A case of primary gastric t-cell lymphoma with bleeding stomach ulcer developed during methotrexate therapy for rheumatoid arthritis

Abstract

A 72-year-old man who had been treated with methotrexate (MTX) for rheumatoid arthritis (RA) presented with the abrupt onset of emesis and was diagnosed as having gastric malignant lymphoma by upper gastrointestinal fiberscopy (GIF) and biopsy at another hospital. He was admitted to our hospital to receive chemotherapy. After admission, he vomited blood again, and endoscopic hemostasis was unsuccessful. Emergency total gastrectomy was thus performed. Finally, we diagnosed the case as primary gastric T-cell lymphoma (PGTL) by histopathological and immunohistochemical findings.
Gastric lymphoma is usually derived from B cells, and PGTL is extremely rare. As PGTL is believed to carry poor prognosis compared to B cell lymphoma, it should be treated by multimodal therapy as well as surgical resection. However, no standard treatment for PGTL has been as tablished as yet because of a small number of cases accumulated. Recently it has been pointed out that there is some relation between MTX for treatment of RA and the onset of malignant lymphoma, and we report this case which is interesting from the standpoint of the onset of malignant lymphoma.