Changes of verruciform xanthoma in an HIV-1+ patient with diffuse psoriasiform skin disease

Verruciform xanthoma occurs most commonly in the oral mucosa; however, rare cutaneous lesions have been described. Although the pathogenesis of this entity is not known, dysregulation of epithelial proliferation and degenerative changes in the epithelium may explain the occurrence of this lesion in association with inflammatory dermatoses, epithelial hamartomas, and epithelial dysplasia. We report an HIV-1+ patient with diffuse psoriasiform skin lesions that showed histologic changes of verruciform xanthoma.

[Xanthelasma of the sigmo-rectal wall]

Xanthelasma is a benign localized collection of lipid-laden histiocytes, that is usually idiopathic and immunohistochemical studies confirmed the histiocytic nature of the proliferation. It is here reported a case in the sigma-rectum, with a review of the recent literature on the argument. Although it is a well recognized entity already described in various organs, its occurrence in the wall of the sigma-rectal channel is at all uncommon. It is suggested that the lesion could be referred to a local immunological disorder, with a cell mediated mechanism.

[Syringomas. Presentation of 7 cases]

OBJECTIVE

To further knowledge of syringoma and its importance within the overall condition of the patient, with a view to making it relevant in the differential diagnosis of other conditions such as xanthomata or milium cysts.

DESIGN

A descriptive study of a crossover type.

SETTING

Primary care and the dermatology clinic of a health centre in the metropolitan area of Madrid.

PATIENTS AND OTHER PARTICIPANTS

The records of patients with syringomas confirmed by histological tests during 1990-1993 were examined. Patients with only a clinical diagnosis were discarded. The different diagnoses on referral by the primary care doctor were also studied.

MEASUREMENTS AND MAIN RESULTS

Seven patients (5 women, two men) were confirmed by histological tests as suffering Syringomas. They were between 16 and 52 years old. Four had lesions only on the eyelids; in the other three they were widespread. All of them were asymptomatic, had been over three years without lesions and had no special previous history. None of them wanted to undergo treatment. The referral diagnoses cited xanthomata in five cases and milium cysts in the others.

CONCLUSIONS

The primary care doctor must become better informed about syringoma, given its frequent confusion with other conditions (xanthomata and milium cysts). This confusion gives rise to unnecessary additional examinations and discomfort for the patients. These lesions should be verified histologically, as it is an nonaggressive method.

Diffuse plane xanthomatosis and acquired palmoplantar keratoderma in association with myeloma

We report a patient with diffuse plane xanthomatosis, acquired palmoplantar keratoderma, and myeloma. Although diffuse plane xanthomatosis is a recognized manifestation of paraproteinaemia, keratoderma is not. However, successful treatment of the myeloma in our patient coincided with a dramatic improvement in the keratoderma, suggesting a genuine association between the two disorders.

Normolipemic papular xanthomatosis in erythrodermic atopic dermatitis

We describe papular xanthomatosis that progressively developed in a patient with long-standing erythrodermic atopic dermatitis and normal lipid metabolism and without an associated systemic disease. Light microscopy showed a lobulated aggregate of sometimes foamy histiocytes. Ultrastructurally, these histiocytes contained lipid inclusions and lacked features of Langerhans or epithelioid cells. Other granulomatous skin diseases such as tuberculosis, sarcoidosis, or foreign body granuloma were excluded by histologic study, polarizing microscopic examination, electron microscopy, and microbiologic investigations. Nevertheless, these xanthomas showed an antigen expression pattern similar to that found in noninfectious granulomas (CD1a-, MS-1-, CD11c+, MRP-8/-14+, 25F9+, RM 3/1+/-, CD36(+), indicating that normolipemic papular xanthomatosis may be reactive process and should not be included among the true cutaneous non-Langerhans cell histiocytoses.

Cerebrotendinous xanthomatosis in two sisters: case reports and MR imaging

Cerebrotendinous xanthomatosis is a rare inherited disorder of bile acid metabolism producing xanthomata and severe, progressive neurological deficits. In spite of the rarity of the condition it is important because it is treatable: the neurological deterioration can be halted and in some cases reversed.

