Necrotizing granulomas in B-cell chronic lymphocytic leukemia/small lymphocytic lymphoma

We present three cases of patients with B-cell small lymphocytic lymphoma/chronic lymphocytic leukemia that were retrieved from our files during a period of 11 months and who suddenly developed lymphadenopathy. Clinically, this lymphadenopathy was thought to represent a manifestation of their background disease and, for this reason, no cultures were performed on fresh tissue. However, histologic studies in all cases showed necrotizing granulomas. When results of our special stains were negative, we submitted the specimens for molecular studies, which demonstrated the presence of tuberculous bacilli in two out of three cases. We believe that tuberculosis can present as a sudden lymphadenopathy in immunocompromised people and we would like to raise the awareness among the clinicians and nursing and pathology laboratory staff about the risks of handling these specimens without proper precautions. Also, we emphasize the fact that, in some cases, tuberculous bacilli cases may need molecular studies to be demonstrated.