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Georgiev A, Genova S, Uchikov P, Kraev K, Kraeva M, Chakarov D, Uchikov A. Solitary primary intraosseous xanthoma of the mandible in a 15-year-old boy: a case report. J Med Case Rep 2024; 18:225. [PMID: 38711147 DOI: 10.1186/s13256-024-04534-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 04/01/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND A xanthoma is a rare bone condition consisting of a predominant collection of lipid-rich, foamy histiocytes. The central xanthoma of the jaws is a unique benign tumor. CASE REPORT A 15-year-old Caucasian male has been presented to our department. He had radiological changes in the area of the left mandibular angle, with an area of diffuse osteolysis of 3.0 cm by 2.0 cm. Computed tomography reveals an area of diffuse osteolysis that starts from the distal root of the lower second molar and reaches the ascending process. A bone biopsy was performed, which revealed a benign proliferative process composed of histiocytic cells involving and infiltrating trabecular bone in a background of loose fibrous connective tissue devoid of any other significant inflammatory infiltrate. The size of the formation was 2.9 cm by 2.0 cm. Immunohistochemical staining for CD68 was strongly positive and negative for S-100 and CD1a. From routine blood tests, cholesterol, triglycerides, and blood sugar are within normal values, which excludes systemic metabolic disease. Subsequent to the surgical intervention, the patient underwent postoperative assessments at intervals of 14, 30, 60 days, and a year later, revealing the absence of any discernible complications during the aforementioned observation periods. CONCLUSION The diagnosis of primary xanthoma of the mandible is rare and can often be confused with other histiocytic lesions. A differential diagnosis should be made with nonossifying fibroma and Langerhans cell histiocytosis, as in our case. In these cases, immunohistochemistry with CD 68, S-100, and CD1a, as well as blood parameters, are crucial for the diagnosis.
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Affiliation(s)
- A Georgiev
- Department of Maxillo Facial Surgery, Multiprofile Hospital for Active Medical Treatment "Sv. Panteleimon" Plovdiv, Plovdiv, Bulgaria
| | - S Genova
- Department of General and Clinical Pathology, Medical Faculty, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - P Uchikov
- Department of Special Surgery, Medical Faculty, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Krasimir Kraev
- Department of Propedeutics of Internal Diseases, Medical Faculty, Medical University of Plovdiv, 15A Vasil Aprilov Boulevard, Plovdiv, 4000, Bulgaria.
| | - M Kraeva
- Department of Otorhinolaryngology, Medical Faculty, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - D Chakarov
- Department of Propaedeutics of Surgical Diseases, Section of General Surgery, Faculty of Medicine, Medical University of Plovdiv, 4002, Plovdiv, Bulgaria
| | - A Uchikov
- Department of Special Surgery, Medical Faculty, Medical University of Plovdiv, Plovdiv, Bulgaria
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Nguyen N, Lee J, Liu Y. A Case Report of Craniofacial Intraosseous Xanthoma in a Patient Seeking Facial Feminization Surgery. Ann Plast Surg 2024; 92:537-539. [PMID: 38470820 DOI: 10.1097/sap.0000000000003822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
BACKGROUND Fibrous dysplasia (FD) is a benign developmental disorder of the bone that causes normal skeletal tissue to be replaced by excess fibrous tissue and poorly differentiated osteoblasts. Intraosseous xanthomas are benign intraosseous tumor growths characterized microscopically by the presence of lipid-laden foamy histiocytes, often with cortical expansion or disruption. Although FD commonly occurs in craniofacial bones, primary intraosseous xanthomas of the skull or facial skeleton are extremely rare. Although 2 distinct conditions, each may be difficult to differentiate on CT imaging when occurring in the facial skeleton. METHODS We report a case of an incidental finding on craniofacial CT of a frontal bone lesion originally thought to be FD. The finding was in a 55-year-old transgender woman who was assigned male at birth before receiving multiprocedural facial feminization surgery. RESULTS The clinical features, radiological findings, and treatment are discussed. Postoperatively, the patient had no sequelae secondary to facial feminization surgery or to the orbital lesion biopsy procedure. Bone graft appeared stable on CT imaging, although FD did not appear to resolve completely. CONCLUSIONS Diagnosis of such lesions is challenging and may require both radiographic and histopathologic assessment. As in the case of this patient, intraosseous xanthomas may also be misdiagnosed as other benign lesions such as FD. In most known cases, surgical intervention leads to complete resolution without recurrence of the lesion.
