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Composite Cutaneous Lymphoma (Iatrogenic Immunodeficiency-Associated Lymphoproliferative Disorder) in a Patient with Rheumatoid Arthritis Treated with Methotrexate: Staging and Evaluation of Response to Therapy with 18F-FDG PET/CT

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Abstract

A 67 year old woman with a 10 year history of rheumatoid arthritis (RA) treated with methotrexate and prednisone, presented with a 2 year history of worsening multiple cutaneous plaques of variable appearance. Two distinct skin lesions were biopsied to reveal a composite cutaneous lymphoma, possibly caused by long term methotrexate therapy. An [18F] fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) was performed to stage the malignancy, and was later repeated to evaluate response to chemotherapy, which guided subsequent management. We present the PET/CT imaging findings of this very rare iatrogenic (methotrexate induced) immunodeficiency-associated lymphoproliferative disorder.

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References

  1. Huwait H, Wang B, Shustik C, Michel RP. Composite cutaneous lymphoma in a patient with rheumatoid arthritis treated with methotrexate. Am J Dermatopathol. 2010;32:65–70.

    Article  PubMed  Google Scholar 

  2. Prince HM, Whittaker S, Hoppe RT. How I treat mycosis fungoides and Sezary syndrome. Blood. 2009;114:4337–53.

    Article  CAS  PubMed  Google Scholar 

  3. Willemze R, Jaffe ES, Burg G, Cerroni L, Berti E, Swerdlow SH, et al. WHO-EORTC classification for cutaneous lymphomas. Blood. 2005;105:3768–85.

    Article  CAS  PubMed  Google Scholar 

  4. Hull PR, Saxena A. Mycosis fungoides and chronic lymphocytic leukaemia—composite T-cell and B-cell lymphomas presenting in the skin. Br J Dermatol. 2000;143:439–44.

    Article  CAS  PubMed  Google Scholar 

  5. Volk AL, Vannucci SA, Cook W, Thompson KA, Listinsky CM. Composite mycosis fungoides and B-cell chronic lymphocytic leukemia. Ann Diagn Pathol. 2002;6:172–82.

    Article  PubMed  Google Scholar 

  6. Kazakov DV, Kutzner H, Palmedo G, Boudova L, Michaelis S, Michal M, et al. Primary cutaneous lymphoproliferative disorders with dual lineage rearrangement. Am J Dermatopathol. 2006;28:399–409.

    Article  PubMed  Google Scholar 

  7. Wolfe F, Michaud K. Lymphoma in rheumatoid arthritis: the effect of methotrexate and anti-tumor necrosis factor therapy in 18,572 patients. Arthritis Rheum. 2004;50:1740–51.

    Article  CAS  PubMed  Google Scholar 

  8. Georgescu L, Quinn GC, Schwartzman S, Paget SA. Lymphoma in patients with rheumatoid arthritis: association with the disease state or methotrexate treatment. Semin Arthritis Rheum. 1997;26:794–804.

    Article  CAS  PubMed  Google Scholar 

  9. Miyazaki T, Fujimaki K, Shirasugi Y, Yoshiba F, Ohsaka M, Miyazaki K, et al. Remission of lymphoma after withdrawal of methotrexate in rheumatoid arthritis: relationship with type of latent Epstein-Barr virus infection. Am J Hematol. 2007;82:1106–9.

    Article  CAS  PubMed  Google Scholar 

  10. Kamel OW, van de Rijn M, Weiss LM, Del Zoppo GJ, Hench PK, Robbins BA, et al. Brief report: reversible lymphomas associated with Epstein-Barr virus occurring during methotrexate therapy for rheumatoid arthritis and dermatomyositis. N Engl J Med. 1993;328:1317–21.