Adult-onset xanthogranuloma appearing symmetrically on the ear lobes

Clinical backgrounds of patients with adult-onset xanthogranuloma are somewhat different from those of patients with juvenile xanthogranuloma, but the histologic findings of both forms of the disease are identical. The lesions of the adult form are usually asymmetric. We describe a patient with adult-onset xanthogranuloma that appeared symmetrically on the ear lobes. This case suggests a possible role for mechanical stimuli (e.g., earrings) in the pathogenesis of adult-onset xanthogranuloma.

[Successful treatment of eruptive xanthomatosis with the antilipemic agents acipimox]

A 51-year-old male patient with histologically confirmed eruptive xanthomatosis is presented. Routine and special laboratory examinations showed complex disturbances of carbohydrate and lipid metabolism, the latter taking the form of classic hyperlipoproteinaemia type IV. Combined oral antilipaemic drugs including acipimox (methylpyrazine carboxylic acid analogue of nicotinic acid) and a low-fat diet resulted in regression of the skin symptoms and normalization of the serum lipid levels.

Atypical xanthomatosis in apolipoprotein E-deficient mice after cholesterol feeding

Apolipoprotein (apo) E-deficient mice were fed a hypercholesterolemic diet for 14 weeks. Mean serum cholesterol levels rose to 37.5 mM. Upon complete necroscopy, massive xanthomatous lesions were noticed in various tissues, with a predilection for subcutaneous and peritendinous tissues, while control animals on the same diet (3.4 mM serum cholesterol) and apo E-deficient mice on a regular chow diet (20 mM serum cholesterol) did not show such lesions. Also, apo E3-Leiden transgenic mice fed a high fat diet, with 60 mM of serum cholesterol, did not exhibit any xanthomatosis. The xanthomatous lesions found in the Apoe knock-out mouse clearly differed in location from xanthomas previously found in low density lipoprotein receptor-deficient mice. We conclude that the lack of apo E results in atypical disseminated xanthomatosis, suggesting that apo E has an important role in determining the tissue distribution of cholesterol deposition.

Pulmonary xanthoma. A case report with immunohistologic study and DNA-image analysis

A case is reported of a xanthoma of the lung in a 32-year-old asymptomatic male. Detailed roentgenographic and immunohistopathologic studies, as well as DNA-image analysis, are presented. The benign nature of this tumor is well recognised and it is generally agreed that conservative local excision with a margin of uninvolved lung is the treatment of choice. The existing literature is reviewed.

Verruciform xanthoma in a psoriatic patient under PUVA therapy

A patient with psoriasis vulgaris developed verruciform xanthoma (VX) on the scrotum during psoralen photochemotherapy (PUVA). Although it is uncertain whether VX was induced by PUVA therapy, we report the first case of VX which appeared in a patient with psoriasis during PUVA therapy. We speculate that UV light may be one of the etiologic factors triggering VX in this case.

Giant xanthomatous dermatofibroma--a case distinguished histologically and immunohistochemically from invasive fibrohistiocytic tumors

A 50-year-old woman presented with a skin tumor on her right calf. The tumor had been noticed 20 years previously and grew to more than 60 mm in diameter. The histological findings were characterized by numerous bland xanthomatous histiocytes and a few atypical giant cells with pyknotic nuclei, although mitotic figures were few. These findings led to the diagnosis of dermatofibroma with unusual xanthomatous expression. Immunohistochemical studies using several markers for histiocytes (lysozyme, alpha 1-antitrypsin, alpha 1-antichymotrypsin and anti-CD68 antibody), anti-factor-XIIIa antibody and anti-CD34 antibody supported the diagnosis.

Xanthogranulomatous cystitis: a case report and review of the literature

Xanthogranulomatous cystitis is a rare benign chronic inflammatory disease of unknown aetiology. We report a case of xanthogranulomatous cystitis. The patient is well more than 15 years after partial cystectomy. The relevant literature is reviewed.

