We report the case of a 62-year-old woman who presented with Sjögren's syndrome and secondary Raynaud's syndrome in 2003.
During the following months, the patient developed joint pain, so she was assessed by Rheumatology, who diagnosed the patient with seronegative rheumatoid arthritis (RA), maintaining previous diagnoses.
The patient was treated with methotrexate 7.5 mg weekly and folic acid, with control of the disease, and took for 8 years.
Recently, the patient came to our Primary Care clinic due to a painful, mobile axillary tumor of 3x4 cm desquamation casually.
The patient had no systemic symptoms.
Physical examination revealed a mobile laterocervical adenopathy <1 cm, with no evidence of visceromegaly or other adenopathies.
The rest of the physical examination was normal.
Initially he was treated with ibuprofen and amoxicillin/clavulanic acid due to suspected infectious process.
After 2 weeks, no change in axillary tumor was observed.
Persistence of adenopathy was achieved by aspiration puncture (PAAF) of the axillary tumor.
The result was suggestive of reactive pattern lymphadenopathy without ruling out low-grade lymphoproliferative process.
The patient was seen by Hematology, which, in order to study the extension of a neoplasic process, performed a whole-body computerized axial tomography.
The imaging result revealed a right axillary lymph node conglomerate.
The biopsy of the adenopatic conglomerate described an architecture completely supported by a lymphoid tumor proliferation that adopts 70 % diffuse pattern and 30 % a nodular pattern.
To complete the study, a bone marrow biopsy was performed, which revealed interstitial and non-trabecular lymphoma.
Immunohistochemical study of tumor cells revealed a positive expression for CD20, CD10, BCL2 and BCL6, and Ki 67 proliferation index was 40%.
The study was completed with the serology for Epstein&#146;s anomaly (EBV), which was positive (positive IgG and negative IgM).
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In conclusion, the patient was diagnosed with centrofollicular non-Hodgkin B lymphoma grade I-II/III with 70% diffuse areas and 30% nodular areas.
Since the patient had been treated for 8 years with methotrexate, and knowing the relationship between the use of methotrexate and the appearance of lymphomas, methotrexate was discontinued and she was treated with chemotherapy: cyclophosphamide, vincristine.
Progressively, the disappearance of the axillary lymph node conglomerate and cure of its lymphoma was observed.
Rituximab is currently used to treat reumatism, with good control of its symptoms.