    Article  CAS  PubMed  Google Scholar 

  11. Ichikawa A, Arakawa F, Kiyasu J, Sato K, Miyoshi H, Niino D, et al. Methotrexate/iatrogenic lymphoproliferative disorders in rheumatoid arthritis: histology, Epstein-Barr virus, and clonality are important predictors of disease progression and regression. Eur J Haematol. 2013;91:20–8.

    Article  CAS  PubMed  Google Scholar 

  12. Kumar R, Xiu Y, Zhuang HM, Alavi A. 18F-fluorodeoxyglucose-positron emission tomography in evaluation of primary cutaneous lymphoma. Br J Dermatol. 2006;155:357–63.

    Article  CAS  PubMed  Google Scholar 

  13. Makis W, Lisbona R. Aggressive variant of primary cutaneous anaplastic large T-cell lymphoma: a new role for 18F-FDG PET/CT. Clin Nucl Med. 2010;35:704–5.

    Article  PubMed  Google Scholar 

  14. Watanabe N, Kato H, Murakami J, Shimizu M, Noguchi K, Kamisaki Y, et al. FDG-PET imaging in cutaneous anaplastic large cell lymphoma. Clin Nucl Med. 2006;31:564–5.

    Article  PubMed  Google Scholar 

  15. Otero HJ, Jagannathan JP, Prevedello LM, Johnston CJ, Ramaiya NH, Van den Abbeele AD, et al. CT and PET/CT findings of T-cell lymphoma. Am J Roentgenol. 2009;193:349–58.

    Article  Google Scholar 

  16. Khong PL, Pang CB, Liang R, Kwong YL, Au WY. Fluorine-18 fluorodeoxyglucose positron emission tomography in mature T-cell and natural killer cell malignancies. Ann Hematol. 2008;87:613–21.

    Article  PubMed  Google Scholar 

  17. Kako S, Izutsu K, Ota Y, Minatani Y, Sugaya M, Momose T, et al. FDG-PET in T-cell and NK-cell neoplasms. Ann Oncol. 2007;18:1685–90.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Diagnostic Imaging, CCI, Diagnostic Imaging, 11560 University Ave NW, Edmonton, Alberta, T6G 1Z2, Canada

    William Makis

  2. MUHC Glen Site, Nuclear Medicine, 1001 Decarie Blvd, Montreal, Quebec, H4A 3J1, Canada

    Anthony Ciarallo

  3. MUHC, Dermatology, 4 Westmount Sq, Suite 100, Westmount, Quebec, H3Z 2S6, Canada

    Beatrice Wang

  4. MUHC Glen Site, Pathology, 1001 Decarie Blvd, Montreal, Quebec, H4A 3J1, Canada

    Milene Gonzalez-Verdecia

  5. MUHC Jewish General Hospital, Nuclear Medicine, 3755 Chemin de la Cote-Sainte-Catherine, Montreal, Quebec, H3T 1E2, Canada

    Stephan Probst

Authors
  1. William Makis
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  2. Anthony Ciarallo
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  3. Beatrice Wang
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  4. Milene Gonzalez-Verdecia
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  5. Stephan Probst
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Corresponding author

Correspondence to William Makis.

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Conflict of Interest

William Makis, Anthony Ciarallo, Beatrice Wang, Milene Gonzalez-Verdecia and Stephan Probst declare that they have no conflict of interest.

Ethical Statement

The study was approved by an institutional review board or equivalent and has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All subjects in the study gave written informed consent or the institutional review board waived the need to obtain informed consent.

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Makis, W., Ciarallo, A., Wang, B. et al. Composite Cutaneous Lymphoma (Iatrogenic Immunodeficiency-Associated Lymphoproliferative Disorder) in a Patient with Rheumatoid Arthritis Treated with Methotrexate: Staging and Evaluation of Response to Therapy with 18F-FDG PET/CT. Nucl Med Mol Imaging 51, 261–265 (2017). https://doi.org/10.1007/s13139-016-0463-4

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  • DOI: https://doi.org/10.1007/s13139-016-0463-4

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