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The mechanism and significance of granuloma formation in lymphoid neoplasms are unknown. Various pathways for granuloma formation have been proposed. Immu-nologically, persistent antigens that are not totally eliminated by the host immune system can lead to granuloma formation. Alternatively, the granulomatous process may represent a local tissue response to the infiltrating malignant cells, but this hypothesis has been criticized because of the occurrence of granulomas in sites where no lymphoma is found. In addition, long-term treatment with interferon-alfa is able to induce granulomatous reactions and may be responsible for the skin changes in some patients.

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