Necrobiotic Xanthogranuloma Presenting as a Solitary Tumor

Štork, Jiří; Kodetová, Daniela; Vosmík, F; Krejča, Miroslav

doi:10.1097/00000372-200010000-00013

Cited by 35 publications

(33 citation statements)

References 12 publications

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“…NXG can be associated with malignancy 1,4 , 8 and can involve internal viscera such as the lungs, heart and liver 5 . As in our case, some 20% of patients with NXG do not have paraproteinemia and cases of NXG with neither paraproteinemia nor significant laboratory abnormality have been reported 1,7 , 9 . Another clinically similar case to ours was recently reported in a 60‐year‐old white woman who presented with a solitary plaque on the buttock without paraproteinemia, leukopenia or systemic lesions 7 .…”

Section: Discussionsupporting

confidence: 80%

“…Necrobiotic xanthogranuloma (NXG) is a rare xanthomatous disorder with distinct clinicopathological findings. There are less than 80 reported cases, including a large series analyzed by Mehregan et al ., 1 in the English literature 1–10 . NXG usually presents with two or more indurated yellow‐red papules, nodules, or plaques sometimes with ulceration 1,2 .…”

Section: Discussionmentioning

confidence: 99%

“…The most common sites are the periorbital area, followed by the trunk, face, arms, upper thighs, legs, shoulders, and buttock 1–5 . Histologically, necrobiotic areas and palisading granulomatous inflammation with xanthomatous histiocytes are characteristic 2,6 , 7 . NXG can be differentiated from necrobiosis lipoidica diabeticorum (NLD) by a more dense infiltrate with a greater proportion of foamy histiocytes, Touton giant cells and angulated giant cells and a wider, deeper band of necrobiosis 8,9 .…”

Section: Discussionmentioning

confidence: 99%

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A case of necrobiotic xanthogranuloma without paraproteinemia presenting as a solitary tumor on the thigh

Chang

Lee

et al. 2003

Int J Dermatology

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A 82‐year‐old Korean woman had had a 6‐month history of an asymptomatic, flat, hard, red to brown tumor on her right thigh. This lesion had been slowly enlarging with an advancing margin. She had noted gradually developing pain associated with necrosis and ulceration on the lesion. Examination revealed a solitary, 8 × 7.5 cm, yellow to dark red, telangiectatic tumor with multiple areas of punched out ulceration and a peripheral elevated yellowish margin on the right inner upper thigh (Fig. 1). No clinically similar lesions on the periorbital area or other sites were seen. Histologic examination revealed a massive palisading granulomatous infiltration with several layers of extensive bands of necrobiotic zone in the entire dermis and deep subcutaneous tissue (Fig. 2a). In the granulomatous infiltrate in the dermis and subcutis, many various‐shaped, some bizarre, angulated, foreign‐body type multinucleated giant cells, many Touton giant cells, and a few Langhans giant cells were found to be scattered (Fig. 2b). There were numerous xanthomatized histiocytes. Dense infiltration of lymphoplasma cells was seen in the periphery of the granuloma and perivascularly. Conspicuous granulomatous panniculitis composed of lymphoplasma cells, polymorphonuclear cells, foam cells, and Touton and foreign‐body giant cells was also seen. However, cholesterol clefts and lymphoid follicles were not seen. Subcutaneous septae were widened by necrobiotic change and fibrosis with thrombosed large vessels. Gram, Gomeri‐methenamine silver and acid‐fast stains were negative. The necrobiotic areas were positive to alcian blue. Laboratory investigation revealed elevated white blood cell counts, anemia and elevated erythrocyte sedimentation rate. The following parameters were within the normal range: lipids, glucose, renal and liver function tests, serum complements, serum immunoglobulins, cryoglobulins and antinuclear antibodies. The findings of chest X‐ray, skull X‐ray and ectorcardiography were normal. Serum electrophoresis and serum immunoelectrophoresis revealed no abnormality. The patient was diagnosed as having necrobiotic xanthogranuloma without paraproteinemia. She was treated with oral steroid (0.5–0.6 mg/kg) and NSAIDS for 1 month with partial improvement of pain and the lesion ceased to enlarge. In the following 1 year of follow‐up, with only intermittent NSAIDS, her lesion did not progress and there were no signs of systemic involvement or new skin lesions. Figure 1 (a) A solitary, red to brown plaque with multiple ulcerations and a peripheral elevated yellowish margin on the inner upper thigh 2 (a) A dermal and subcutaneous massive xanthogranulomatous infiltrate with zonal necrobiosis of collagen (× 20). (b) Prominent infiltrate of xanthomatized histiocytes and giant cells with perivascular lymphoplasma cells (H&E, × 100)

