Granuloma Annulare-Like Infiltrates With Concomitant Cutaneous Involvement by B-Cell Non-Hodgkinʼs Lymphoma

Abstract

Granulomatous infiltrates, including granuloma annulare-like changes, in patients with T-cell non-Hodgkin's lymphoma and Hodgkin's disease are well described but are exceedingly uncommon in B-cell non-Hodgkin's lymphoma. Herein, we describe a 73-year-old male with a 10-year history of B-cell chronic lymphocytic leukemia who developed erythematous annular plaques symmetrically on his upper extremities. Biopsies of these lesions revealed both granuloma annulare-like areas, in conjunction with nodular atypical lymphoid infiltrates consistent with secondary involvement by B-cell chronic lymphocytic leukemia. To our knowledge, this is the first report of cutaneous lesions resembling granuloma annulare with concomitant involvement by B-cell chronic lymphocytic leukemia. Awareness of this association may prevent nonrecognition of a neoplastic B-cell infiltrate in a granuloma annulare-like process.

Different histologic patterns of cutaneous granulomas in systemic lymphoma

“…[10][11][12] Their lymphomas were HL, a small lymphocytic lymphoma, follicular lymphomas, a diffuse large cell B-lymphoma, mycosis fungoides, Sezary syndrome, and Lennert's lymphoma. 14 The lag between the onset of granuloma annulare and the diagnosis of lymphomas varied from 5 years before to 27 years after. The histologic features of the granuloma annulare lesions were typical in all cases, ie, a palisading pattern of histiocytes around a central area of necrobiotic collagen and mucin.…”

The granulomatous reaction pattern

“…Furthermore, eosinophils are often present and there may be lichenoid changes at the dermal-epidermal interface. 435 Negative staining for both hemosiderin and human herpesvirus 8 can be used to distinguish interstitial granuloma annulare from early Kaposi's sarcoma in which both are usually positive. Another characteristic feature is the presence of a palisade of histiocytes around one or many collagen fibers, which often have a basophilic hue.…”

T cell contributions to the different phases of granuloma formation

“…Granulomas are often associated with autoimmune diseases such as in Crohn's disease, Wegener's granulomatosis or rheumatoid arthritis [3]. They can also occur in association with some forms of cancer such as both Hodgkin's and non-Hodgkin's lymphoma [4,5]. Finally granulomas can also manifest as the primary disease in the absence of any known inciting agent, as in sarcoidosis and granuloma annulare [6].…”