穿刺吸引細胞診で腺癌と診断された頸部other iatrogenic immunodeficiency-associated lymphoproliferative disordersの１例

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Methotrexate (MTX) is the standard drug for rheumatoid arthritis. However, MTX is considered to be a risk factor for the development of malignant lymphoma. It is classified among other iatrogenic immunodeficiency-associated lymphoproliferative disorders (OIIA-LPD) in the WHO classifications. We report a case of OIIA-LPD diagnosed as cervical lymph node metastasis from adenocarcinoma by fine-needle aspiration cytology.A 52-year-old female with RA had been treated with MTX for two years. She noticed an elastic hard mass of 30mm in diameter in her left neck. Fine-needle aspiration cytology diagnosed it as lymph node metastasis from adenocarcinoma. Ultrasonography of thyroid, lung CT and GI tract examination showed no abnormal findings. A massive abnormal uptake was found on FDG-PET examination. Open biopsy was performed to detect the primary lesion. Pathological and immunohistochemical findings led to a diagnosis of OIIA-LPD, which was anaplastic large cell lymphoma histopathologically. The incidence of OIIA-LPD may increase in head and neck surgical practice because MTX therapy is the standard treatment for RA. It is important to take OIIA-LPD into consideration for lymphadenopathy of a patient taking MTX.
信州医学会の論文