Cutaneous Lymphomas With Prominent Granulomatous Reaction

Abstract

The presence of a granulomatous reaction in lesions of cutaneous lymphomas has been described in the past in several cases. Especially in mycosis fungoides, a "granulomatous" variant of the disease has been well characterized. We studied the clinicopathologic features of cutaneous lymphomas with prominent granulomatous reaction, including both cutaneous T-cell lymphomas and B-cell lymphomas (primary cutaneous lymphoma 22, secondary cutaneous lymphoma one). Biopsies of 23 patients with histopathologic features of cutaneous T-cell lymphoma or cutaneous B-cell lymphoma with prominent granulomatous reaction were included in this study. A prominent granulomatous reaction was defined as the presence of a granulomatous component exceeding 25% of the dermal infiltrate. There were 14 cases of mycosis fungoides, two of subcutaneous panniculitis-like T-cell lymphoma, four of small/medium pleomorphic T-cell lymphoma, one of follicle center cell lymphoma, one of large B-cell lymphoma, and one of secondary cutaneous peripheral T-cell lymphoma. Altogether, a prominent granulomatous reaction could be observed in 1.8% of all patients with cutaneous lymphoma (primary or secondary) registered in the files of the Department of Dermatology of the University of Graz (Graz, Austria), demonstrating that there is a distinct, albeit small, proportion of cases revealing this peculiar reaction pattern. In seven cases a misdiagnosis of granulomatous dermatitis preceded the correct diagnosis for a period of 1-216 months, suggesting that sequential biopsies and complete phenotypic and molecular genetic analyses should be carried out in cases of "unusual" granulomatous dermatitis.

A study of histologic and immunophenotypical staining patterns in cutaneous lymphoid hyperplasia

“…12,14 The presence of eosinophils and epithelioid cell granulomas also favors CLH because they are infrequently observed in cutaneous B-cell lymphoma (CBCL). 7,16,17 Absence of clonality, as demonstrated by polyclonal K and L light chain stains and negative TCR and immunoglobulin heavy (IgH) gene rearrangements studies, are also considered to be supportive of CLH. 3,6,7 None of the aforementioned criteria, however, is discriminative by itself, and the diagnosis is based on a constellation of several findings.…”

“…14,18 The presence of eosinophils and clusters of epithelioid histiocytes may be helpful in the differential diagnosis because they are less frequently observed in CBCL. 7,16,17 Negative gene rearrangement studies are usually supportive of CLH, although there are rare reported cases that progressed into cutaneous lymphoma despite the lack of clonality. 15 The remaining 8 CLH cases in our series did not reveal GC clusters, although in 2 cases there were 1 or more small aggregates of blast-like B cells that failed to stain for any of the GC markers.…”

“…23,24 A prominent granulomatous reaction (exceeding 25% of the dermal infiltrate) was found in only 1.8% of all cases with cutaneous B-cell or T-cell lymphoma registered in the files of the Department of Dermatology of the University of Graz. 17 Most of the cases were mycosis fungoides. 17 Recently, the same group from Graz 25 observed granulomatous changes near rests of hair follicles or sweat glands, which were invaded or partially destroyed by the infiltrates in some of their cases, which they termed ''cutaneous nodular proliferation of pleomorphic T lymphocytes of undetermined significance.''…”

Granulomatous Slack Skin: Treatment with Extensive Surgery and Review of the Literature

“…Up to now, 39 cases have been reported in the literature [6, 7, 8, 9, 10, 11]. In this article, we present a new case; the clinical, histological, immunohistochemical and ultrastructural results and genetic studies are discussed as well as the molecular biology.…”

Solitary Small- to Medium-Sized Pleomorphic T-Cell Nodules of Undetermined Significance: Clinical, Histopathological, Immunohistochemical and Molecular Analysis of 26 Cases

“…PCR analysis of the T-cell receptor γ gene was performed in 24 cases according to standard procedures as described previously with minor modifications [10]. …”