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Affiliation(s)
- Nghiem Nguyen
- From the Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena
| | | | - Yuan Liu
- Department of Plastic Surgery, Garfield Specialty Center, Southern California Permanente Medical Group, San Diego
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Venkat S, Islam MN, Bhattacharyya I, Cohen DM, Kratochvil FJ, Woods TR, Ganatra S, Alramadhan SA. Xanthoma of the Jaw Bones: Cases Series and Review of Literature. Head Neck Pathol 2024; 18:19. [PMID: 38502367 PMCID: PMC10951172 DOI: 10.1007/s12105-024-01615-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 01/12/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Intraosseous xanthomas are rare benign lesions sometimes associated with excess lipid production. Xanthoma of the jaw bones (XJB) was first reported in 1964, and fewer than 50 cases have been reported in the English literature to date. The etiopathogenesis of XJB is highly suggestive of a reactive process or a metabolic condition. METHOD Seven cases of XJBs were retrieved from the archives of 4 oral and maxillofacial pathology services. Clinical, radiographic and histopathologic features of all these cases were retrospectively analyzed. Immunohistochemical (IHC) stains for S100 and CD68 were performed. RESULTS All seven cases involved the mandible. Patients' age ranged between 13 and 69 years with an evenly distributed female to male ratio. One patient had a medical history of hyperlipidemia, but the medical and dental histories of the others were unremarkable. For most cases, XJB was an incidental finding discovered during routine radiographic examination. Swelling and cortical expansion were noted in a few cases. Radiographically, cases typically presented as either well-defined multilocular or unilocular lesions, which were either radiolucent or mixed radiolucent/radiopaque. All the lesions were treated with surgical curettage and no recurrence was observed during subsequent follow-ups. Each of the seven cases exhibited sheets of foamy macrophages. The diagnosis is established by exclusion of entities with overlapping microscopic features and involved correlation with the clinical, histological, radiographic and IHC profiles. Immunohistochemically, all the cases expressed diffuse positivity for CD68 and were negative for S100. CONCLUSION XJB is a rare lesion of unknown etiology, which may mimic other benign or reactive jaw lesions. Due to its rarity and the potential diagnostic challenges it presents, clinicians must remain vigilant and consider CXJ in their differential when assessing radiolucent jaw anomalies.
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Affiliation(s)
- Shankar Venkat
- Department of Oral and Maxillofacial Pathology, University of Florida College of Dentistry, Gainesville, FL, USA
| | - Mohammed N Islam
- Department of Oral and Maxillofacial Pathology, University of Florida College of Dentistry, Gainesville, FL, USA
| | - Indraneel Bhattacharyya
- Department of Oral and Maxillofacial Pathology, University of Florida College of Dentistry, Gainesville, FL, USA
| | - Donald M Cohen
- Department of Oral and Maxillofacial Pathology, University of Florida College of Dentistry, Gainesville, FL, USA
| | - F James Kratochvil
- Department of Pathology and Radiology, Oregon Health and Science University School of Dentistry, Portland, OR, USA
| | - Tina R Woods
- The Medical University of South Carolina, Charleston, SC, USA
| | - Seema Ganatra
- University of Alberta, Edmonton Clinic Health Academy, Edmonton, AB, Canada
| | - Saja A Alramadhan
- University of Mississippi Medical Center, 2500 N. State St, Jackson, MS, 39216-4505, USA.
