An Unusual Case of Multiple Tendinous Xanthomas Involving the Extremities and the Ears

Abstract

Tendinous and subcutaneous xanthomas are nodular deposits of lipid-filled macrophages, which commonly form on the Achilles tendon, hands, feet, elbows, and knees. These nodules are frequently associated with familial hyperlipidemia, a group of diseases involving impaired cholesterol metabolism, and the accelerated development of atherosclerotic plaques. Since xanthomas may precede the diagnosis of hyperlipidemia, early identification can lead to preventative treatment that reduces the risk and morbidity of cardiovascular disease, including myocardial infarction. This case report presents a 43-year-old African-American male with multiple xanthomas involving the Achilles tendon, soles, hands, knees, elbows, and is associated with the unusual involvement of the ear.

Multiple tuberous and tendinous xanthomas diagnosed on fine‐needle aspiration cytology—report of a rare case

“…Studies have shown that the most frequent site for xanthomas in these patients is the Achilles tendon . Other sites can include the extensor tendons of the hands and feet, as the extensor tendon areas are subject to mechanical stress …”

“…Other conditions that could be considered in the differential diagnosis of xanthomas occurring at ankles and knees are as follows: giant cell tumor of tendon sheath, diffuse villonodular synovitis, lipoma, neurofibroma and rarely sarcomas. Appropriate clinical setting and cytology would lead to the right diagnosis in such situations …”

“…The treatment options in these patients include changes in lifestyle and diet, pharmacologic agents like statins and in advanced cases invasive procedures like lipid apheresis and liver transplantation …”

“…Xanthomas are nodular deposits of lipid‐filled macrophages, which usually develop in skin and subcutis around eyes, deep soft tissues, Achilles tendon, hands, feet, elbows and knees . These nodules are frequently associated with a group of diseases with impaired cholesterol metabolism such as primary/secondary hyperlipidemia, hypothyroidism, obesity, primary biliary cirrhosis, etc.…”

“…5 Other sites can include the extensor tendons of the hands and feet, as the extensor tendon areas are subject to mechanical stress. 1,6 Courtice et al indicated that mechanical stress, similarly to the effect of mild heat injury to skin, also increases capillary permeability around the mechanical stress exposed areas, which may lead to the accumulation of LDL. This theory may explain why tuberous xanthomas are predominantly encountered in mechanical stress exposed regions.…”