Nodular Lesions on the Face and Trunk

Abstract

A 27-year-old man presented to the department of dermatology for evaluation and treatment of widespread nodular lesions on his face and trunk. He reported that the progressive development of the nodules began when he was 20 years old. The lesions were easily traumatized. He denied ocular symptoms, hoarseness, difficulty breathing, polydipsia, polyuria, or seizure disorder. No family history of a similar eruption could be elicited. He was otherwise healthy and took no medications.Findings from the physical examination revealed numerous nontender yellow-brown papules and nodules on his face, neck, and trunk, primarily in flexural areas, including the groin and axillae bilaterally (Figs 1 and 2). These lesions ranged from 1 to 3 cm.Laboratory data revealed normal serum lipid levels and normal results from urinalysis.A shave biopsy specimen of a nodule from the right antecubital fossa revealed a flattened epidermis surrounding a dermis heavily infiltrated with Touton giant cells, histiocytic cells with vesicular nuclei, and abundant eosinophilic cytoplasm and fasicles of spindle cells (Figs 3 and 4). Prominent collec¬ tions of foam cells and lymphocytes were also seen.Significant epidermal involvement, nuclear features of Lan¬ gerhans cells, such as prominent folds or grooves, and cytolog¬ ie atypia were absent.

The Various Clinical Patterns of Xanthoma disseminatum

“…XD is usually considered to be a chronic disorder with a generally benign course [2,3,18,25], A review of the liter ature and the evaluation of the follow-up of our 7 cases per mit us to evidence three clinical variants of XD, according to their evolution and prognosis: a self-healing form, a per sistent form and a progressive form.…”

“…Ultrastructural [9,12,17,20 ] and immunohistochemical [4,12,13,17] studies permit nowadays an easy differentia tion between XD and LCH so that XD cannot be mistaken for a variant of LCH [ 18]. In fact, the cells in XD do not have Birbeck granules in their cytoplasm, usually contain lipidic vacuoles, phagosomes and cholesterol crystals and show irregular scalloped borders.…”