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Clinicopathological Features of Methotrexate-associated Lymphoproliferative Disorders in the Gastrointestinal Tract
Takeya Edagawa1, Hiroyoshi Iwagami1, Takuji Akamatsu1
1Departments of Gastroenterology and Hepatology, Japanese Red Cross Wakayama Medical Center, Japan.
Abstract:
Methotrexate may cause methotrexate-associated lymphoproliferative disorder (MTX-LPD); however, this disease is uncommon in the gastrointestinal tract. We examined six patients with MTX-LPD in the gastrointestinal tract at our hospital. All of the lesions were ulcerative. Four cases regressed spontaneously, all of which were positive for Epstein-Barr virus-encoded small RNA by in situ hybridization. Two patients who did not regress were negative for Epstein-Barr virus RNA, one of whom received chemotherapy, and one underwent surgery. The prognosis of this disease is considered to be good. MTX-LPD should considered when ulcerative lesions are observed during endoscopy in patients receiving MTX.
Insights
Methotrexate-associated lymphoproliferative disorder (MTX-LPD) can occur in the GI tract. Spontaneous regression was observed in Epstein-Barr virus-positive cases, suggesting a good prognosis for MTX-LPD.
Area of Science:
- Gastroenterology
- Oncology
- Immunology
Background:
- Methotrexate (MTX) is a common immunosuppressant.
- MTX can induce lymphoproliferative disorders (MTX-LPD).
- Gastrointestinal MTX-LPD is rare.
Purpose of the Study:
- To investigate the clinical characteristics of gastrointestinal MTX-LPD.
- To identify factors associated with regression and prognosis.
Main Methods:
- Retrospective analysis of six patients with gastrointestinal MTX-LPD.
- Review of clinical data, endoscopic findings, and histopathology.
- Epstein-Barr virus (EBV) detection using in situ hybridization.
Main Results:
- All six MTX-LPD cases presented as ulcerative lesions.
- Four cases (EBV-positive) showed spontaneous regression.
- Two EBV-negative cases required chemotherapy or surgery.
Conclusions:
- Gastrointestinal MTX-LPD is an uncommon but important complication of MTX therapy.
- EBV positivity may correlate with spontaneous regression.
- Early consideration of MTX-LPD is crucial for patients with ulcerative lesions during MTX treatment.
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