Department of Diagnostic Pathology, Kanto Rosai Hospital, 1-1 Kizukisumiyoshi Nakahara-ku, 211-8510, Kawasaki, Japan.
Pathol Res Pract. 2010 Jan 15;206(1):9-13. doi: 10.1016/j.prp.2009.03.005. Epub 2009 Jul 23.
Patients affected by autoimmune diseases (rheumatoid arthritis (RA), psoriasis, and dermatomyositis) treated with methotrexate (MTX) develop lymphoproliferative disorders (LPDs). These cases have been reported to be diffuse large B-cell lymphoma, Hodgkin lymphoma, or polymorphous post-transplant LPDs. However, angioimmunoblastic T-cell lymphoma (AITL) is extremely rare in the medical literature. In this report, we describe three cases of RA patients who developed MTX-associated LPDs resembling AITL. They developed systemic lymph node swelling after initiation of MTX. The affected lymph nodes showed the histological finding of AITL: polymorphous infiltrates, mainly T-cells and arborizing high endothelial venules. Two cases showed a predominance of CD4-positive cells in proliferative T-cells, whereas the third case showed CD8-positive cells. CD10 was negative in all cases. RNA in situ hybridization of Epstein-Barr virus (EBV) demonstrated EBV-positive B-cells to be scattered in two cases, but not in one case. The lymphoadenopathy spontaneously regressed with cessation of MTX in all three cases, but one case recurred. These are interesting cases of MTX-associated LPDs mimicking AITL, and cessation of MTX is the only cure for patients with MTX-associated LPDs resembling AITL.
患有自身免疫性疾病（类风湿关节炎 (RA)、银屑病和皮肌炎）的患者在接受甲氨蝶呤 (MTX) 治疗后会发生淋巴增殖性疾病 (LPD)。这些病例报告为弥漫性大 B 细胞淋巴瘤、霍奇金淋巴瘤或多形性移植后 LPD。然而，血管免疫母细胞性 T 细胞淋巴瘤 (AITL) 在医学文献中极为罕见。在本报告中，我们描述了三例 RA 患者发生 MTX 相关 LPD，类似于 AITL。他们在开始使用 MTX 后出现全身淋巴结肿大。受累淋巴结表现出 AITL 的组织学发现：多形性浸润，主要为 T 细胞和分枝状高内皮静脉。两例病例显示增殖性 T 细胞中 CD4 阳性细胞占优势，而第三例病例显示 CD8 阳性细胞。所有病例 CD10 均为阴性。EB 病毒 (EBV) 的 RNA 原位杂交显示，两例病例中 EBV 阳性 B 细胞呈散在分布，但一例病例中未发现。所有三例患者的淋巴结病均在停止使用 MTX 后自发消退，但一例患者复发。这些是有趣的 MTX 相关 LPD 病例，类似于 AITL，停止使用 MTX 是治疗 MTX 相关 LPD 类似于 AITL 的唯一方法。
