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Abstract：
A 64-year-old woman was receiving oral methotrexate (MTX) for rheumatoid arthritis (RA) for 15 years. She underwent esophagogastroduodenoscopy because of discomfort in the chest. Endoscopic findings revealed an ulcer in the lower esophagus extending to the gastroesophageal junction (EGJ). The ulcer occupied half of the esophageal lumen and had a sharp and clear margin. Magnifying narrow-band imaging endoscopy revealed the deposition of white plaque, and there were few microvessels in the edge and bottom of the ulcer. Histologic examination of the biopsy specimens from the oral edge of the lesion revealed proliferation of atypical lymphoid cells (immunophenotype results: CD20 [+], CD3 [partially +], CD5 [-], and BCL-2 [-]]. The patient was diagnosed with methotrexate-associated lymphoproliferative disorder (MTX-LPD) and was advised to stop MTX intake. After 2 months of stopping MTX, the ulcer was found to be almost regressed and showed signs of healing. MTX-LPD in the lower esophagus extending to the EGJ is extremely rare. This case can help in expanding the understanding of esophageal MTX-LPD.
摘要：
一名64岁的女性接受口服甲氨蝶呤（MTX）治疗类风湿关节炎（RA）15年。由于胸部不适，她接受了食管胃十二指肠镜检查。内窥镜检查结果显示，下食管溃疡延伸至胃食管交界处（EGJ）。溃疡占据了食管腔的一半，边缘清晰清晰。放大窄带成像内镜显示白色斑块沉积，溃疡的边缘和底部几乎没有微血管。病变口腔边缘活检标本的组织学检查显示非典型淋巴样细胞增殖（免疫表型结果：CD20[+]，CD3[部分+]，CD5[-],andBCL-2[-]].患者被诊断为甲氨蝶呤相关淋巴增生性疾病（MTX-LPD），建议停止摄入MTX。停止MTX2个月后，发现溃疡几乎消退，并有愈合的迹象。在食管下段延伸至EGJ的MTX-LPD极为罕见。该病例有助于加深对食管MTX-LPD的认识。