Reticulohistiocytoma and multicentric reticulohistiocytosis. Histopathologic and immunophenotypic distinct entities

The clinicopathological and immunohistochemical features of four patients with systemic multicentric reticulohistiocytosis (MR) were compared with five cases of solitary and one case of multiple reticulohistiocytoma (RH), which were confined to the skin only. The MR cases mostly affected the limbs of older women, while RH affected young male adults without preference to site. Characteristically, both entities consisted of oncocytic mononuclear histiocytes (with granular eosinophilic cytoplasm similar to oncocytic thyroid cells) and multinucleated histiocytes with a ground-glass appearance, which appeared to be much larger (> 200 microns) and bizarre in cases of RH compared with cases of MR (50-100 microns). In RH a variable number of vacuolated, spindle-shaped, and xanthomatized mononuclear histiocytes were also present. Immunohistochemical profiles showed positivity of mononuclear histiocytes with HHF35, factor XIIIa, and LN3 (HLA-DR), with a variable number of multinucleated histiocytes in RH showing binding with peanut agglutinin. In mono- and multinucleated histiocytes in both entities macrophage markers KP1 (CD68), KiM1P, HAM56, lysozyme, and alpha 1-antitrypsin were positive. However, macrophage markers MAC387 (L1 antigen) and Leu-M1 (CD15) were negative. Vimentin was universally positive in both conditions, with all other markers (S100, desmin, smooth muscle-specific actin, and QBEnd 10 [CD34]) negative. This study shows that histology supplemented by immunocytochemistry delineates MR from RH and immunohistochemical profiles indicate a cell lineage relationship between RH and adult xanthogranuloma.

Atypical periorbital xanthogranulomas associated with systemic benign lymphoepithelial lesions

The report reviews the clinical, laboratory, and pathologic features of a 47-year-old woman with systemic benign lymphoepithelial lesions in whom atypical periorbital xanthogranulomas with rare central necrosis subsequently developed.

Plexiform xanthomatous tumor. A report of three cases

We describe three cases of plexiform xanthomatous tumor in middle-aged men. The tumors shared some morphological features with xanthoma, cholesterotic fibrous histiocytoma, and plexiform fibrohistiocytic tumor. However, no hyperlipoproteinemia was found in our cases, and many morphological features distinguish the plexiform xanthomatous tumor from all the other entities.

Perineal xanthogranulomatous pseudotumor due to intermittent catheterization: a liposarcoma mimic. Case report

A large perineal fatty tissue mass shown to be an encapsulated xanthogranulomatous reaction was found in a spinal cord injured man whose neuropathic bladder was for a long time being managed by clean intermittent catheterization, but who had chronic urinary tract infection. He was also known to be a chronic alcoholic. We would say that an alcohol numbed sensorium and multiple catheterizations led to recurrent small urethral perforations which in the setting of chronic bacteriuria promoted the unusual inflammatory mass. Appreciating the increasing use of clean intermittent catheterization for the spinal cord injured, we suspect that similar cases of 'xanthogranulomatous pseudotumors' will be found, and therefore we describe this most unusual clinical presentation.

Retroperitoneal xanthogranuloma in a patient with Erdheim-Chester disease

A case of Erdheim-Chester disease with retroperitoneal and renal sinus xanthogranuloma that occurred in a 50-year-old woman is presented. The 12 previously reported cases of Erdheim-Chester disease associated with retroperitoneal xanthogranuloma are reviewed and compared with 13 sporadic cases of retroperitoneal xanthogranuloma. Retroperitoneal xanthogranuloma is distinguished from inflammatory malignant fibrous histiocytoma by its lack of neutrophils, inconspicuous vascularity, lack of nuclear atypia, and abundant collagen. It is distinguished from inflammatory fibrosarcoma by its numerous foamy histiocytes, relative lack of plasma cells, and lack of nuclear atypia; it is distinguished from retroperitoneal fibrosis principally by its many foamy histiocytes, lack of plasma cells, and lack of vasculitis.