Methotrexate-associated Lymphoproliferative Disorder in the Liver Resembling Hepatocellular Carcinoma Treated with Transarterial Chemoembolization

Intern Med. 2020 Sep 15;59(18):2255-2260. doi: 10.2169/internalmedicine.4787-20. Epub 2020 Jun 9.

Abstract

Methotrexate-related lymphoproliferative disorder (MTX-LPD) is known to be a side effect of MTX, but its involvement in the liver has been rarely reported. We herein report a 70-year-old woman with autoimmune hepatitis and rheumatoid arthritis who developed multiple liver tumors. We initially considered that she had developed rapid-growing hepatocellular carcinoma (HCC) in the cirrhotic liver based on imaging tests. A tumor biopsy and transcatheter arterial chemoembolization were thus performed. The tumors were then diagnosed as diffuse large B-cell lymphoma pathologically and considered to be MTX-LPD. This case indicates that MTX-LPD should be considered even in cirrhotic patients with liver tumors resembling HCC.

Keywords: AIH; DLBCL; MTX-LPD; RA; liver tumor.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Carcinoma, Hepatocellular / diagnosis
  • Chemoembolization, Therapeutic / methods
  • Diagnosis, Differential
  • Female
  • Humans
  • Liver Neoplasms / diagnosis
  • Lymphoma, Large B-Cell, Diffuse / diagnosis
  • Lymphoproliferative Disorders / chemically induced*
  • Lymphoproliferative Disorders / diagnosis*
  • Lymphoproliferative Disorders / pathology
  • Lymphoproliferative Disorders / therapy
  • Methotrexate / adverse effects*
  • Methotrexate / therapeutic use

Substances

  • Methotrexate