Department of Pathology and Laboratory Medicine, Taichung Veterans General Hospital.
Institute of Biomedical Sciences, National Chung Hsing University, Taichung.
Appl Immunohistochem Mol Morphol. 2020 Apr;28(4):316-324. doi: 10.1097/PAI.0000000000000731.
Granulomatous reaction is not uncommon in histopathology, with various etiologies in different organs and geographic regions. Lymphoma is one of the underlying causes of granuloma; and sometimes the neoplastic cells may be masked by the granulomatous reaction. In this report, we present our experience with 7 lymphoma cases of various histologic types with coexisting granuloma to show the diagnostic challenges. In all cases, a granulomatous reaction was simultaneously present with the neoplastic cells. The 7 cases included 3 cases of adult T-cell leukemia/lymphoma in the lymph node or skin including one coexisting with mycobacterial infection, 2 cases of classical Hodgkin lymphoma involving the liver, and 1 case each of systemic Epstein-Barr virus-positive peripheral T-cell lymphoma and a hepatic inflammatory pseudotumor-like follicular dendritic cell sarcoma. Three cases were initially misdiagnosed as reactive change or mycobacterial infection instead of lymphoma, and a wrong histologic lymphoma type was diagnosed in 1 case. In this report, we showed that granulomatous reaction might mask lymphomas of various histologic types; and a diagnosis of mycobacterial infection or sarcoidosis could not exclude the possibility of an underlying lymphoma. We emphasized the importance of detailed histologic examination with the aid of ancillary studies to reach a correct diagnosis and to avoid inappropriate management of the patients. Our study also broadened the spectrum of lymphoma types coexisting with granuloma.
肉芽肿反应在组织病理学中并不罕见，不同器官和地理区域有不同的病因。淋巴瘤是肉芽肿的潜在原因之一；有时，肿瘤细胞可能被肉芽肿反应所掩盖。在本报告中，我们介绍了 7 例不同组织学类型的伴有共存肉芽肿的淋巴瘤病例，以展示诊断挑战。在所有病例中，均同时存在肉芽肿反应和肿瘤细胞。这 7 例包括 3 例成人 T 细胞白血病/淋巴瘤累及淋巴结或皮肤，其中 1 例合并分枝杆菌感染，2 例经典霍奇金淋巴瘤累及肝脏，1 例全身 EBV 阳性外周 T 细胞淋巴瘤和 1 例肝炎性假瘤样滤泡树突状细胞肉瘤。有 3 例最初误诊为反应性改变或分枝杆菌感染而非淋巴瘤，1 例误诊为错误的组织学淋巴瘤类型。在本报告中，我们表明肉芽肿反应可能掩盖各种组织学类型的淋巴瘤；诊断分枝杆菌感染或类肉瘤病不能排除潜在淋巴瘤的可能性。我们强调了详细的组织学检查以及辅助研究的重要性，以做出正确的诊断并避免对患者的不适当治疗。我们的研究还拓宽了伴有肉芽肿的淋巴瘤类型谱。
