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Vol.51 No.6 contents | Japanese/English |
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- Case Report -
A Case of Methotrexate-associated Lymphoproliferative Disorders Mimicking Advanced Lung Cancer
Osamu Kawano1, Kotaro Mizuno1, Ichiro Fukai11Department of General Thoracic Surgery, Suzuka General Hospital, Japan
Background. It is known that methotrexate (MTX) therapy for rheumatoid arthritis can cause malignant lymphoma. We report such a case requiring differential diagnosis from lung cancer showing multiple metastases. Case. A man in his 50's receiving MTX treatment for rheumatoid arthritis since 1991 was referred to our hospital because of dry cough and a mass shadow in the right hilum in chest X-ray. Chest CT revealed the tumor, 6×5×5 cm in size, in the right hilum in addition to multiple pulmonary and renal nodules, therefore we made a diagnosis of the right lung cancer with multiple metastases. Unexpectedly, PET-CT showed the uptake of FDG not only in these sites, but also in the chest wall, pancreas, peritoneum, and submandibular lymph nodes. These findings of PET-CT reminded us of the possibility that the lesion might not be advanced lung cancer. Withdrawal of MTX was required because of deteriorating general condition. Chest CT 3 weeks after the event confirmed the reduction of all tumors and all tumors were disappeared finally. His clinical course enabled a diagnosis of methotrexate-associated lymphoproliferative disorders (MTX-LPD). Conclusion. The pulmonary tumor arising in the patient receiving MTX treatment should remind all pulmonary physicians of the possible entity of MTX-LPD.
key words: Methotrexate, Lymphoma, Methotrexate-associated lymphoproliferative disorders, Pulmonary malignant lymphoma, Lung cancer
Received: February 25, 2011
Accepted: July 13, 2011
JJLC 51 (6): 718-723, 2011
