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Abstract：
A 69-year-old woman had been undergoing treatment with methotrexate for rheumatoid arthritis for 9 years. Because fever and right hypochondriac pain continued, she visited the nearby hospital. The enlargement of intraabdominal multiple lymph nodes was detected through abdominal computed tomography. Esophagogastroduodenoscopy showed a depressed lesion in the lower intrathoracic esophagus, and squamous cell carcinoma was diagnosed by a biopsy. Positron emission tomography-computed tomography showed a highly abnormal accumulation of lymph nodes, mainly in the upper abdomen, and some lymph nodes around the aorta. Suspecting methotrexate-lymphoproliferative disorder, we discontinued the oral administration of methotrexate. Multiple lymphadenopathy reduced by the withdrawal of the oral administration of methotrexate. We operated for esophageal cancer, and she was discharged on the 17th postoperative day. The postoperative pathological result showed moderately differentiated squamous cell carcinoma. Metastasis to the lymph nodes around the esophagus was observed, and the patient was diagnosed with T1b (SM3), N2 M0, Stage II cancer. Immunostaining showed enlarged lymph nodes composed of CD20-positive cells and with cells positive for EBV-encoded small RNA in situ hybridization. This case shows that patients with rheumatoid arthritis who are being administered methotrexate may have enlarged lymph nodes due to methotrexate-lymphoproliferative disorder.
摘要：
一名69岁的女性接受甲氨蝶呤治疗类风湿关节炎9年。因为发烧和右侧软骨下痛持续，她参观了附近的医院。通过腹部计算机断层扫描检测到腹内多个淋巴结肿大。食管胃十二指肠镜检查显示胸内食管下段病变凹陷，活检诊断为鳞状细胞癌。正电子发射断层扫描-计算机断层扫描显示淋巴结高度异常积聚，主要在上腹部,主动脉周围有淋巴结.怀疑甲氨蝶呤-淋巴增生性疾病,我们停止口服甲氨蝶呤.口服甲氨蝶呤后，多发性淋巴结病减少。我们手术治疗食道癌,她在术后第17天出院.术后病理结果为中分化鳞状细胞癌。观察到食管周围淋巴结转移，患者被诊断为T1b（SM3），N2M0，II期癌症。免疫染色显示由CD20阳性细胞和EBV编码的小RNA原位杂交阳性的细胞组成的肿大淋巴结。该病例表明，正在服用甲氨蝶呤的类风湿性关节炎患者可能由于甲氨蝶呤-淋巴增生性疾病而淋巴结肿大。
