1
|
Tsukamoto M, Morimoto T, Hirata H, Yoshihara T, Mawatari M. Methotrexate-Associated Lymphoproliferative Disease of the Thoracic Spine Misdiagnosed as Metastatic Spinal Tumor: A Case Report. Cureus 2022; 14:e27692. [PMID: 36134046 PMCID: PMC9481197 DOI: 10.7759/cureus.27692] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2022] [Indexed: 11/29/2022] Open
Abstract
Methotrexate (MTX) is increasingly used in the treatment of rheumatoid arthritis. Many recent reports have identified MTX-related lymphoproliferative disorder (MTX-LPD) as lymphoma that develops during MTX therapy. However, spinal lesions, which are extremely rare, can be misdiagnosed as spinal metastases or pyogenic spondylitis. Here, we describe a 69-year-old man with rheumatoid arthritis who had MTX-LPD of the thoracic spine. He complained of back pain and weakness in the bilateral iliopsoas muscle. A radiographical assessment by his previous physician revealed the cause to be a spinal tumor. They performed posterior spinal decompression and fixation, and a pathological examination revealed only inflammatory changes, necrosis, and increased collagen fiber growth, with no evidence of malignancy. Nevertheless, magnetic resonance imaging two weeks after the surgery showed an increase in the size of the spinal tumor. When the lesion paralyzed the patient soon afterward, the physician considered that a total en bloc spondylectomy was necessary and referred the patient to our hospital. MTX-LPD was suspected because of a history of MTX administration, and a biopsy, posterior spinal decompression, and fixation were performed again. Following the histopathological diagnosis of the tumor as MTX-LPD, MTX administration was terminated. Three months following surgery, the tumors' removal was confirmed. Because MTX-LPD can be treated with MTX withdrawal, correct diagnoses should be made, and unnecessary treatments avoided.
Collapse
|
2
|
Methotrexate-associated lymphoproliferative disorder of the thoracic spine in a patient with rheumatoid arthritis receiving methotrexate: a case report. Skeletal Radiol 2021; 50:2117-2123. [PMID: 33772624 PMCID: PMC8364545 DOI: 10.1007/s00256-021-03764-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 03/18/2021] [Accepted: 03/18/2021] [Indexed: 02/02/2023]
Abstract
Methotrexate-associated lymphoproliferative disorder is recognized as a lymphoma that occurs following methotrexate administration. The lesion of the spine is extremely rare, and only one case of lesion in the lumbar spine has been reported so far. Here, we present a case of methotrexate-associated lymphoproliferative disorder of the thoracic spine in a 54-year-old woman with rheumatoid arthritis. The lesion formed an extra-skeletal tumor mass from lateral to the vertebral body to the paravertebral muscle extending posterior to the epidural space without bone destruction. Magnetic resonance imaging showed low signal intensities on both T1- and T2-weighted images and high signal intensity with short-tau inversion recovery. These radiological findings were similar to those for primary spinal lymphoma. The lesion rapidly paralyzed the patient, forcing her to be treated with posterior spinal decompression. The lesion could not be resected because it adhered to the dura. Following the histopathological diagnosis as methotrexate-associated lymphoproliferative disorder, methotrexate administration was terminated. The remaining mass lesion showed complete regression within 6 months. Methotrexate-associated lymphoproliferative disorder, which could be cured by the discontinuation of methotrexate, should be considered a differential diagnosis in spinal lesion cases showing lymphoma-like appearance with methotrexate treatment to avoid unnecessary treatments.
Collapse
|
4
|
Pathogenesis and FDG-PET/CT findings of Epstein-Barr virus-related lymphoid neoplasms. Ann Nucl Med 2017; 31:425-436. [PMID: 28497429 DOI: 10.1007/s12149-017-1180-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 05/08/2017] [Indexed: 12/19/2022]
Abstract
Epstein-Barr virus (EBV) is one of the most common viruses, infecting more than 90% of the adult population worldwide. EBV genome is detected in some lymphoid neoplasms. Not only their histopathological subtypes, but also their backgrounds and their clinical courses are variable. A number of B-cell lymphoproliferative disorders associated with the immunocompromised state are related to EBV infection. The incidences of these disorders have been increasing along with generalization of organ transplantations and use of immunosuppressive treatments. Furthermore, some EBV-positive lymphoma can also occur in immunocompetent patients. While evaluating patients with generalized lymphadenopathy of unknown cause by positron emission tomography/computed tomography with 2-deoxy-2-[18F]fluoro-D-glucose (FDG-PET/CT), the possibility of lymphoid neoplasms should be considered in some patients, and a careful review of the background and previous history of the patients is necessary. In this review article, we describe the pathogenesis of EBV-related lymphoid neoplasms and then present FDG-PET/CT images of representative diseases. In addition, we also present a review of other EBV-related diseases, such as infectious mononucleosis and nasopharyngeal carcinoma.
