Related Experiment Videos
EBV-associated diffuse large B-cell lymphoma in a psoriatic treated with methotrexate
Shih-Chuan Hsiao1, Ryo Ichinohasama, Shu-Hui Lin
1Department of Hemato-Oncology, St. Martin de Porres Hospital, Chia-Yi, Taiwan.
Pathology, Research and Practice
|October 28, 2008
Summary
Methotrexate-associated lymphoproliferative disorder (MTX-LPD) can occur in patients with psoriasis treated with methotrexate. This case highlights an Epstein-Barr virus-positive lymphoma with aggressive progression.
Area of Science:
- Oncology
- Immunology
- Pathology
Background:
- Methotrexate-associated lymphoproliferative disorder (MTX-LPD) is a rare but serious complication in patients treated with methotrexate (MTX), often for autoimmune conditions like rheumatoid arthritis and psoriasis.
- While MTX-LPD typically affects patients with rheumatoid arthritis, its occurrence in psoriasis patients, particularly those on high-dose MTX, warrants attention.
Observation:
- This report details a 50-year-old Taiwanese male with severe psoriasis who developed Epstein-Barr virus (EBV)-positive MTX-LPD.
- The lymphoma presented with nodal and extranodal involvement, characterized by a diffuse, polymorphic lymphoid infiltrate.
- Tumor cells exhibited B-cell markers, CD138, EBV-LMP1, EBNA2, and kappa light chain restriction, indicative of EBV type III latency.
Findings:
- The lymphoid infiltrate was predominantly composed of immunoblasts and plasmablasts with frequent plasmacytic differentiation.
- In situ hybridization confirmed the presence of EBV within the tumor cells.
- The patient experienced progressive disease and died 19 months after diagnosis.
Implications:
- MTX-LPD associated with psoriasis predominantly affects middle-aged males and often presents as diffuse large B-cell lymphoma with immunoblastic morphology and plasmacytic features.
- This case underscores the importance of monitoring for MTX-LPD in psoriasis patients receiving methotrexate, especially those with EBV infection.
- Understanding the characteristics and aggressive nature of EBV-positive MTX-LPD is crucial for timely diagnosis and management.
Related Concept Videos
01:30Leishmaniasis
Leishmaniasis is a protozoal disease caused by species of the genus Leishmania and transmitted through the bite of infected female sandflies. The parasite exists in two principal morphological forms during its life cycle. A sandfly acquires intracellular amastigotes from an infected reservoir host, such as a dog. Within the sandfly, these forms differentiate into motile, flagellated promastigotes. During a subsequent blood meal, promastigotes are injected into the human host, where they...
02:56Treatment Resistent Cancers
Cancer is the second leading cause of death in the United States. A cancer cell is genetically unstable and hence can mutate faster. They can also modify their microenvironment and escape immune surveillance. The difficulties in treating cancer are further compounded by the emergence of rapid resistance to anticancer drugs. The most common ways to attain resistance in cancer cells include alteration in drug transport and metabolism, modification of drug target, elevated DNA damage response, or...
01:29Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents
Crohn's disease is an inflammatory bowel disorder marked by chronic inflammation of the GI tract. Various treatment strategies for Crohn's disease are employed, such as immunomodulatory agents, glucocorticoids, and biologics or anti-TNF therapy. Azathioprine (Imuran), a commonly used immunomodulatory drug for Crohn's disease, is converted in the body to mercaptopurine, which inhibits purine biosynthesis and cell proliferation. Both are utilized in severe cases of Inflammatory Bowel Disease...
02:56Treatment Resistant Cancers
Cancer is the second leading cause of death in the United States. A cancer cell is genetically unstable and hence can mutate faster. They can also modify their microenvironment and escape immune surveillance. The difficulties in treating cancer are further compounded by the emergence of rapid resistance to anticancer drugs. The most common ways to attain resistance in cancer cells include alteration in drug transport and metabolism, modification of drug target, elevated DNA damage response, or...