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Mewar P, Foss RD. Benign fibrohistiocytic jaw lesions: a 48-year clinicopathologic analysis and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol 2023:S2212-4403(23)00428-5. [PMID: 37277279 DOI: 10.1016/j.oooo.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/23/2023] [Accepted: 04/02/2023] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Intra-osseous fibrohistiocytic lesions have long been reported in the literature; evidence suggests they represent a heterogeneous group of reactive and neoplastic processes. This study evaluated a series of gnathic fibrohistiocytic lesions to identify and categorize their clinical, radiographic and morphologic spectrum. STUDY DESIGN A retrospective case search over 48 years was conducted for maxillary and mandibular intra-bony fibrohistiocytic lesions. Diagnoses were confirmed and demographic, radiographic, clinical and follow-up data was analyzed. RESULTS Fifty cases met the inclusion criteria. Most cases (80%) were found in the second through fourth decades (mean, 29 years). The most common location (86%) was the posterior mandible. Radiographic presentations varied, but a few patterns emerged, including a distinctive mottled, honeycomb type with punctate lucencies. All cases demonstrated fibrous components admixed with variable histiocytes. Eight cases (16%) were histiocyte-rich with dominant sheets of xanthoma cells. Immunohistochemical staining revealed strong CD68 and CD163 expression, along with variable smooth muscle actin staining. The vast majority (92%) of cases were treated conservatively. Available follow-up showed lesional stability in 17 cases (average, 85 months) with 2 recurrences (24 months each) and no evidence of malignant transformation. CONCLUSIONS This study is the largest to date of fibrohistiocytic gnathic lesions, revealing distinctive radiographic and histologic findings and characteristic clinical and immunophenotypic features. Available evidence suggests that most of these are indolent, slow-growing lesions amenable to conservative therapy.
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Affiliation(s)
- Parth Mewar
- Head and Neck Pathology, The Joint Pathology Center, Silver Spring, MD; Oral and Maxillofacial Pathology, Madigan Army Medical Center, Joint Base Lewis-McChord, WA.
| | - Robert D Foss
- Head and Neck Pathology, The Joint Pathology Center, Silver Spring, MD
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Primary Mandibular Condyle Xanthoma: Case Report and Literature Review. REPORTS 2023. [DOI: 10.3390/reports6010006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
Bone xanthoma is a rare benign primary bone lesion histologically characterized by sheets of foamy cells which are macrophages with a cytoplasm filled with droplets of fat. It is usually associated with endocrine or metabolic diseases, in the absence of which the lesion is called primary xanthoma. Because of the lack of pathognomonic radiologic and clinical features, they require a differential diagnosis with a broad spectrum of lesions with a varying degree of malignant potential. We describe a case of primary mandibular xanthoma of a 16-year-old girl without typical cutaneous manifestations and alterations in lipid values. The temporomandibular joint involvement at the mandibular condyle is peculiar in the case described here. We present even a qualitative systematic review of the literature on primary xanthoma of the jaws in others to draw up treatment guidelines.
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Primary intraosseous xanthoma of the mandible – A case report, novel approach to removal, and review of the literature. ORAL AND MAXILLOFACIAL SURGERY CASES 2022. [DOI: 10.1016/j.omsc.2022.100273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Kim MJ, Kang MJ, Kang SH. Primary xanthoma inferior to the right mandibular third molar and intraoral vertical ramus osteotomy. Imaging Sci Dent 2022; 52:231-238. [PMID: 35799964 PMCID: PMC9226232 DOI: 10.5624/isd.20210303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/24/2022] [Accepted: 03/09/2022] [Indexed: 12/05/2022] Open
Abstract
Intraosseous xanthoma of the mandible is a rare benign disorder. A 17-year-old male patient presented with a suspected abscess in the right mandibular third molar, detected on a panoramic radiograph. The patient had no history of systemic or lipid-related metabolic diseases and complained of no specific symptoms or pain. A radiographic examination revealed a heterogeneous radiolucency extending from the apical to the distal aspect of the right mandibular third molar tooth germ. The lesion measured 9×16×24 mm (antero-posterior×mediolateral×supero-inferior) and showed a relatively well-defined, multilocular, foamy appearance with hyperostotic borders spreading to the inferior alveolar nerve canal. After excisional biopsy, a diagnosis of central xanthoma was made. The lesion recurred, and intraoral vertical ramus osteotomy was done near the lesion. For the treatment of xanthoma of the mandible, extensive and delicate surgical treatment under general anesthesia should be considered.
