Histopnthology 1977, I, 3 I 5-3 I 6
Correspondence
Sir: The recent paper by Reid, Fox & Whittaker (1977), ‘Eosinophilic granuloma of lymph nodes’, following on the original report of Morgenfeld & Schajowicz (1971) brings to three the cases published in detail of eosinophilic granuloma confined to lymph nodes. These cases were aged 2 , 25 and 34 years apd apart from the granuloma, the nodes were normal. We wish to report a similar granulomatous lesion in which the nodes were abnormal. A man aged 53 years presented with right cervical lymphadenopathy and hepatosplenomegaly, and was found to have typical peripheral blood and bone marrow features of chronic lymphocytic leukaemia. Retrospectively he would now be staged according to
Rai, Sawitsky, Cronkite, Chanana, Levy & Pasternack (1975) as stage 11. A lymph node biopsy was performed and the bulk of the tissue was histologically entirely consistent with the diagnosis of chronic lymphocytic leukaemia. Also present, however, were some serpiginous areas bounded by substantial numbers of normal histiocytes and associated with large numbers of eosinophils, many in aggregates showing central necrosis. The capsule of the node was focally involved in the granuloma and there was some replacement fibrosis of the lesion. The diagnosis of extraskeletal eosinophilic granuloma in a patient with chronic lymphocytic leukaemia was made. Treatment was begun with chlorambucil and
Figure I. Lymph node with chronic lymphocytic leukaemia and the margin of an area bounded by histiocytes and containing numerous eosinophils. H & E. x 315.
315
3I6
Correspondence
afier a period further nodes appeared in the neck for which radiotherapy was given. Over the ensuing 5 years, the patient received 4 g of chlorambucil in all and at the moment is in a reasonable clinical condition undergoing further chemotherapy. During this same period no skeletal lesion or extraskeletal lesion attributable to eosinophilic granuloma has been detected and the haematological picture has remained true to that of chronic lymphocytic leukaemia. In this particular case the presence of the eosinophilic granuloma was presumptively coincidental and does not seem to have in any way interfered with the patient's better than average survival with stage 11 chronic lymphocytic leukaemia (Phillips, Kempin, Passe, MikC & Clarkson 1977).
References MORGENPELD M.D. & SCHAJOWICZ F. (1971) Solitary eosinophilic granuloma of lymph node; five year follow up. Pediatrics 48, 301-305
PHILLIPS E.A., KEMPIN S., PASSE S., MIKEV. & CLARKSON B. (1977) Prognostic factors in chronic lymphocytic leukaemia and their implications for therapy. Cliriirs in Haematology 6, 203-222 RAI K.R., SAWITSKYA., CRONKITEE.P., A.D., LEVYR.N. & PASTERCHANANA NACK B.S. (1975) Clinical staging of chronic lymphocytic leukaemia. Blood 46, 219-234 REIDH., Fox H. & WHITTAKER J.S. (1977) Eosinophilic granuloma of lymph nodes. Histopathology I, 3 1-37 J.K. Wood *F. Walker
Department of' Haematology, Leicester Royal Infirmary, Leicester LEI 5 W W
* Department of Pathology, University of Leicester, Leicester LEI 7RH
Correspondence
Sir: The recent paper by Reid, Fox & Whittaker (1977), ‘Eosinophilic granuloma of lymph nodes’, following on the original report of Morgenfeld & Schajowicz (1971) brings to three the cases published in detail of eosinophilic granuloma confined to lymph nodes. These cases were aged 2 , 25 and 34 years apd apart from the granuloma, the nodes were normal. We wish to report a similar granulomatous lesion in which the nodes were abnormal. A man aged 53 years presented with right cervical lymphadenopathy and hepatosplenomegaly, and was found to have typical peripheral blood and bone marrow features of chronic lymphocytic leukaemia. Retrospectively he would now be staged according to
Rai, Sawitsky, Cronkite, Chanana, Levy & Pasternack (1975) as stage 11. A lymph node biopsy was performed and the bulk of the tissue was histologically entirely consistent with the diagnosis of chronic lymphocytic leukaemia. Also present, however, were some serpiginous areas bounded by substantial numbers of normal histiocytes and associated with large numbers of eosinophils, many in aggregates showing central necrosis. The capsule of the node was focally involved in the granuloma and there was some replacement fibrosis of the lesion. The diagnosis of extraskeletal eosinophilic granuloma in a patient with chronic lymphocytic leukaemia was made. Treatment was begun with chlorambucil and
Figure I. Lymph node with chronic lymphocytic leukaemia and the margin of an area bounded by histiocytes and containing numerous eosinophils. H & E. x 315.
315
3I6
Correspondence
afier a period further nodes appeared in the neck for which radiotherapy was given. Over the ensuing 5 years, the patient received 4 g of chlorambucil in all and at the moment is in a reasonable clinical condition undergoing further chemotherapy. During this same period no skeletal lesion or extraskeletal lesion attributable to eosinophilic granuloma has been detected and the haematological picture has remained true to that of chronic lymphocytic leukaemia. In this particular case the presence of the eosinophilic granuloma was presumptively coincidental and does not seem to have in any way interfered with the patient's better than average survival with stage 11 chronic lymphocytic leukaemia (Phillips, Kempin, Passe, MikC & Clarkson 1977).
References MORGENPELD M.D. & SCHAJOWICZ F. (1971) Solitary eosinophilic granuloma of lymph node; five year follow up. Pediatrics 48, 301-305
PHILLIPS E.A., KEMPIN S., PASSE S., MIKEV. & CLARKSON B. (1977) Prognostic factors in chronic lymphocytic leukaemia and their implications for therapy. Cliriirs in Haematology 6, 203-222 RAI K.R., SAWITSKYA., CRONKITEE.P., A.D., LEVYR.N. & PASTERCHANANA NACK B.S. (1975) Clinical staging of chronic lymphocytic leukaemia. Blood 46, 219-234 REIDH., Fox H. & WHITTAKER J.S. (1977) Eosinophilic granuloma of lymph nodes. Histopathology I, 3 1-37 J.K. Wood *F. Walker
Department of' Haematology, Leicester Royal Infirmary, Leicester LEI 5 W W
* Department of Pathology, University of Leicester, Leicester LEI 7RH
