抄録
A 77-year-old male patient was admitted to hospital complaining of epigastralgia and general fatigue. Serum blood analysis showed hepatic dysfunction and hypoalbuminemia. Ulcerative lesions were found in the fornix and gastric angle. Pathological examination of biopsies from the gastric ulcerative lesions revealed lymphoid infiltration. Abdominal US showed multiple low echoic lesions in the liver and contrast-enhanced CT revealed multiple low-density masses in the liver and spleen, suspected to be malignant lymphoma or metastatic tumors. Malignant T-cell lymphoma was immunohistochemically confirmed using samples taken via US-guided liver biopsy. No reactivation of Epstein-Barr virus was present in Epstein-Barr virus-encoded RNA (EBER) in situ hybridization of tumor cells. The patient suffered from rheumatoid arthritis (RA) and had been treated with methotrexate (MTX) for four years. Due to suspicion that MTX was associated with the tumor formation, MTX therapy was discontinued. Subsequently the patient’s symptoms disappeared and laboratory findings improved. Approximately one year later, the gastric ulcers were healing and the hepatic tumors had disappeared. Since that time, the patient has had no recurrence. The final diagnosis was methotrexate-associated lymphoproliferative disorder (MTX-LPD). Several studies have documented that RA itself as well as MTX treatment for RA are risk factors for development of malignant lymphoma. Although case reports of gastric ulcers and hepatic tumors accompanying MTX-LPD are rare, we would suggest that MTX-LPD is included as a differential diagnosis for gastric ulcerative lesions.
