Granulomas may be encountered in association with a variety of malignant neoplasms in the following circumstances:

- Commonly in Hodgkin disease and non-Hodgkin T cell lymphomas,  seminoma of the testis and ovarian dysgerminoma. Some individuals with seminoma may develop granulomatous lymphadenitis in non-metastatic lymph nodes in sites distant from the primary tumor. In Hodgkin disease granulomas may be seen in iiver and spleen which exhibit no evidence of Hodgkin disease involvement.

- Uncommonly in carcinomas arising from varied sites and in lymph nodes draining the site of carcinoma.

- Granulomatous reaction to a therapeutic agent; i.e. BCG, Interferon, Methotrexate.

- Coincidental occurrence of a systemic granulomatous disease and a malignant neoplasm.

The following images are examples of granulomas associated with malignant neoplasms

GRANULOMAS ASSOCIATED WITH MALIGNANT NEOPLASMS

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1A- Hodgkin disease, lymph node; granuloma

1B- Hodgkin disease, lymph node; minute epithelioid granulomas

1C- Hodgkin disease, lymph node; minute epithelioid granulomas

2A- Non-Hodgkin lymphoma, lymph node

2B- Non-Hodgkin lymphoma, lymph node

4A- Seminoma-non-necrotizing granulomas

3B- Non-Hodgkin lymphoma, skin

3C- Non-Hodgkin lymphoma, skin

4D- Seminoma-early necrosis in granuloma with apoptotic bodies

4E- Seminoma-necrotizing granuloma

4F- Seminoma-necrotizing granuloma

4B- Seminoma-non-necrotizing granuloma

4C- Seminoma-non-necrotizing granuloma

4-G Seminoma-intratubular  granulomas

4H- Seminoma-intratubular  granuloma

4 I- Seminoma-granulomatous angiitis

4J- Seminoma-granulomatous angiitis

5- Adenocarcinoma of colon metastatic to lymph node

6A- Adenocarcinoma of colon, poorly differentiated metastatic to lymph node

6B- Adenocarcinoma of colon, poorly differentiated metastatic to lymph node

7- Adenocarcinoma of stomach, poorly differentiated metastatic to lymph node

8- Large cell carcinoma of lung 

9A- Squamous  cell carcinoma of lung 

9B- Squamous  cell carcinoma of lung 

11- Squamous  cell carcinoma, poorly differentiated, urinary bladder

12A- Melanoma following BCG therapy

12B- Soft tissue around melanoma following BCG therapy

12C- Granulomatous angiitis at site of intralesional BCG therapy for melanoma

12D- Granulomatous angiitis at site of intralesional BCG therapy for melanoma

12E- Lymph node draining site of intralesional BCG therapy for melanoma

12F- Lymph node draining site of intralesional BCG therapy for melanoma

10A- Squamous  cell carcinoma of lung 

10B- Squamous  cell carcinoma of lung 

10C- Mediastinal lymph node draining squamous cell carcinoma of lung

3A- Non-Hodgkin lymphoma, skin

13- Invasive duct carcinoma of breast

14A-  Mycosis fungoides, skin,low magnification (courtesy of Dr. Emmanuel Maicas-with permission)

14B-  Mycosis fungoides, skin,med. magnification (courtesy of Dr. Emmanuel Maicas-with permission)

14C-  Mycosis fungoides, skin, granulomatous,high magnification (courtesy of Dr. Emmanuel Maicas-with permission)