Tabata Mika M, Novoa Roberto A, Martires Kathryn J
Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.
Department of Dermatology, Stanford University, Stanford, California, USA.
BMJ Case Rep. 2018 Aug 11;2018:bcr-2018-224961. doi: 10.1136/bcr-2018-224961.
The association of malignant lymphomas with non-necrotic epithelioid granulomas has been reported rarely since 1977. Hodgkin's disease-associated widespread cutaneous granuloma annulare (GA) has been reported in only eight patients. We report the second case of subcutaneous GA associated with Hodgkin's disease. A 73-year-old man with Epstein-Barr virus-associated Hodgkin's lymphoma and paraneoplastic subcutaneous GA, presented 3 months after the diagnosis of malignancy. Examination revealed a large, broad erythematous, indurated, subcutaneous plaque spanning the majority of the left lower back and flank with no associated symptoms. Initial biopsy was suggestive of morphea. Prompted by positron emission tomography (PET) findings of increased fluorodeoxyglucose (FDG) uptake, a second, deeper biopsy was performed, revealing subcutaneous palisaded granulomatous dermatitis. After complete workup, the diagnosis most strongly suggested subcutaneous GA. This case highlights the importance of deep incisional biopsies, the fluorodeoxyglucose - positron emission tomography (FDG-PET) findings in GA and the rare association of GA with Hodgkin's disease which may signal the presence of malignancy.
自1977年以来，恶性淋巴瘤与非坏死性上皮样肉芽肿的关联鲜有报道。霍奇金病相关的广泛皮肤环状肉芽肿（GA）仅在8例患者中被报道过。我们报告第二例与霍奇金病相关的皮下GA。一名73岁男性，患有与爱泼斯坦-巴尔病毒相关的霍奇金淋巴瘤及副肿瘤性皮下GA，在恶性肿瘤诊断后3个月出现。检查发现左下腹和侧腹大部分区域有一个大的、广泛的红斑、硬结性皮下斑块，无相关症状。初次活检提示硬斑病。正电子发射断层扫描（PET）显示氟脱氧葡萄糖（FDG）摄取增加，促使进行了第二次更深层的活检，结果显示为皮下栅栏状肉芽肿性皮炎。经过全面检查，最强烈提示的诊断为皮下GA。该病例突出了深层切口活检的重要性、GA中氟脱氧葡萄糖-正电子发射断层扫描（FDG-PET）的表现以及GA与霍奇金病的罕见关联，后者可能提示恶性肿瘤的存在。
