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

The American Journal of Dermatopathology
Hassan HuwaitRené P Michel

Abstract

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.

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Citations

Aug 15, 2013·Journal of Cutaneous Pathology·Kristina BuderAndreas Kerstan
Mar 29, 2016·Japanese Journal of Ophthalmology·Yuka KobayashiKoh-Hei Sonoda
Nov 9, 2018·Archives of Pathology & Laboratory Medicine·Stephanie ChenAlexandra C Hristov
Dec 22, 2017·Journal of the Endocrine Society·Tullia de Risi-PuglieseNicolas Dupin
Dec 25, 2013·The American Journal of Dermatopathology·Meenakshi Batrani, Jag Bhawan
Apr 12, 2019·The American Journal of Dermatopathology·Aadil AhmedKamran Mirza

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