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Affiliation(s)
- Min-Ji Kim
- Department of Oral and Maxillofacial Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Min-Jun Kang
- Department of Oral and Maxillofacial Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Sang-Hoon Kang
- Department of Oral and Maxillofacial Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
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Yellowish nodular changes in infants - juvenile xanthogranuloma and xanthoma. Postepy Dermatol Alergol 2021; 38:159-162. [PMID: 34408584 PMCID: PMC8362781 DOI: 10.5114/ada.2021.104292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 03/03/2020] [Indexed: 11/17/2022] Open
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Wilkinson PE, Merkourea S, Gopalakrishnan R, Argyris PP. Primary Intraosseous Xanthomas of the Jaws: A Series of Six Cases Including an Example with Formation of Apoptosis-Related Hyaline Globules, So-Called "Thanatosomes". Head Neck Pathol 2020; 14:859-868. [PMID: 31916206 PMCID: PMC7669974 DOI: 10.1007/s12105-020-01126-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 01/03/2020] [Indexed: 12/13/2022]
Abstract
Primary intraosseous xanthomas of the jaws (PIXJ) are rare and predominantly affect the posterior mandible (86%) of normolipemic patients, with a mean age of 30 years and no gender predilection. Clinically, PIXJ exhibit indolent biologic behavior; curettage is considered treatment of choice. Only 36 PIXJ have been reported. Apoptosis-related hyaline globules (HGs), also known as "thanatosomes", have not been previously reported in PIXJ. Cases diagnosed as xanthoma of bone were retrieved. Six cases fulfilling currently accepted criteria were identified and their clinicopathologic and immunohistochemical properties are presented herein. Mean age for PIXJ was 21.8 years (range = 12-33) and F:M ratio = 2:1. All cases presented as well-demarcated, unilocular or multilocular radiolucencies. Microscopically, PIXJ featured sheets of lipid-laden macrophages with eosinophilic or foamy cytoplasm. A secondary fibroblastic population lacking storiform pattern was evident in two cases. Adipocytes (3/6), peripheral neurovascular bundles (1/6), bone fragments (3/6) and dystrophic calcifications (3/6) were observed enclosed by the xanthoma cells. Notably, one case exhibited numerous, spherical, eosinophilic HGs containing apoptotic nuclei. PIXJ were consistently CD68(+) and negative for CD1α and S100. CD45 decorated lymphocytes and the membrane of foamy histiocytes. Xanthoma cells stained for lysozyme and plasma proteins including alpha-1 antitrypsin (AAT), IgG and IgA in one probed case. HGs were lysozyme(+), AAT(+), IgG(+), IgA(+), PAS(+) and diastase-resistant, and fuchsinophilic with Masson's trichrome. PIXJ represent infrequent, solitary, mandibular lesions with a predilection for the second and third decade of life. Thanatosomes associated with cell injury and death can be present in PIXJ.
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Affiliation(s)
- Peter E. Wilkinson
- grid.17635.360000000419368657Division of Oral and Maxillofacial Pathology, Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, 515 Delaware Street SE 16-206B, Minneapolis, MN 55455 USA
| | - Stavroula Merkourea
- grid.5216.00000 0001 2155 0800School of Dentistry, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Rajaram Gopalakrishnan
- grid.17635.360000000419368657Division of Oral and Maxillofacial Pathology, Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, 515 Delaware Street SE 16-206B, Minneapolis, MN 55455 USA
| | - Prokopios P. Argyris
- grid.17635.360000000419368657Division of Oral and Maxillofacial Pathology, Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, 515 Delaware Street SE 16-206B, Minneapolis, MN 55455 USA ,grid.17635.360000000419368657Department of Biochemistry, Molecular Biology, and Biophysics, College of Biological Sciences, University of Minnesota, Minneapolis, MN 55455 USA ,grid.17635.360000000419368657Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455 USA ,grid.17635.360000000419368657Institute for Molecular Virology, University of Minnesota, Minneapolis, MN 55455 USA
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David E, Dupont C, Desdoits A, Bronfen C, Laquievre A. Recurrence of a primary xanthoma of the humerus in a 9-year-old normolipidemic child. Arch Pediatr 2019; 26:411-414. [PMID: 31630906 DOI: 10.1016/j.arcped.2019.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 06/25/2019] [Accepted: 09/22/2019] [Indexed: 10/25/2022]
Abstract
Xanthomas are rare bone tumors that occur more often in patients with hyperlipidemia or metabolic disorders. We report the case of a 9-year-old child presenting with right shoulder pain after a trauma. A benign osteolytic lesion was found in the proximal humeral metaphysis. Curettage of the lesion was performed. Histologic findings confirmed intraosseous xanthoma. Although there was no evidence of dyslipidemia or metabolic disease, the patient suffered local recurrence at the 8-month follow-up, requiring a second surgery with bone grafting. This difficult and rare diagnosis must be kept in mind with osteolytic lesions.
