Variably acid-fast bacteria in a rare case of coexistent malignant lymphoma and cutaneous sarcoid-like granulomas

A 74-year-old woman presented clinical, laboratory, and histologic evidence of coexistent cutaneous sarcoid-like granulomas, malignant lymphocytic lymphoma, and multiple basal cell carcinomas, all occurring within slightly more than a one-year period. Variably acid-fast coccoid forms were observed in the histologic sections of the cutaneous, noncaseating granulomas; and similar, variably acid-fast, extra and intracellular coccoid forms and granular bodies were seen in the lymph nodes showing lymphoma. The possible relationship between sarcoid-like granulomas, sarcoidosis, and malignancy is discussed, as well as the possible role of cell wall deficient forms (L-forms) of mycobacteria in the pathogenesis of these diseases.