• 作者：M.A. Pastor-Nieto^a ; ^{tonales@terra.es} ; L.G. Kilmurray^b ; A. Ló ; pez-Chumillas^b ; F. O’ ; Valle^c ; R. Garcí ; a-del Moral^c ; A.M. Puig^b ; P. Bautista^a
• 关键词：ú ; lceras orales ; linfoma B difuso de c&eacute ; lulas grandes ; metotrexato ; virus de Epstein-Barr ; arthritis reumatoide
• 刊名：Actas Dermo-Sifiliogr谩ficas
• 出版年：2009
• 期刊代码：pca35_00017310
• 类别：med
• 出版时间：March 2009
• 卷：100
• 期：2
• 页码：142-146
• 文件大小：440 K

Methotrexate-associated lymphoproliferative disorders are a heterogeneous group of lymphoid proliferations or lymphomas that develop in patients with autoimmune diseases treated using methotrexate.

These lymphoproliferative disorders are often associated with Epstein-Barr virus infection and occasionally regress after the withdrawal of methotrexate therapy. The lymphoproliferative disorder in this case was diffuse large B-cell lymphoma, unusually presenting as oral ulcers in a 79-year-old woman on treatment with methotrexate for longstanding rheumatoid arthritis. Latent membrane protein 1 positivity was detected by immunohistochemistry and Epstein-Barr-virus encoded small RNA positivity by chromogenic in situ hybridization. Clonality was confirmed by immunohistochemistry (魏 light-chain restriction), polymerase chain reaction (monoclonal immunoglobulin H gene rearrangement), and capillary electrophoresis (GeneScan). Staging procedures were negative. Withdrawal of methotrexate therapy led to complete remission within 6 weeks, and the patient is alive and disease-free 18 months after the diagnosis was made.

The oral cavity is not often involved in the initial presentation of methotrexate-associated lymphoproliferative disorders, and presentation with intraoral ulcers is very rare. We have performed a review of the literature on methotrexate-associated lymphoproliferative disorders presenting as ulcers in the oral cavity.