Biomaterial Database

Composite cutaneous lymphoma in a patient with rheumatoid arthritis treated with methotrexate. 2010

Hassan Huwait, and Beatrice Wang, and Chaim Shustik, and René P Michel

Department of Pathology, McGill University and McGill University Health Center, Quebec, Canada.

Patients with rheumatoid arthritis, whether treated or not with immunosuppressive agents including methotrexate, have an increased risk of lymphoproliferative disorders. Termed "iatrogenic immunodeficiency-associated lymphoproliferative disorders" in the 2008 World Health Organization classification of lymphoid neoplasms, they include Hodgkin and non-Hodgkin lymphomas. Composite lymphomas are rare, particularly in skin, with none reported in immunodeficiency states. We report the case of a 67 year-old woman with a long history of rheumatoid arthritis, on methotrexate treatment, who developed multiple skin lesions exhibiting a malignant infiltrate displaying both B- and T-cell phenotypes and dual clonal gene rearrangement by polymerase chain reaction, consistent with a cutaneous composite lymphoma. The patient received chemotherapy including rituximab with partial response, but the T-cell component recurred. To the best of our knowledge, this is the first case report of a cutaneous composite lymphoma in a patient with an iatrogenic immunodeficiency representing a dual challenge, diagnostic for the pathologist and therapeutic for the hematologist.

UI	MeSH Term	Description	Entries
D008727	Methotrexate	An antineoplastic antimetabolite with immunosuppressant properties. It is an inhibitor of TETRAHYDROFOLATE DEHYDROGENASE and prevents the formation of tetrahydrofolate, necessary for synthesis of thymidylate, an essential component of DNA.	Amethopterin,Methotrexate Hydrate,Methotrexate Sodium,Methotrexate, (D)-Isomer,Methotrexate, (DL)-Isomer,Methotrexate, Dicesium Salt,Methotrexate, Disodium Salt,Methotrexate, Sodium Salt,Mexate,Dicesium Salt Methotrexate,Hydrate, Methotrexate,Sodium, Methotrexate
D009378	Neoplasms, Multiple Primary	Two or more abnormal growths of tissue occurring simultaneously and presumed to be of separate origin. The neoplasms may be histologically the same or different, and may be found in the same or different sites.	Neoplasms, Synchronous,Neoplasms, Synchronous Multiple Primary,Multiple Primary Neoplasms,Multiple Primary Neoplasms, Synchronous,Synchronous Multiple Primary Neoplasms,Synchronous Neoplasms,Multiple Primary Neoplasm,Neoplasm, Multiple Primary,Neoplasm, Synchronous,Primary Neoplasm, Multiple,Primary Neoplasms, Multiple,Synchronous Neoplasm
D004273	DNA, Neoplasm	DNA present in neoplastic tissue.	Neoplasm DNA
D005260	Female		Females
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000368	Aged	A person 65 years of age or older. For a person older than 79 years, AGED, 80 AND OVER is available.	Elderly
D001172	Arthritis, Rheumatoid	A chronic systemic disease, primarily of the joints, marked by inflammatory changes in the synovial membranes and articular structures, widespread fibrinoid degeneration of the collagen fibers in mesenchymal tissues, and by atrophy and rarefaction of bony structures. Etiology is unknown, but autoimmune mechanisms have been implicated.	Rheumatoid Arthritis
D012878	Skin Neoplasms	Tumors or cancer of the SKIN.	Cancer of Skin,Skin Cancer,Cancer of the Skin,Neoplasms, Skin,Cancer, Skin,Cancers, Skin,Neoplasm, Skin,Skin Cancers,Skin Neoplasm
D015322	Gene Rearrangement, B-Lymphocyte	Ordered rearrangement of B-lymphocyte variable gene regions coding for the IMMUNOGLOBULIN CHAINS, thereby contributing to antibody diversity. It occurs during the differentiation of the IMMATURE B-LYMPHOCYTES.	B-Cell Gene Rearrangement,B-Lymphocyte Gene Rearrangement,Gene Rearrangement, B-Cell,B Cell Gene Rearrangement,B Lymphocyte Gene Rearrangement,B-Cell Gene Rearrangements,B-Lymphocyte Gene Rearrangements,Gene Rearrangement, B Cell,Gene Rearrangement, B Lymphocyte,Gene Rearrangements, B-Cell,Gene Rearrangements, B-Lymphocyte,Rearrangement, B-Cell Gene,Rearrangement, B-Lymphocyte Gene,Rearrangements, B-Cell Gene,Rearrangements, B-Lymphocyte Gene
D015329	Gene Rearrangement, T-Lymphocyte	Ordered rearrangement of T-cell variable gene regions coding for the antigen receptors.	Gene Rearrangement, T-Cell Antigen Receptor,T-Cell Gene Rearrangement,T-Lymphocyte Gene Rearrangement,Gene Rearrangement, T-Cell,Gene Rearrangement, T Cell,Gene Rearrangement, T Cell Antigen Receptor,Gene Rearrangement, T Lymphocyte,Gene Rearrangements, T-Cell,Gene Rearrangements, T-Lymphocyte,Rearrangement, T-Cell Gene,Rearrangement, T-Lymphocyte Gene,Rearrangements, T-Cell Gene,Rearrangements, T-Lymphocyte Gene,T Cell Gene Rearrangement,T Lymphocyte Gene Rearrangement,T-Cell Gene Rearrangements,T-Lymphocyte Gene Rearrangements