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Primary Adrenal Lymphoma Possibly Associated With Epstein–Barr Virus Reactivation Due to Immunosuppression Under Methotrexate Therapy

Primary adrenal lymphoproliferative disorder (LPD) is an extremely rare disease that is widely known to be associated with methotrexate (MTX) use in patients with rheumatoid arthritis (RA). A 70-year-old man was incidentally found to have a tumor at the dorsal part of the liver in a medical check-up...

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Autores principales: Ohkura, Yu, Shindoh, Junichi, Haruta, Shusuke, Kaji, Daisuke, Ota, Yasunori, Fujii, Takeshi, Hashimoto, Masaji, Watanabe, Goro, Matsuda, Masamichi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4616607/
https://www.ncbi.nlm.nih.gov/pubmed/26252293
http://dx.doi.org/10.1097/MD.0000000000001270
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author Ohkura, Yu
Shindoh, Junichi
Haruta, Shusuke
Kaji, Daisuke
Ota, Yasunori
Fujii, Takeshi
Hashimoto, Masaji
Watanabe, Goro
Matsuda, Masamichi
author_facet Ohkura, Yu
Shindoh, Junichi
Haruta, Shusuke
Kaji, Daisuke
Ota, Yasunori
Fujii, Takeshi
Hashimoto, Masaji
Watanabe, Goro
Matsuda, Masamichi
author_sort Ohkura, Yu
collection PubMed
description Primary adrenal lymphoproliferative disorder (LPD) is an extremely rare disease that is widely known to be associated with methotrexate (MTX) use in patients with rheumatoid arthritis (RA). A 70-year-old man was incidentally found to have a tumor at the dorsal part of the liver in a medical check-up. He had a history of RA treated with MTX. Abdominal ultrasonography demonstrated a low echoic mass (30 mm in diameter) at the dorsal part of the liver, located close to the inferior vena cava. Preoperative differential diagnoses included intrahepatic cholangiocarcinoma, adrenal tumor, and hepatic malignant lymphoma, but no definitive diagnosis was reached. On exploratory laparotomy, the tumor seemed to be derived from the right adrenal gland and adhered tightly to segment 7 of the liver. Therefore, right adrenectomy with partial resection of segment 7 of the liver was performed. Pathological findings revealed diffuse inflammatory cell infiltration with a population of small atypical lymphoid cells, with positive immunohistochemical evidence for Epstein–Barr virus (EBV). Final diagnosis was primary adrenal iatrogenic EBV-positive LPD, classified as “other iatrogenic immunodeficiency-associated LPDs: Hodgkin-like lesions.” In this report, we described the possibility of the spontaneous healing of MTX-associated LPD (MTX-LPD) before treatment and the importance of doubting MTX-LPD and doing immunostaining to necrotic tissue. To our knowledge, this is the first reported case of MTX-related EBV-positive LPD, Hodgkin-like lesion, of the unilateral adrenal gland in patient with RA.
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spelling pubmed-46166072015-10-27 Primary Adrenal Lymphoma Possibly Associated With Epstein–Barr Virus Reactivation Due to Immunosuppression Under Methotrexate Therapy Ohkura, Yu Shindoh, Junichi Haruta, Shusuke Kaji, Daisuke Ota, Yasunori Fujii, Takeshi Hashimoto, Masaji Watanabe, Goro Matsuda, Masamichi Medicine (Baltimore) 7100 Primary adrenal lymphoproliferative disorder (LPD) is an extremely rare disease that is widely known to be associated with methotrexate (MTX) use in patients with rheumatoid arthritis (RA). A 70-year-old man was incidentally found to have a tumor at the dorsal part of the liver in a medical check-up. He had a history of RA treated with MTX. Abdominal ultrasonography demonstrated a low echoic mass (30 mm in diameter) at the dorsal part of the liver, located close to the inferior vena cava. Preoperative differential diagnoses included intrahepatic cholangiocarcinoma, adrenal tumor, and hepatic malignant lymphoma, but no definitive diagnosis was reached. On exploratory laparotomy, the tumor seemed to be derived from the right adrenal gland and adhered tightly to segment 7 of the liver. Therefore, right adrenectomy with partial resection of segment 7 of the liver was performed. Pathological findings revealed diffuse inflammatory cell infiltration with a population of small atypical lymphoid cells, with positive immunohistochemical evidence for Epstein–Barr virus (EBV). Final diagnosis was primary adrenal iatrogenic EBV-positive LPD, classified as “other iatrogenic immunodeficiency-associated LPDs: Hodgkin-like lesions.” In this report, we described the possibility of the spontaneous healing of MTX-associated LPD (MTX-LPD) before treatment and the importance of doubting MTX-LPD and doing immunostaining to necrotic tissue. To our knowledge, this is the first reported case of MTX-related EBV-positive LPD, Hodgkin-like lesion, of the unilateral adrenal gland in patient with RA. Wolters Kluwer Health 2015-08-07 /pmc/articles/PMC4616607/ /pubmed/26252293 http://dx.doi.org/10.1097/MD.0000000000001270 Text en Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. http://creativecommons.org/licenses/by/4.0 This is an open access article distributed under the Creative Commons Attribution License 4.0, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0
spellingShingle 7100
Ohkura, Yu
Shindoh, Junichi
Haruta, Shusuke
Kaji, Daisuke
Ota, Yasunori
Fujii, Takeshi
Hashimoto, Masaji
Watanabe, Goro
Matsuda, Masamichi
Primary Adrenal Lymphoma Possibly Associated With Epstein–Barr Virus Reactivation Due to Immunosuppression Under Methotrexate Therapy
title Primary Adrenal Lymphoma Possibly Associated With Epstein–Barr Virus Reactivation Due to Immunosuppression Under Methotrexate Therapy
title_full Primary Adrenal Lymphoma Possibly Associated With Epstein–Barr Virus Reactivation Due to Immunosuppression Under Methotrexate Therapy
title_fullStr Primary Adrenal Lymphoma Possibly Associated With Epstein–Barr Virus Reactivation Due to Immunosuppression Under Methotrexate Therapy
title_full_unstemmed Primary Adrenal Lymphoma Possibly Associated With Epstein–Barr Virus Reactivation Due to Immunosuppression Under Methotrexate Therapy
title_short Primary Adrenal Lymphoma Possibly Associated With Epstein–Barr Virus Reactivation Due to Immunosuppression Under Methotrexate Therapy
title_sort primary adrenal lymphoma possibly associated with epstein–barr virus reactivation due to immunosuppression under methotrexate therapy
topic 7100
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4616607/
https://www.ncbi.nlm.nih.gov/pubmed/26252293
http://dx.doi.org/10.1097/MD.0000000000001270
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