final definitive diagnosis of methotrexate-associated lymphoproliferative disorders was made. Conclusions We review 11 reported cases of hepatic methotrexate-associated lymphoproliferative disorders including the present case. Physicians should discontinue methotrexate in patients with rheumatoid arthritis treated with methotrexate when elevated soluble interleukin-2 receptor and hypovascular lesions in contrast-enhanced computed tomography are confirmed considering the possibility of methotrexate-associated lymphoproliferative disorders.

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Epstein–Barr virus infection associated hepatic lymphoma in a patient treated with methotrexate for rheumatoid arthritis

Cited by 13 publications

References 8 publications

Clinical management and susceptibility of primary hepatic lymphoma: A cases-based retrospective study

Clinical management and susceptibility of primary hepatic lymphoma: A cases-based retrospective study

Intraoral localized methotrexate‐associated lymphoproliferative disorders concurrent with antiresorptive agent‐related osteonecrosis of the jaw: A case report and literature review

Hepatic methotrexate-associated lymphoproliferative disorders identified by multiple liver tumors: a case report and review of the literature

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