Granuloma annulare, relapsing polychondritis, sarcoidosis, and systemic lupus erythematosus: conditions whose dermatologic manifestations may occur as hematologic malignancy‐associated mucocutaneous paraneoplastic syndromes

Abstract

IntroductionThe appearance of certain dermatoses has heralded either the diagnosis of a previously unsuspected malignancy or the detection of cancer recurrence in an oncology patient. 1,2 These associated mucosal and cutaneous conditions are referred to as mucocutaneous paraneoplastic syndromes. 3 In this issue, Zappasodi et al . 4 review some of the mucocutaneous paraneoplastic syndromes that occur in patients with hematologic malignancies. Albeit less commonly, other dermatologic conditions and systemic disorders can also occur in a paraneoplastic setting associated with hematologic malignancies: granuloma annulare, relapsing polychondritis, sarcoidosis, and systemic lupus erythematosus. Granuloma AnnulareGranuloma annulare is a chronic dermatosis of undetermined etiology. Clinically, the skin lesions present as flesh-colored to red papules and small nodules, which appear either as individual lesions or as an annular arrangement of confluent lesions. Mucin-containing areas of necrobiotic collagen in the dermis are surrounded by palisading granulomas consisting of epithelioid histiocytes, lymphocytes, and multinucleated giant cells.Granuloma annulare can be localized to a specific area of the body or generalized. Perforating and subcutaneous variants of the condition may also occur. Several factors have been described to precipitate the development of granuloma annulare: sunburn, drug eruption, flu-like illness, trauma, insect bites, and acute phlebitis. In addition, granuloma annulare has been observed in patients with potentially associated diseases -particularly diabetes mellitus and thyroid disease, but also drug allergy, hypertension, obesity, arthritis, atopy, sarcoidosis, and human immunodeficiency virus infection. [5][6][7][8][9] Skin lesions of leukemia or lymphoma that histopathologically mimic granuloma annulare have also been described in patients with hematologic malignancies. 10-14 Cancer-associated granuloma annulare has been reported predominantly in patients with hematologic malignancies (most commonly non-Hodgkin's lymphoma and Hodgkin's disease) and, less often, in individuals with solid tumors (Table 1). 5,6,[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] Relapsing PolychondritisRelapsing polychondritis is a multisystemic disorder characterized by recurrent inflammation and degeneration of cartilaginous tissues -particularly those of the ears, nose, larynx, and trachea. [34][35][36][37] The dermatologic manifestations of relapsing polychondritis are variable and include aphthosis [oral and complex (genital)], nodules (on the extremities), purpura, papules, sterile pustules, superficial phlebitis, livedo reticularis, ulcers (on the extremities), and distal necrosis. 38 The aorta, bone, bronchi, central nervous system, ears, eyes, genitals, heart valves, kidneys, larynx, mouth, nose, and trachea are potential sites of extracutaneous involvement in patients with relapsing polychondritis. 34,38,39 The diagnostic criteria for relapsing polychondritis were initially e...

Granuloma Annulare

“…Although no causative relationship has been established between GA and malignancy, older patients, patients with atypical clinical presentations, and patients with recalcitrant disease should have routine age-appropriate cancer screening for both solid organ and hematologic malignancies. 29,63,65 There have been multiple reports of GA occurring in a setting of HIV infection. 37,[66][67][68][69][70] Presenting morphologies are variable, but often the presentation is atypical.…”

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“…It is also well known that the development of RP is strongly associated with human leucocyte antigen HLA-DR4 [3,35,36]. A link between HLA antigen variants and development of colorectal cancer [37] and hematological disorders [2] was established. In addition, the inflammation of colorectal stroma and connective tissue may be the main substratum of the 2 diseases [21].…”

“…Less commonly solid neoplasms have also been reported [2]. Although it has been noted that RP may occur with colic cancer, colorectal cancer associated with RP remains scarce.…”

“…Gning SB, et al [21] recorded only one case of rectal cancer with RP in a Many associated autoimmune diseases, connective tissue diseases, vasculitis and hematologic disorders have been described in one third of patients [1]. Less frequently, RP has been associated with solid neoplasms [2].…”

“…Some case reports and series presumed a link between malignancy and RP. About 85 cases of RP associated with malignancies have been reported in the literature [2].…”