Diffuse Large B-cell Lymphoma with Adrenal Involvement Presenting as Other Iatrogenic Immunodeficiency-associated Lymphoproliferative Disorders: Sustained Remission with Methotrexate Termination Alone in Two Cases

Intern Med. 2023 Feb 15;62(4):601-604. doi: 10.2169/internalmedicine.0130-22. Epub 2022 Jul 5.

Abstract

Methotrexate-associated lymphoproliferative disorders (MTX-LPDs) with diffuse large B-cell lymphoma (DLBCL) pathology present with high rates of spontaneous regression after methotrexate (MTX) termination, especially in Epstein-Barr virus-encoded RNA (EBER)-positive cases. DLBCL with adrenal involvement is known for an extremely dismal prognosis. However, the prognosis of adrenal DLBCL in the context of MTX-LPD is unknown. We herein report two EBER-positive adrenal DLBCL MTX-LPD patients who achieved long-term remissions of 22 and 40 months with MTX termination alone. Both patients are doing well with no relapse at the time of reporting. Unlike adrenal DLBCL in general, adrenal involvement may not be a poor prognostic factor when restricted to DLBCL MTX-LPDs.

Keywords: EBER; MTX-LPDs; OIIA-LPDs; PAL; primary adrenal lymphoma.

Publication types

  • Case Reports

MeSH terms

  • Arthritis, Rheumatoid* / complications
  • Epstein-Barr Virus Infections* / complications
  • Epstein-Barr Virus Infections* / pathology
  • Herpesvirus 4, Human
  • Humans
  • Iatrogenic Disease
  • Immunologic Deficiency Syndromes* / complications
  • Lymphoma, Large B-Cell, Diffuse* / pathology
  • Lymphoproliferative Disorders* / chemically induced
  • Lymphoproliferative Disorders* / complications
  • Lymphoproliferative Disorders* / diagnosis
  • Methotrexate / adverse effects
  • Neoplasm Recurrence, Local / complications

Substances

  • Methotrexate