Association between palisaded and interstitial granulomatous dermatoses and haematological neoplasms: evidence beyond coincidence?

BACKGROUND

Palisaded and interstitial granulomatous dermatoses (PIGDs) are a spectrum of presumed reactive cutaneous disorders sometimes associated with underlying diseases, notably malignant haemopathies. Specific associations between some of these dermatoses and particular haematological neoplasms may exist.

OBJECTIVES

To describe the spectrum of haematological neoplasms associated with PIGDs and to establish whether specific associations exist.

METHODS

We conducted a retrospective monocentric study of all cases of patients with PIGD associated with haematological neoplasms seen in our department and undertook a systematic literature review. Clinical and pathological data were extracted from patient files and articles.

RESULTS

In total, 146 cases were identified (31 from our institution, 115 from the literature review). Granuloma annulare (N = 76) and elastolytic giant cell granulomas (N = 9) were mainly associated with B- and T-cell lymphoid neoplasms (59/85, 69%). Four patients with necrobiosis lipoidica were identified, of which two were associated with plasma cell dyscrasias. Interstitial granulomatous dermatitis (N = 22) was associated in half of patients with myeloid neoplasms (n = 11). This association was even stronger (n = 11, 65%) for palisaded neutrophilic granulomatous dermatitis (N = 17), especially with chronic myelomonocytic leukaemia (n = 8, 47%). We also identified 18 patients with unclassified granulomatous dermatoses that were most often associated with lymphoid neoplasm (n = 10, 56%). Medical history and clinical course data suggestive of a link that was not coincidental were identified in 41 of 146 patients (28.1%).

CONCLUSIONS

This work shows that some PIGD appear to be specifically associated with certain types of haematological neoplasms. The pathophysiological basis of these associations remains to be elucidated.