A Case of Mediastinal Methotrexate-associated Lymphoproliferative Disorder in a Patient with Esophageal Cancer

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  • Shimada Yoshifumi
    Department of Chest Surgery, Toyama City Hospital Department of Thoracic and Cardiovascular Surgery, University of Toyama
  • Doki Yoshinori
    Department of Chest Surgery, Toyama City Hospital Department of Thoracic and Cardiovascular Surgery, University of Toyama
  • Segawa Masataka
    Department of Chest Surgery, Toyama City Hospital
  • Honma Takahiro
    Department of Thoracic and Cardiovascular Surgery, University of Toyama
  • Yamamoto Yutaka
    Department of Thoracic and Cardiovascular Surgery, University of Toyama
  • Ojima Norihiro
    Department of Thoracic and Cardiovascular Surgery, University of Toyama
  • Kitamura Naoya
    Department of Thoracic and Cardiovascular Surgery, University of Toyama
  • Akemoto Yuushi
    Department of Thoracic and Cardiovascular Surgery, University of Toyama
  • Imura Jyouji
    Department of Diagnostic Pathology, University of Toyama
  • Yoshimura Naoki
    Department of Thoracic and Cardiovascular Surgery, University of Toyama

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  • 食道癌縦隔リンパ節転移との鑑別を要したメトトレキサート関連リンパ増殖性疾患の1例

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Abstract

<p>Background. Methotrexate-associated lymphoproliferative disorder (MTX-LPD) has become more widely known as a drug-induced disease which can cause some critical adverse reactions, with the increasing use of MTX for patients with rheumatoid arthritis (RA). Case. A 78-year-old woman complaining of dysphagia and coughing was admitted to our institute. Chest CT study revealed diffuse lymph nodes swelling in the mediastinum compressing the bronchus and esophagus, and esophageal cancer was detected by upper digestive fiberscopy. Initially, we suspected progressive esophageal cancer, but the symptoms and radiographic findings improved after cessation of MTX administration for the treatment of RA. Mediastinoscopic biopsy revealed lymph node MTX-LPD, and esophageal cancer was proved to be early stage disease followed by additional submucosal resection by endoscopy. Conclusions. We report a case of MTX-LPD coexisting with thoracic malignant disease. To avoid the risk of overstaging of the malignant disease, appropriate correlation with histopathological diagnosis should be attempted before deciding the therapeutic course.</p>

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