Vanishing Cardiac Tumor: Cardiac Involvement in Methotrexate-Associated Lymphoproliferative Disorders.
Vanishing Cardiac Tumor: Cardiac Involvement in Methotrexate-Associated Lymphoproliferative Disorders.
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消失的心脏肿瘤：甲氨蝶呤相关的淋巴细胞增殖性疾病的心脏受累。
DOI：
10.1161/circimaging.119.009689
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发表时间：
2019
期刊：
影响因子：
--
通讯作者：
Miura T.
中科院分区：
文献类型：
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作者：
Kishiue N;Yano T;Koyama M;Nishikawa R;Nagano N;Kouzu H;Kokubu N;Kawamura R;Muranaka A;Kikuchi S;Tsuchida A;Miura T.
类风湿关节炎与LPD频率增加有关，可能是由慢性炎症和使用免疫抑制剂介导的。MTX是类风湿性关节炎的锚定药物，已被认为是类风湿性关节炎患者LPD的有效促进剂，称为MTXLPD。1,2 MTXLPD没有组织学类型特异性，但弥漫性大b细胞淋巴瘤占MTX-LPD病例的一半以上。1,2 EBV基因组经常存在于MTX- lpd的淋巴瘤细胞中，这表明MTX通过EBV感染促进EBV阳性淋巴瘤的发生，这是由于类风湿关节炎患者对潜伏性EBV的免疫抑制或再激活。1,2重要的是，EBV基因组的存在和MTX停药后淋巴细胞的恢复被报道为回归的预测因素。1,3 MTX-LPD的结外累及比其他类型的恶性淋巴瘤更为频繁，MTX-LPD最常见的结外病变是肺，也有报道累及脑、脾、肝、扁桃体、直肠和牙龈。据我们所知，这是第一个描述MTX-LPD累及心脏的报告。有趣的是，一项早期的原位杂交研究显示，在9例移植后LPD尸检病例中，有4例在心外膜脂肪和心肌间质中发现了携带ebv的淋巴瘤细胞。4
Rheumatoid arthritis is associated with an increased frequency of LPD, possibly being mediated by chronic inflammation and use of immunosuppressants. 1 Treatment with MTX, an anchor drug for rheumatoid arthritis, has been recognized as a potent promoter of LPD in patients with rheumatoid arthritis, which is called MTXLPD. 1, 2 There is no histological type-specific for MTXLPD, but diffuse large B-cell lymphoma accounts for more than half of MTX-LPD cases. 1, 2 The EBV genome is frequently present in lymphoma cells of MTX-LPD, suggesting that MTX promotes EBV-positive lymphomas via EBV infection due to immunosuppression or reactivation of latent EBV in patients with rheumatoid arthritis. 1, 2 Importantly, the presence of EBV genome and lymphocyte recovery after MTX discontinuation were reported as predictive factors of regression. 1, 3 Extranodal involvement is more frequent in MTX-LPD than that in other types of malignant lymphomas, and the most common extranodal lesion affected by MTX-LPD is the lung and involvement of the brain, spleen, liver, tonsil, rectum, and gingiva has also been reported. 1, 2 To our knowledge, this report is the first to describe cardiac involvement in MTX-LPD. Interestingly, an earlier study using in situ hybridization showed EBV-bearing lymphoma cells in epicardial fat and the myocardial interstitium in 4 of 9 autopsy cases with post-transplant LPD. 4