Chevrel G, Berger F, Miossec P, Blanc M, Jeanneret J, Felman C, Tebib J
Department of Rheumatology, Hôpital E. Herriot, Lyon, France.
Arthritis Rheum. 1999 Aug;42(8):1773-6. doi: 10.1002/1529-0131(199908)42:8<1773::AID-ANR29>3.0.CO;2-R.
We describe 2 patients with seropositive rheumatoid arthritis treated with methotrexate (MTX) who developed Hodgkin's disease (HD) and non-Hodgkin's lymphoma. Followup allowed a lymph node biopsy at 4 different time points in 1 patient and at 2 in the other. In the first patient, the steps included a long history of benign follicle hyperplasia, a polymorphic diffuse B cell lymphoproliferation, and finally HD unassociated with Epstein-Barr virus (EBV). In the second patient, a polymorphic diffuse lymphoproliferation was followed by a monomorphic large B cell lymphoproliferation associated with EBV. The cytogenetic analysis showed a monoclonal proliferation associated with the same chromosomal abnormalities found in 1 of the clones observed in the initial biopsy. These 2 cases illustrate the complexity of the role of MTX in the outbreak of such manifestations.
我们描述了2例接受甲氨蝶呤（MTX）治疗的血清阳性类风湿性关节炎患者，他们分别发展为霍奇金淋巴瘤（HD）和非霍奇金淋巴瘤。随访过程中，对其中1例患者在4个不同时间点进行了淋巴结活检，对另1例患者在2个时间点进行了活检。在第一例患者中，病变过程包括长期的良性滤泡增生、多形性弥漫性B细胞淋巴增殖，最终发展为与爱泼斯坦-巴尔病毒（EBV）无关的HD。在第二例患者中，多形性弥漫性淋巴增殖之后是与EBV相关的单形性大B细胞淋巴增殖。细胞遗传学分析显示存在单克隆增殖，且与初次活检中观察到的1个克隆所发现的相同染色体异常相关。这2例病例说明了MTX在此类表现发作中所起作用的复杂性。
