Methotrexate-related lymphoproliferative disorder of the stomach in a patient with rheumatoid arthritis: a case of disease regression after methotrexate cessation
Methotrexate-related lymphoproliferative disorder of the stomach in a patient with rheumatoid arthritis: a case of disease regression after methotrexate cessation
复制标题
类风湿性关节炎患者与甲氨蝶呤相关的胃淋巴增殖性疾病：甲氨蝶呤停药后疾病消退一例
DOI：
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复制
发表时间：
2016
影响因子：
1
通讯作者：
K. Nagai
中科院分区：
文献类型：
--
作者：
K. Ikeda;Takefumi Nakamura;T. Kinoshita;M. Fujiwara;S. Uose;H. Someda;Takashi Miyoshi;Katsuhiro Io;K. Nagai
摘要
我们报告的情况下，一个78岁的妇女与蛋氨酸相关的胃淋巴组织增生性疾病（LPD）。患者有类风湿性关节炎（RA）病史，并接受甲氨蝶呤（MTX）治疗。内视镜检查发现胃部圆形隆起病灶，活检标本显示非典型淋巴样细胞增生。免疫组化结果显示，这些非典型细胞呈L-26阳性，而CD 3和EBER阴性。因此，我们诊断MTX相关的LPD表现出弥漫性大B细胞淋巴瘤的特征。使用18 F-氟脱氧葡萄糖（FDG）的正电子发射断层扫描-计算机断层扫描（PET-CT）联合显示，除了纵隔和左胸壁的FDG亲和力略有增加外，胃中的亲和力也增加。我们决定不开始化疗，但停止MTX给药，并使用内窥镜和PET-CT进行随访。停止MTX后的内镜检查显示升高的病变逐渐消退。停药6个月后PET-CT显示胃内FDG亲和力未增加。虽然在胃中观察到疾病消退，但PET-CT上其他FDG-亲合斑点保持不变。因此，我们进行了化疗作为额外的治疗。化疗后的PET-CT上，FDG-avid斑点保持不变超过1年，我们最终得出结论，它们是RA相关的炎性病变。在MTX相关LPD患者中，停止MTX可能是一种治疗选择，但根据临床病程进行仔细随访和化疗至关重要。
Abstract
We report the case of a 78-year-old woman with methotrexate-related gastric lymphoproliferative disorder (LPD). The patient had a history of rheumatoid arthritis (RA) and had been treated with methotrexate (MTX). Endoscopic examination revealed round elevated lesions in the stomach, and a biopsy specimen showed atypical lymphoid cell proliferation. Immunohistological study found these atypical cells to be positive for L-26 but not for CD3 or EBER. Therefore, we made a diagnosis of MTX-related LPD showing features of diffuse large B-cell lymphoma. Combined positron emission tomography-computed tomography (PET-CT) using 18F-fluorodeoxyglucose (FDG) showed increased avidity in the stomach in addition to slightly increased FDG-avidity in the mediastinum and left chest wall. We decided not to start chemotherapy but to discontinue administration of MTX, with follow-up using endoscopy and PET-CT. The endoscopic examinations after cessation of MTX demonstrated gradual regression of the elevated lesions. PET-CT 6 months after cessation showed no increased FDG avidity in the stomach. While disease regression was observed in the stomach, the other FDG-avid spots remained unchanged on PET-CT. Therefore, we performed chemotherapy as additional therapy. On PET-CT after chemotherapy, the FDG-avid spots remained unchanged for more than 1 year, and we eventually concluded that they were RA-related inflammatory lesions. In patients with MTX-related LPD, cessation of MTX may be a therapeutic option, but careful follow-up and chemotherapy in accordance with the clinical course are essential.
影响因子：
45.3
作者：
Salloum, E;Cooper, DL;Murren, J
通讯作者：
Murren, J