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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A case of necrobiotic xanthogranuloma without paraproteinemia presenting as a solitary tumor on the thigh

Chang

Lee

et al. 2003

Int J Dermatology

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“…In our case, either paraproteinemia or other associated hematologic disorders were not detected. So far, only a few cases of NXG without paraproteinemia have been reported, [7,8] suggesting that NXG is not always associated with paraproteinemia or malignancies. By contrast, several papers show paraproteinemia might develop after the onset of skin lesions of NXG as long as 12 years [9] or even 20 years [10].…”

Section: Discussionmentioning

confidence: 99%

Periorbital necrobiotic xanthogranuloma without paraproteinemia

Nakamura-Wakatsuki¹,

Yamamoto²

2013

Our Dermatol Online

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Introduction: Necrobiotic xanthogranuloma (NXG) is a rare histiocytic disease which most frequently involves periorbital areas. NXG is associated with paraproteinemia with a ratio over 80%. However, a few cases of NXG without paraproteinemia (isolated NXG) have also been reported. Main observation: A 58-year-old Japanese woman complained about asymptomatic dermal nodules on the bilateral lower eyelids. The histopathological examination revealed granulomatous inflammation. Paraproteinemia was not detected either in the serum or in the urine. The size of the nodules has been constant, and she has been under careful follow-up without any systemic therapies. Conclusions: NXG is frequently associated with paraproteinemia, which may develop later. Patients with NXG need careful follow-up including repeated blood tests.

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“…3,4 Therefore, whole-body CT or magnetic resonance scans and a bone marrow aspirate and trephine biopsy should be performed. Other reported associations include diabetes mellitus and hyperlipidemia.…”

Section: 2mentioning

confidence: 99%

Erythematous Papules, Plaques, and Nodular Lesions on the Trunk and Within Preexisting Scars

Koch¹,

Goerdt²,

Géraud³

2013

JAMA Dermatol

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A 79-year-old woman presented with yellowish erythematous papules, plaques, and nodules on her trunk and arms that had developed over the previous 5 months and were slowly growing (Figure, A). Some of the lesions were found within preexisting postsurgical scars, such as on the shoulder and submammary region (Figure, B). The lesions were asymptomatic but a cause for cosmetic concerns. The patient had a history of breast cancer 2 years previously with subsequent breast ablation and radiation therapy. Furthermore, she underwent an implantation of a shoulder endoprosthesis. She was referred to us by her gynecologist owing to suspected cutaneous metastatic carcinoma of the breast. Laboratory investigations revealed normal findings on complete blood cell count (white blood cell count of 3670/μL [reference range, 4200-10 000/μL]), a hemoglobin level of 11.1 g/dL (range, 12.3-15.2 g/dL), and a monoclonal gammopathy of IgG κ type. (To convert white blood cell count to × 10 9 /L, multiply by 0.001; to convert hemoglobin level to grams per liter, multiply by 10.0.) A skin biopsy specimen was taken from the plaque within the scar in the submammary region (Figure, C).

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Necrobiotic Xanthogranuloma Presenting as a Solitary Tumor

Cited by 35 publications

References 12 publications

A case of necrobiotic xanthogranuloma without paraproteinemia presenting as a solitary tumor on the thigh

A case of necrobiotic xanthogranuloma without paraproteinemia presenting as a solitary tumor on the thigh

Periorbital necrobiotic xanthogranuloma without paraproteinemia

Erythematous Papules, Plaques, and Nodular Lesions on the Trunk and Within Preexisting Scars

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