Comparison of Epstein–Barr virus-positive mucocutaneous ulcer associated with treated lymphoma or methotrexate in Japan

© 2018 John Wiley & Sons Ltd Aims: The aim of the present study was to compare treated lymphoma-associated Epstein–Barr virus (EBV)-positive mucocutaneous ulcer (EBVMCU) and methotrexate (MTX)-associated EBVMCU. Methods and results: Of a series of 15 Japanese patients (11 women, four men; medi...

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Main Authors: Teerada Daroontum, Kei Kohno, Ahmed E. Eladl, Akira Satou, Ayako Sakakibara, Shoichi Matsukage, Naoki Yakushiji, Charin Ya-In, Shigeo Nakamura, Naoko Asano, Seiichi Kato
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Published: 2018
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http://cmuir.cmu.ac.th/jspui/handle/6653943832/58916
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spelling th-cmuir.6653943832-589162018-09-05T04:35:02Z Comparison of Epstein–Barr virus-positive mucocutaneous ulcer associated with treated lymphoma or methotrexate in Japan Teerada Daroontum Kei Kohno Ahmed E. Eladl Akira Satou Ayako Sakakibara Shoichi Matsukage Naoki Yakushiji Charin Ya-In Shigeo Nakamura Naoko Asano Seiichi Kato Medicine © 2018 John Wiley & Sons Ltd Aims: The aim of the present study was to compare treated lymphoma-associated Epstein–Barr virus (EBV)-positive mucocutaneous ulcer (EBVMCU) and methotrexate (MTX)-associated EBVMCU. Methods and results: Of a series of 15 Japanese patients (11 women, four men; median age 74 years, range 35–84 years), seven received MTX for the treatment of autoimmune disease and eight developed EBVMCU after treatment of malignant lymphoma [diffuse large B-cell lymphoma (n = 4) without EBV association, adult T-cell leukaemia/lymphoma (n = 2), angioimmunoblastic T-cell lymphoma (n = 1), and follicular lymphoma (n = 1)]. Ulcers were observed in the oral cavity (n = 11), gastrointestinal tract (n = 2), and skin (n = 2). All were histologically characterised by a mixture of EBV-positive large B-cell proliferation and Hodgkin/Reed–Sternberg-like cells on a polymorphous background. A total of 46% (6/13) had monoclonal immunoglobulin heavy chain gene rearrangement, but none had clonal T-cell receptor gene rearrangement. Spontaneous regression occurred in 13 of 15 cases (87%); the other two cases (13%) achieved complete remission after treatment. Of two patients in the treated lymphoma-associated subgroup, one developed multiple new ulcerative lesions on previously unaffected skin, and the other had a relapse of EBVMCU in the oral cavity. No significant clinicopathological differences were found between the subgroups. Notably, none of the patients died from EBVMCU. However, the treated lymphoma-associated subgroup had lower overall survival (P = 0.004) and a shorter follow-up period (P = 0.003) than the MTX-associated subgroup, owing to death from non-associated causes. Conclusions: Treated lymphoma-associated EBVMCU, which is an indolent and self-limited condition, must be recognised to avoid misdiagnosing it as a relapse of malignant lymphoma during treatment. 2018-09-05T04:35:02Z 2018-09-05T04:35:02Z 2018-06-01 Journal 13652559 03090167 2-s2.0-85043379572 10.1111/his.13464 https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85043379572&origin=inward http://cmuir.cmu.ac.th/jspui/handle/6653943832/58916
institution Chiang Mai University
building Chiang Mai University Library
country Thailand
collection CMU Intellectual Repository
topic Medicine
spellingShingle Medicine
Teerada Daroontum
Kei Kohno
Ahmed E. Eladl
Akira Satou
Ayako Sakakibara
Shoichi Matsukage
Naoki Yakushiji
Charin Ya-In
Shigeo Nakamura
Naoko Asano
Seiichi Kato
Comparison of Epstein–Barr virus-positive mucocutaneous ulcer associated with treated lymphoma or methotrexate in Japan
description © 2018 John Wiley & Sons Ltd Aims: The aim of the present study was to compare treated lymphoma-associated Epstein–Barr virus (EBV)-positive mucocutaneous ulcer (EBVMCU) and methotrexate (MTX)-associated EBVMCU. Methods and results: Of a series of 15 Japanese patients (11 women, four men; median age 74 years, range 35–84 years), seven received MTX for the treatment of autoimmune disease and eight developed EBVMCU after treatment of malignant lymphoma [diffuse large B-cell lymphoma (n = 4) without EBV association, adult T-cell leukaemia/lymphoma (n = 2), angioimmunoblastic T-cell lymphoma (n = 1), and follicular lymphoma (n = 1)]. Ulcers were observed in the oral cavity (n = 11), gastrointestinal tract (n = 2), and skin (n = 2). All were histologically characterised by a mixture of EBV-positive large B-cell proliferation and Hodgkin/Reed–Sternberg-like cells on a polymorphous background. A total of 46% (6/13) had monoclonal immunoglobulin heavy chain gene rearrangement, but none had clonal T-cell receptor gene rearrangement. Spontaneous regression occurred in 13 of 15 cases (87%); the other two cases (13%) achieved complete remission after treatment. Of two patients in the treated lymphoma-associated subgroup, one developed multiple new ulcerative lesions on previously unaffected skin, and the other had a relapse of EBVMCU in the oral cavity. No significant clinicopathological differences were found between the subgroups. Notably, none of the patients died from EBVMCU. However, the treated lymphoma-associated subgroup had lower overall survival (P = 0.004) and a shorter follow-up period (P = 0.003) than the MTX-associated subgroup, owing to death from non-associated causes. Conclusions: Treated lymphoma-associated EBVMCU, which is an indolent and self-limited condition, must be recognised to avoid misdiagnosing it as a relapse of malignant lymphoma during treatment.
format Journal
author Teerada Daroontum
Kei Kohno
Ahmed E. Eladl
Akira Satou
Ayako Sakakibara
Shoichi Matsukage
Naoki Yakushiji
Charin Ya-In
Shigeo Nakamura
Naoko Asano
Seiichi Kato
author_facet Teerada Daroontum
Kei Kohno
Ahmed E. Eladl
Akira Satou
Ayako Sakakibara
Shoichi Matsukage
Naoki Yakushiji
Charin Ya-In
Shigeo Nakamura
Naoko Asano
Seiichi Kato
author_sort Teerada Daroontum
title Comparison of Epstein–Barr virus-positive mucocutaneous ulcer associated with treated lymphoma or methotrexate in Japan
title_short Comparison of Epstein–Barr virus-positive mucocutaneous ulcer associated with treated lymphoma or methotrexate in Japan
title_full Comparison of Epstein–Barr virus-positive mucocutaneous ulcer associated with treated lymphoma or methotrexate in Japan
title_fullStr Comparison of Epstein–Barr virus-positive mucocutaneous ulcer associated with treated lymphoma or methotrexate in Japan
title_full_unstemmed Comparison of Epstein–Barr virus-positive mucocutaneous ulcer associated with treated lymphoma or methotrexate in Japan
title_sort comparison of epstein–barr virus-positive mucocutaneous ulcer associated with treated lymphoma or methotrexate in japan
publishDate 2018
url https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85043379572&origin=inward
http://cmuir.cmu.ac.th/jspui/handle/6653943832/58916
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