Collapse
|
5
|
Watanabe S, Manabe O, Hirata K, Oyama-Manabe N, Hattori N, Kikuchi Y, Kobayashi K, Toyonaga T, Tamaki N. The usefulness of (18)F-FDG PET/CT for assessing methotrexate-associated lymphoproliferative disorder (MTX-LPD). BMC Cancer 2016; 16:635. [PMID: 27528380 PMCID: PMC4986273 DOI: 10.1186/s12885-016-2672-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 08/03/2016] [Indexed: 12/01/2022] Open
Abstract
Background Methotrexate-associated lymphoproliferative disorder (MTX-LPD) is a benign lymphoid proliferation or malignant lymphoma in patients who have been treated with MTX. MTX withdrawal and observation for a short period should be considered in the initial management of patients who develop LPD while on MTX therapy. Here we evaluated the diagnostic accuracy and predictive value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for MTX-LPD. Methods We retrospectively investigated the cases of 15 patients clinically suspected of having MTX-LPD. A total of 324 anatomic regions (207 nodal and 117 extranodal regions) were assessed by 18F-FDG PET/CT and by multi-detector row CT (MDCT). Each anatomic region was classified as either malignant or benign. The uptake of 18F-FDG was assessed semi-quantitatively with the standardized uptake value maximum (SUVmax), the whole-body metabolic tumor volume (WBMTV), and the whole-body total lesion glycolysis (WBTLG) in order to investigate predictive factors of spontaneous regression after the withdrawal of MTX. Results MTX-LPD lesions were observed in 92/324 (28.4 %) regions. 18F-FDG PET/CT showed 90.2 % sensitivity, 97.4 % specificity, and 95.4 % accuracy, values which were significantly higher than those of MDCT (59.8, 94.8, and 84.9 %, respectively. p < 0.002). After the withdrawal of MTX, 9/15 patients (60.0 %) achieved complete response (CR). The SUVmax, WBMTV and WBTLG values of the CR patients were 9.2 (range 2.8–47.1), 44.3 (range 0–362.6) ml, 181.8 (range 0–2180.9) ml, respectively, which were not significantly different from those of the non-CR patients: 10.6 (range 0–24.9), 15.7 (range 0–250.1) ml, and 97.4 (range 0–1052.1) ml. Conclusions Although 18F-FDG PET/CT was a useful tool to detect MTX-LPD lesions, none of the 18F-FDG PET parameters before the withdrawal of MTX could be used to predict CR after the withdrawal of MTX.
Collapse
Affiliation(s)
- Shiro Watanabe
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, N15 W7, Kita-Ku, Sapporo, 0608638, Hokkaido, Japan
| | - Osamu Manabe
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, N15 W7, Kita-Ku, Sapporo, 0608638, Hokkaido, Japan.
| | - Kenji Hirata
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, N15 W7, Kita-Ku, Sapporo, 0608638, Hokkaido, Japan
| | - Noriko Oyama-Manabe
- Department of Diagnostic and Interventional Radiology, Hokkaido University Graduate School of Medicine, N15 W7, Kita-Ku, Sapporo, 0608638, Hokkaido, Japan
| | - Naoya Hattori
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, N15 W7, Kita-Ku, Sapporo, 0608638, Hokkaido, Japan
| | - Yasuka Kikuchi
- Department of Diagnostic and Interventional Radiology, Hokkaido University Graduate School of Medicine, N15 W7, Kita-Ku, Sapporo, 0608638, Hokkaido, Japan
| | - Kentaro Kobayashi
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, N15 W7, Kita-Ku, Sapporo, 0608638, Hokkaido, Japan
| | - Takuya Toyonaga
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, N15 W7, Kita-Ku, Sapporo, 0608638, Hokkaido, Japan
| | - Nagara Tamaki
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, N15 W7, Kita-Ku, Sapporo, 0608638, Hokkaido, Japan
| |
Collapse
|
6
|
Wang SC, Xie Q, LV WF. Positron emission tomography/computed tomography imaging and rheumatoid arthritis. Int J Rheum Dis 2014; 17:248-55. [PMID: 24606324 DOI: 10.1111/1756-185x.12316] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Shi-Cun Wang
- PET/CT Center; Anhui Provincial Hospital; Hefei Anhui China
| | - Qiang Xie
- PET/CT Center; Anhui Provincial Hospital; Hefei Anhui China
| | - Wei-Fu LV
- Department of Radiology; Anhui Provincial Hospital; Hefei Anhui China
| |
Collapse
|
7
|
Ota H, Koyama N, Nakamura A, Matsuda M, Yamamoto Y, Tomoda K, Yoshikawa M, Kimura H, Enomoto Y, Obayashi C. [Case report; a case of methotrexate-associated lymphoproliferative disorders caused with multiple lung nodules]. ACTA ACUST UNITED AC 2013; 102:2676-8. [PMID: 24400548 DOI: 10.2169/naika.102.2676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Hiroyo Ota
- Second Department of Internal Medicine, Nara Medical University, Japan
| | - Noriko Koyama
- Second Department of Internal Medicine, Nara Medical University, Japan
| | - Atsuhiro Nakamura
- Second Department of Internal Medicine, Nara Medical University, Japan
| | - Masayuki Matsuda
- Second Department of Internal Medicine, Nara Medical University, Japan
| | | | - Koichi Tomoda
- Second Department of Internal Medicine, Nara Medical University, Japan
| | | | - Hiroshi Kimura
- Second Department of Internal Medicine, Nara Medical University, Japan
| | | | | |
Collapse
|
8
|
Ding H, Wu F. Image guided biodistribution and pharmacokinetic studies of theranostics. Am J Cancer Res 2012; 2:1040-53. [PMID: 23227121 PMCID: PMC3516836 DOI: 10.7150/thno.4652] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Accepted: 06/17/2012] [Indexed: 11/05/2022] Open
Abstract
Image guided technique is playing an increasingly important role in the investigation of the biodistribution and pharmacokinetics of drugs or drug delivery systems in various diseases, especially cancers. Besides anatomical imaging modalities such as computed tomography (CT), magnetic resonance imaging (MRI), molecular imaging strategy including optical imaging, positron emission tomography (PET) and single-photon emission computed tomography (SPECT) will facilitate the localization and quantization of radioisotope or optical probe labeled nanoparticle delivery systems in the category of theranostics. The quantitative measurement of the bio-distribution and pharmacokinetics of theranostics in the fields of new drug/probe development, diagnosis and treatment process monitoring as well as tracking the brain-blood-barrier (BBB) breaking through by high sensitive imaging method, and the applications of the representative imaging modalities are summarized in this review.
Collapse
|