Clinical and histopathologic features of paraneoplastic granuloma annulare in association with solid organ malignancies: A case-control study

J Am Acad Dermatol. 2018 Nov;79(5):913-920.e1. doi: 10.1016/j.jaad.2018.06.022. Epub 2018 Jun 18.

Abstract

Background: Granuloma annulare (GA) is a granulomatous skin eruption rarely associated with cancer. We report seven cases of paraneoplastic GA in association with solid organ malignancy.

Objective: To compare the clinical and histopathological features of paraneoplastic GA to case-matched controls of classic GA.

Methods: Retrospective chart and histopathological review of 7 individuals and 13 age- and sex-matched controls. Paraneoplastic GA was defined as GA occurring within 6 months of the diagnosis of solid organ malignancy and/or persistent GA that resolved with cancer treatment.

Results: Most cases of paraneoplastic GA were associated with lung cancer (4/7). The clinical and histopathological features of paraneoplastic and classic GA were similar. Compared to classic GA, paraneoplastic GA cases were more often generalized disease (6/7 vs 6/13), refractory to treatment, and had a perivascular inflammatory cell infiltrate (5/7 vs 2/13). All cases of paraneoplastic GA that underwent definitive treatment of their cancer improved.

Limitations: Single-institution, retrospective review with a small sample size.

Conclusion: Paraneoplastic GA is rare, similar to classic GA, and refractory to treatment. We advocate for age-appropriate screening in individuals with GA that is nonresponsive to multiple lines of systemic treatment and evaluating patients with concerning signs or symptoms for an underlying neoplasm.

Keywords: granuloma annulare; paraneoplastic; solid organ malignancy.

MeSH terms

  • Aged
  • Brain Neoplasms / epidemiology
  • Brain Neoplasms / pathology
  • Breast Neoplasms / epidemiology
  • Breast Neoplasms / pathology
  • Case-Control Studies
  • Cell Transformation, Neoplastic / pathology*
  • Female
  • Glioblastoma / epidemiology
  • Glioblastoma / pathology
  • Glioblastoma / therapy
  • Granuloma Annulare / epidemiology*
  • Granuloma Annulare / pathology*
  • Humans
  • Incidence
  • Lung Neoplasms / epidemiology*
  • Lung Neoplasms / pathology
  • Male
  • Melanoma / epidemiology
  • Melanoma / pathology
  • Melanoma / therapy
  • Middle Aged
  • Paraneoplastic Syndromes / epidemiology
  • Paraneoplastic Syndromes / pathology*
  • Prognosis
  • Risk Assessment
  • Skin Neoplasms / epidemiology
  • Skin Neoplasms / pathology
  • Treatment Outcome