Oebisu Naoto, Hoshi Manabu, Ieguchi Makoto, Iwai Tadashi, Tanaka Sayaka, Osawa Masahiko, Nakamura Hiroaki
Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Osaka 545-8585, Japan.
Department of Diagnostic Pathology, Osaka City University Graduate School of Medicine, Osaka, Osaka 545-8585, Japan.
Mol Clin Oncol. 2018 Aug;9(2):187-191. doi: 10.3892/mco.2018.1654. Epub 2018 Jun 14.
Methotrexate (MTX) is the key drug for the treatment of rheumatoid arthritis (RA). MTX-treated RA has been associated with the development of lymphoproliferative disorders (LPDs). Notably, the hyperimmune state of RA itself or the immunosuppressive state induced by MTX administration may contribute to development of LPD. Furthermore, Epstein-Barr virus (EBV) has been indicated to contribute to the development of MTX-LPD. MTX-associated LPD (MTX-LPD) may affect nodal or extranodal sites, including the gastrointestinal tract, skin, lungs, kidneys, and soft tissues, at an almost equal frequency. However, it is rare for MTX-LPD to manifest as multiple bone tumors with a pathological fracture. The present study reported the case of a 46-year-old Japanese woman with RA who had complications of EBV-positive MTX-LPD during an approximate 5-year course of MTX therapy. The present study indicated a rare case in which the LPD had spread to multiple bones in a patient with a pathologic fracture. Notably, the LPD was subclassified as diffuse large B-cell lymphoma (DLBCL).
甲氨蝶呤（MTX）是治疗类风湿关节炎（RA）的关键药物。接受MTX治疗的RA患者与淋巴增殖性疾病（LPDs）的发生有关。值得注意的是，RA本身的高免疫状态或MTX给药诱导的免疫抑制状态可能促使LPD的发生。此外，有迹象表明，爱泼斯坦-巴尔病毒（EBV）与MTX-LPD的发生有关。MTX相关的LPD（MTX-LPD）可能以几乎相同的频率累及淋巴结或结外部位，包括胃肠道、皮肤、肺、肾和软组织。然而，MTX-LPD表现为多发性骨肿瘤并伴有病理性骨折的情况较为罕见。本研究报告了1例46岁日本女性RA患者，在接受MTX治疗约5年的过程中出现了EBV阳性的MTX-LPD并发症。本研究表明，这是1例罕见的LPD扩散至多处骨骼并伴有病理性骨折的病例。值得注意的是，该LPD被归类为弥漫性大B细胞淋巴瘤（DLBCL）。
