Composite cutaneous lymphoma in a patient with rheumatoid arthritis treated with methotrexate.

Abstract

Patients with rheumatoid arthritis, whether treated or not with immunosuppressive agents including methotrexate, have an increased risk of lymphoproliferative disorders. Termed "iatrogenic immunodeficiency-associated lymphoproliferative disorders" in the 2008 World Health Organization classification of lymphoid neoplasms, they include Hodgkin and non-Hodgkin lymphomas. Composite lymphomas are rare, particularly in skin, with none reported in immunodeficiency states. We report the case of a 67 year-old woman with a long history of rheumatoid arthritis, on methotrexate treatment, who developed multiple skin lesions exhibiting a malignant infiltrate displaying both B- and T-cell phenotypes and dual clonal gene rearrangement by polymerase chain reaction, consistent with a cutaneous composite lymphoma. The patient received chemotherapy including rituximab with partial response, but the T-cell component recurred. To the best of our knowledge, this is the first case report of a cutaneous composite lymphoma in a patient with an iatrogenic immunodeficiency representing a dual challenge, diagnostic for the pathologist and therapeutic for the hematologist.

• Authors: Hassan Huwait, Beatrice Wang, Chaim Shustik, René P Michel
• Journal: The American Journal of dermatopathology (Am J Dermatopathol) Vol. 32 Issue 1 Pg. 65-70 (Feb 2010) ISSN: 1533-0311 [Electronic] United States
• PMID: 20098085 (Publication Type: Case Reports, Journal Article)

Chemical References

• Antirheumatic Agents
• DNA, Neoplasm
• Methotrexate

Topics

• Aged
• Antirheumatic Agents (adverse effects)
• Arthritis, Rheumatoid (complications, drug therapy, pathology)
• DNA, Neoplasm (analysis)
• Female
• Gene Rearrangement, B-Lymphocyte (genetics)
• Gene Rearrangement, T-Lymphocyte (genetics)
• Gene Rearrangement, gamma-Chain T-Cell Antigen Receptor (genetics)
• Humans
• Lymphoma, B-Cell (chemically induced, genetics, pathology)
• Lymphoma, T-Cell, Cutaneous (chemically induced, genetics, pathology)
• Methotrexate (adverse effects)
• Neoplasms, Multiple Primary (chemically induced, genetics, pathology)
• Skin Neoplasms (chemically induced, genetics, pathology)