Epstein‐Barr virus‐related diffuse large B‐cell lymphoma type methotrexate‐associated lymphoproliferative disorders presenting in the adrenal gland

Abstract

Introduction Methotrexate‐associated lymphoproliferative disorders appear during treatment with methotrexate as an immunosuppressive drug. However, the mechanism and frequency are still unknown, and the treatment is undefined. Case presentation A 76‐year‐old woman was admitted to the hospital with back pain, and magnetic resonance imaging showed a tumor in the right adrenal region. She had received methotrexate for rheumatoid arthritis. Enhanced computed tomography showed a tumor of 90 mm in diameter on the dorsal side of the liver abutting to the inferior vena cava. The preoperative diagnosis was a hepatic invasion of right adrenocortical carcinoma and right adrenalectomy was performed. The histopathological diagnosis was diffuse large B‐cell lymphoma. The final diagnosis was methotrexate‐associated lymphoproliferative disorders. Conclusion It is important to consider methotrexate‐associated lymphoproliferative disorders before surgery when neoplastic lesions are found in patients taking methotrexate.

Keywords

• DLBCL
• EBV
• methotrexate
• MTX‐LPD
• primary adrenal lymphoma