Cutaneous Granulomas and Malignant Lymphomas

Cerroni, Lorenzo

doi:10.1159/000068461

Cited by 29 publications

(19 citation statements)

References 21 publications

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“…In this context, it should be reminded that granulomatous features can be observed in several types of cutaneous B-and T-cell lymphoma. 24 The main differential diagnoses in these cases include granulomatous mycosis fungoides and reactive granulomatous conditions, 8 but distinction is usually easy on clinicopathologic correlation. Besides destruction of adnexal structures, ulceration was observed in a small percentage of our cases (7%).…”

Section: Discussionmentioning

confidence: 99%

Primary Cutaneous CD4+ Small-/Medium-Sized Pleomorphic T-Cell Lymphoma: A Cutaneous Nodular Proliferation of Pleomorphic T Lymphocytes of Undetermined Significance? A Study of 136 Cases

Beltraminelli¹,

Leinweber²,

Kerl³

et al. 2009

The American Journal of Dermatopathology

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224

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Patients with skin nodules characterized by the infiltrate of pleomorphic small/medium T lymphocytes are currently classified as "primary cutaneous CD4+ small-/medium-sized pleomorphic T-cell lymphoma" (SMPTCL) or as T-cell pseudolymphoma. The distinction is often arbitrary, and patients with similar clinicopathologic features have been included in both groups. We studied 136 patients (male:female = 1:1; median age: 53 years, age range: 3-90 years) with cutaneous lesions that could be classified as small-/medium-sized pleomorphic T-cell lymphoma according to current diagnostic criteria. All but 3 patients presented with solitary nodules located mostly on the head and neck area (75%). Histopathologic features were characterized by nonepidermotropic, nodular, or diffuse infiltrates of small- to medium-sized pleomorphic T lymphocytes. A monoclonal rearrangement of the T-cell receptor-gamma gene was found in 60% of tested cases. Follow-up data available for 45 patients revealed that 41 of them were alive without lymphoma after a median time of 63 months (range: 1-357 months), whereas 4 were alive with cutaneous disease (range: 2-16 months). The incongruity between the indolent clinical course and the worrying histopathologic and molecular features poses difficulties in classifying these cases unambiguously as benign or malignant, and it may be better to refer to them with a descriptive term such as "cutaneous nodular proliferation of pleomorphic T lymphocytes of undetermined significance," rather than forcing them into one or the other category. On the other hand, irrespective of the name given to these equivocal cutaneous lymphoid proliferations, published data support a nonaggressive therapeutic strategy, particularly for patients presenting with solitary lesions.

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Section: Discussionmentioning

confidence: 99%

Primary Cutaneous CD4+ Small-/Medium-Sized Pleomorphic T-Cell Lymphoma: A Cutaneous Nodular Proliferation of Pleomorphic T Lymphocytes of Undetermined Significance? A Study of 136 Cases

Beltraminelli¹,

Leinweber²,

Kerl³

et al. 2009

The American Journal of Dermatopathology

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196

224

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“…Cutaneous non-infectious granulomas associated with malignant lymphomas may be of two types. 3 The first type is characterized by granulomatous infiltrates admixed with neoplastic cells within specific skin lesions of malignant lymphoma. In fact, a prominent granulomatous infiltrate (defined as a granulomatous reaction exceeding 25% of the dermal infiltrate) has been found in 1.8% of all cases of T-and B-cell lymphomas (including both primary and secondary cases).…”

Section: Discussionmentioning

confidence: 99%

“…5 Also small/medium pleomorphic T-cell lymphoma, subcutaneous ''panniculitis-like'' T-cell lymphoma, Sézary syndrome, and cutaneous marginal zone B-cell lymphoma may exhibit a granulomatous histologic pattern. 3,6 Not only may the clinical presentation of the underlying lymphoma take on a peculiar or unusual pattern such as in the case of granulomatous slack skin, but the granulomatous component may even obscure the malignant process representing a pitfall in diagnosing lymphoma. 4 This type of granuloma seems to be related to the presence of many T-lymphocytes within the skin infiltrates.…”

Section: Discussionmentioning

confidence: 99%

“…In fact, they are particularly prominent in T-cell lymphomas or in B-cell lymphomas with a strong T-cell reaction, like marginal zone B-cell lymphoma. 3 The second type consists of sarcoid-like granulomas or other granulomatous skin processes that are a non-specific manifestation of the underlying lymphoma. This association has been termed ''sarcoidosis-lymphoma syndrome'' and refers to the development of non-caseating granulomas at sites free from any histological evidence of malignancy, in particular lymph nodes, liver, and spleen.…”

Section: Discussionmentioning

confidence: 99%

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Different histologic patterns of cutaneous granulomas in systemic lymphoma

Rongioletti

Cerroni

Massone

et al. 2004

Journal of the American Academy of Dermatology

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“…The histopathological features are variable, including sarcoidal, palisaded, necrobiotic, and tuberculoid granulomas. 7,8 An unusual case of GA with specific infiltrates of B-cell chronic lymphocytic leukemia has been described, underlying the need for complete phenotypic investigations in cases of GA with dense lymphoid infiltrates. 9 In addition, a histopathologic variant of mycosis fungoides (MF) simulating the interstitial type of GA has been described (interstitial MF).…”

Section: Discussionmentioning

confidence: 99%

Granuloma Annulare With Prominent Lymphoid Infiltrates (“Pseudolymphomatous” Granuloma Annulare)

Cota

Ferrara

Cerroni

2012

The American Journal of Dermatopathology

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Granuloma annulare (GA) is characterized histopathologically by 3 patterns: necrobiotic granuloma, interstitial incomplete form and, rarely, sarcoidal or tuberculoid granuloma. The amount of lymphoid infiltrate in GA is usually limited. We describe 10 cases of GA with prominent "pseudolymphomatous" lymphoid infiltrates mimicking cutaneous lymphoid hyperplasia. Patients were 6 males and 4 females (mean age 49.9 years, median age 47 years, age range 25-70). Lesions were localized to a limited area of the body (n = 6), or involved the entire trunk (n = 3), or were generalized (n = 1). The correct clinical diagnosis of GA was provided only in 30% of the cases. In all cases, histopathologic features were characterized by dense, nodular, superficial, and deep infiltrates of lymphocytes. Immunohistology revealed predominance of T lymphocytes in 7 of 7 tested cases. This "pseudolymphomatous" variant of GA represents a pitfall in the histopathologic diagnosis of the disease and may be misinterpreted as other types of cutaneous lymphoproliferative disorders.

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Cutaneous Granulomas and Malignant Lymphomas

Cited by 29 publications

References 21 publications

Primary Cutaneous CD4+ Small-/Medium-Sized Pleomorphic T-Cell Lymphoma: A Cutaneous Nodular Proliferation of Pleomorphic T Lymphocytes of Undetermined Significance? A Study of 136 Cases

Primary Cutaneous CD4+ Small-/Medium-Sized Pleomorphic T-Cell Lymphoma: A Cutaneous Nodular Proliferation of Pleomorphic T Lymphocytes of Undetermined Significance? A Study of 136 Cases

Different histologic patterns of cutaneous granulomas in systemic lymphoma

Granuloma Annulare With Prominent Lymphoid Infiltrates (“Pseudolymphomatous” Granuloma Annulare)

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