Methotrexate-associated lymphoproliferative disorder demonstrating composite lymphoma of EBV-negative diffuse large B-cell lymphoma and EBV-positive mucocutaneous ulcer.

Abstract	Other iatrogenic immunodeficiency-associated lymphoproliferative disorders induced by immunosuppressive drugs, such as methotrexate (MTX-LPD), exhibit numerous pathological findings. We report the case of an 81-year-old Japanese woman diagnosed with MTX-LPD exhibiting two distinct pathological features from two different sites. Excisional biopsy of the left cervical lymph node revealed EBV-negative diffuse large B-cell lymphoma and biopsy of a pharyngeal ulcer revealed EBV-positive mucocutaneous ulcer. She was treated using an R-CHOP regimen and maintained complete remission for years. This case demonstrates the heterogeneous pathology of MTX-LPD and suggests the necessity of multiple biopsy.
Authors	Keiichi Moriya, Yara Yukie Kikuti, Joaquim Carreras, Yusuke Kondo, Sawako Shiraiwa, Naoya Nakamura
Journal	Journal of clinical and experimental hematopathology : JCEH (J Clin Exp Hematop) Vol. 60 Issue 1 Pg. 11-16 ( 2020) ISSN: 1880-9952 [Electronic] Japan
PMID	32224560 (Publication Type: Case Reports, Journal Article)
Chemical References	Immunosuppressive Agents R-CHOP protocol Rituximab Vincristine Doxorubicin Cyclophosphamide Prednisone Methotrexate
Topics	Aged, 80 and over Antineoplastic Combined Chemotherapy Protocols (therapeutic use) Composite Lymphoma (chemically induced, complications, diagnosis, drug therapy) Cyclophosphamide (therapeutic use) Doxorubicin (therapeutic use) Epstein-Barr Virus Infections (complications, diagnosis) Female Humans Immunosuppressive Agents (adverse effects) Lymphoma, Large B-Cell, Diffuse (chemically induced, complications, diagnosis, drug therapy) Lymphoproliferative Disorders (chemically induced, complications, diagnosis, drug therapy) Methotrexate (adverse effects) Pharynx (drug effects, pathology) Prednisone (therapeutic use) Rituximab (therapeutic use) Ulcer (chemically induced, complications, diagnosis) Vincristine (therapeutic use)

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