A Case of Methotrexate-Associated Lymphoproliferative Disorders of Anorectal Lesion

A 70-year-old male patient was admitted to our hospital complaining of anal pain. Endoscopic examination revealed an ulcerative lesion with necrotic tissue in the lower rectum and anal canal. Computed tomography revealed a thick wall of the lower rectum, and no mass lesion was detected in the liver,...

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Veröffentlicht in:Nippon Daicho Komonbyo Gakkai Zasshi 2017, Vol.70(5), pp.310-315
Hauptverfasser: Kuge, Hiroyuki, Yoshikawa, Shuusaku, Masuda, Tsutomu, Uchida, Hideki, Yokotani, Tomoyo, Yamaoka, Kentaro, Inagaki, Mizumi, Yokoo, Takashi, Inatsugi, Naoki, Miyazawa, Yoshio
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container_issue 5
container_start_page 310
container_title Nippon Daicho Komonbyo Gakkai Zasshi
container_volume 70
creator Kuge, Hiroyuki
Yoshikawa, Shuusaku
Masuda, Tsutomu
Uchida, Hideki
Yokotani, Tomoyo
Yamaoka, Kentaro
Inagaki, Mizumi
Yokoo, Takashi
Inatsugi, Naoki
Miyazawa, Yoshio
description A 70-year-old male patient was admitted to our hospital complaining of anal pain. Endoscopic examination revealed an ulcerative lesion with necrotic tissue in the lower rectum and anal canal. Computed tomography revealed a thick wall of the lower rectum, and no mass lesion was detected in the liver, lung or lymph nodes. Pathological examination of a biopsy from the rectal ulcerative lesion showed lymphoid infiltration (group 2). Immunohistochemically, diffuse large B cell lymphoma (DLBCL) was confirmed using samples taken from the rectal biopsy. No reactivation of Epstein-Barr virus was present in Epstein-Barr virus encoded RNA (EBER) in in situ hybridization of tumor cells. The patient had been treated with methotrexate (MTX) due to rheumatoid arthritis (RA) for 5 years. We discontinued administration of MTX. The endoscopic findings after cessation of MTX gradually improved and the rectal ulcer completely healed and disappeared. Since that time, the patient has had no recurrence. The final diagnosis was methotrexate-associated lymphoproliferative disorder (MTX-LPD). Case reports of MTX-LPD in anorectal lesions are very rare in Japan.
doi_str_mv 10.3862/jcoloproctology.70.310
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Endoscopic examination revealed an ulcerative lesion with necrotic tissue in the lower rectum and anal canal. Computed tomography revealed a thick wall of the lower rectum, and no mass lesion was detected in the liver, lung or lymph nodes. Pathological examination of a biopsy from the rectal ulcerative lesion showed lymphoid infiltration (group 2). Immunohistochemically, diffuse large B cell lymphoma (DLBCL) was confirmed using samples taken from the rectal biopsy. No reactivation of Epstein-Barr virus was present in Epstein-Barr virus encoded RNA (EBER) in in situ hybridization of tumor cells. The patient had been treated with methotrexate (MTX) due to rheumatoid arthritis (RA) for 5 years. We discontinued administration of MTX. The endoscopic findings after cessation of MTX gradually improved and the rectal ulcer completely healed and disappeared. Since that time, the patient has had no recurrence. 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Endoscopic examination revealed an ulcerative lesion with necrotic tissue in the lower rectum and anal canal. Computed tomography revealed a thick wall of the lower rectum, and no mass lesion was detected in the liver, lung or lymph nodes. Pathological examination of a biopsy from the rectal ulcerative lesion showed lymphoid infiltration (group 2). Immunohistochemically, diffuse large B cell lymphoma (DLBCL) was confirmed using samples taken from the rectal biopsy. No reactivation of Epstein-Barr virus was present in Epstein-Barr virus encoded RNA (EBER) in in situ hybridization of tumor cells. The patient had been treated with methotrexate (MTX) due to rheumatoid arthritis (RA) for 5 years. We discontinued administration of MTX. The endoscopic findings after cessation of MTX gradually improved and the rectal ulcer completely healed and disappeared. Since that time, the patient has had no recurrence. 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subjects anorectal resion
MTX–associated lymphoproliferative disorders
title A Case of Methotrexate-Associated Lymphoproliferative Disorders of Anorectal Lesion
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