Peripheral T‐Cell Lymphoma with Secondary Epithelioid Granulomatous Cutaneous Involvement: A Clinicopathologic Study of Four Cases

Abstract

Epithelioid granuloma formation has rarely been observed in specific cutaneous lesions from T-cell lymphomas other than those of mycosis fungoides/Sézary syndrome (MF/SS). Three patients diagnosed with nodal and/or extranodal (tonsillar) non-Hodgkin's peripheral T-cell lymphoma (PTCL) and one patient with angioimmunoblastic T-cell lymphoma (AILD), developed specific cutaneous involvement showing prominent epithelioid cell and/or granulomatous inflammation. The original diagnostic lesions had no granulomatous features. In addition to a specific lymphomatous infiltrate, prominent dermal and/or subcutaneous granulomatous infiltrates were observed. Sarcoid-like granulomas were observed in two patients (one of them presented a granuloma annulare-like pattern in early lesions), granulomatous panniculitis was noted in one patient and in one patient with AILD, masses of epithelioid cells were noted. The clinicopathological features of cutaneous involvement by PTCL showing a florid epithelioid and/or granulomatous cell reaction are reviewed. Various histopathological patterns can be observed. The diagnostic difficulties of these cases are stressed.

Cutaneous lymphomas showing prominent granulomatous component: clinicopathological features in a series of 16 cases

“…The observation of ‘specific’ granulomatous cutaneous lesions in nodal or extranodal (non‐cutaneous) lymphomas also seems to be a rare phenomenon 4,5 . Isolated reports of unspecified peripheral T‐cell lymphoma 4,5 and angioimmunoblastic 4,52,53 and Lennert's lymphoma 54 involving the skin presenting a marked cutaneous epithelioid granulomatous inflammation have been reported. Original and diagnostic nodal biopsy specimens may not show granulomatous features.…”

Advances in the understanding and management of angioimmunoblastic T‐cell lymphoma

“…EBV‐positive cells are rarely demonstrated (Martel et al , 2000; Brown et al , 2001). A florid epithelioid or granulomatous reaction has been described in occasional cases, which may mimic sarcoidosis or an infectious process (Scarabello et al , 2002; Suarez‐Vilela & Izquierdo‐Garcia, 2003; Pujol et al , 2005; Jayaraman et al , 2006).…”

Granulomatous interstitial nephritis secondary to chronic lymphocytic leukemia/small lymphocytic lymphoma

“…Among lymphoproliferative malignancies, they are most commonly seen in Hodgkin lymphoma, encountered in approximately 14% of cases [25][26][27], and may also develop in non-Hodgkin lymphomas, including CLL/SLL [28], Burkitt lymphoma [29,30], peripheral T-cell lymphoma [31], and diffuse large B-cell lymphoma [32]. They may occur in lymph nodes, spleen, and/or liver, with or without concomitant lymphoma in the same biopsy [25].…”