The Journal of the Japanese Association for Chest Surgery
Online ISSN : 1881-4158
Print ISSN : 0919-0945
ISSN-L : 0919-0945
Surgical resection of methotrexate-related lymphoproliferative disease difficult to differentiate from primary lung cancer
Akihiro YoneiHirokazu Moriyama
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2019 Volume 33 Issue 7 Pages 723-729

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Abstract

Since first being reported in 1991, methotrexate-related lymphoproliferative disease (MTX-LPD) has been extensively investigated and established as an independent disease entity. This disease is rarely associated with lung lesions and even more rarely with solitary lung lesions. Here, we report the case of a 68-year-old woman treated with methotrexate (MTX) for rheumatoid arthritis who was referred to our hospital with suspected primary lung cancer in the left lower lobe measuring 27 mm. Bronchoscopy failed to establish a definitive diagnosis, but the lesion was suspected to be lung malignancy based on findings from different imaging studies and was then removed by video-assisted thoracoscopic left lower lobectomy. The resected specimen was pathologically diagnosed as diffuse large B-cell lymphoma. The patient was diagnosed with MTX-LPD because EBV-encoded small RNA in situ hybridization (EBER ISH) added from patient information was positive. MTX-LPD can be ameliorated or resolved by the discontinuation of MTX. For patients who develop a lung tumor during MTX treatment, the treatment plan should be decided in consideration of MTX-LPD as a differential diagnosis.

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© 2019 The Japanese Association for Chest Surgery
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