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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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 |
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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 |
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© 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. |
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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 |
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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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1681425154730622976 |