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Granuloma annulare‐like eruption associated with B‐cell chronic lymphocytic leukemia
Author(s) -
Sokumbi Olayemi,
Gibson Lawrence E.,
Comfere Nneka I.,
Peters Margot S.
Publication year - 2012
Publication title -
journal of cutaneous pathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.597
H-Index - 75
eISSN - 1600-0560
pISSN - 0303-6987
DOI - 10.1111/j.1600-0560.2012.01967.x
Subject(s) - granuloma annulare , pathology , histopathology , medicine , cd20 , immunophenotyping , chronic lymphocytic leukemia , histiocyte , lymphoma , cd5 , cutaneous lymphoma , leukemia , immunology , mycosis fungoides , antigen
Background Cutaneous granulomatous inflammation can occur in patients with T‐cell lymphoma and Hodgkin disease. We describe the unusual microscopic pattern of a granuloma annulare (GA)‐like eruption co‐existing with B‐cell chronic lymphocytic leukemia (B‐ CLL ). Methods We reviewed the histopathology and immunophenotype of skin biopsies from two patients with B‐ CLL and cutaneous lesions resembling GA. Results Both patients had symptomatic cutaneous lesions clinically resembling GA; one had lesions refractory to standard dermatologic therapy. Histopathology showed GA‐like palisaded histiocytic infiltration, with subtle collections of lymphocytes interspersed among the granulomatous inflammation. Immunohistochemistry showed strong expression of CD20 and CD79a , with aberrant CD5 co‐expression, confirming cutaneous involvement by B‐ CLL . Conclusions Co‐existence of a GA‐like infiltrate and cutaneous B‐ CLL raises the possibility that granulomatous inflammation occurs as a secondary response to dermal infiltration by leukemic cells. Because histopathologic findings can be subtle, knowledge of this association is essential to avoid overlooking the diagnosis. Regardless of whether histopathology reflects a reactive or primary phenomenon, documentation of cutaneous involvement by B‐ CLL may serve as a rationale for specific treatment of the underlying B‐ CLL in patients with skin lesions unresponsive to dermatologic therapy and for whom there is no other justification for leukemia‐targeted therapy.