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Affiliation(s)
- E David
- UNICAEN, department of pediatrics, Normandie université, CHU de Caen Normandie, 14000 Caen France.
| | - C Dupont
- UNICAEN, department of pediatrics, Normandie université, CHU de Caen Normandie, 14000 Caen France
| | - A Desdoits
- UNICAEN, department of pediatrics, Normandie université, CHU de Caen Normandie, 14000 Caen France
| | - C Bronfen
- UNICAEN, department of pediatric orthopedic surgery, Normandie université, CHU de Caen Normandie, 14000 Caen France
| | - A Laquievre
- UNICAEN, department of pediatric orthopedic surgery, Normandie université, CHU de Caen Normandie, 14000 Caen France
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de Arruda JAA, Almeida TFA, Abreu LG, do Amaral MBF, Anbinder AL, Flores RM, Agostini M, Romañach MJ, Silva TA, de Andrade BAB, Mesquita RA. Intraosseous xanthoma of the mandible: A multi‐institutional case series with a literature review. J Oral Pathol Med 2019; 48:935-942. [DOI: 10.1111/jop.12940] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 07/16/2019] [Accepted: 07/18/2019] [Indexed: 12/20/2022]
Affiliation(s)
- José Alcides Almeida de Arruda
- Department of Oral Surgery and Pathology, School of Dentistry Universidade Federal de Minas Gerais Belo Horizonte Brazil
| | | | - Lucas Guimarães Abreu
- Department of Paediatric Dentistry, School of Dentistry Universidade Federal de Minas Gerais Belo Horizonte Brazil
| | | | - Ana Lia Anbinder
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology Universidade Estadual Paulista ‐ UNESP São José dos Campos Brazil
| | - René Martínez Flores
- Department of Oral Medicine and Oral Pathology, School of Dentistry Universidad Andrés Bello Viña del Mar Chile
| | - Michelle Agostini
- Department of Oral Diagnosis and Pathology, School of Dentistry Universidade Federal do Rio de Janeiro Rio de Janeiro Brazil
| | - Mário José Romañach
- Department of Oral Diagnosis and Pathology, School of Dentistry Universidade Federal do Rio de Janeiro Rio de Janeiro Brazil
| | - Tarcília Aparecida Silva
- Department of Oral Surgery and Pathology, School of Dentistry Universidade Federal de Minas Gerais Belo Horizonte Brazil
| | | | - Ricardo Alves Mesquita
- Department of Oral Surgery and Pathology, School of Dentistry Universidade Federal de Minas Gerais Belo Horizonte Brazil
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12
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Brooks JK, Mostoufi B, Sultan AS, Khoury ZH, Price JB, Papadimitriou JC, Basile JR, Drachenberg CB, Younis RH. Central xanthoma of the mandible associated with hyperlipidemia: A rare presentation. Int J Pediatr Otorhinolaryngol 2018; 105:75-78. [PMID: 29447824 DOI: 10.1016/j.ijporl.2017.11.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 11/19/2017] [Accepted: 11/21/2017] [Indexed: 11/25/2022]
Abstract
Xanthoma is a common, self-limiting cutaneous lesion of non-Langerhans cell, lipid-laden foamy histiocytes that is often concomitant with hyperlipidemia. The intraosseous counterpart is rarely encountered and typically presents as a painless, expansile osteolytic process in the context of hyperlipidemia or normolipidemia. Only a scant number of gnathic xanthomas have been reported in the otolaryngologic literature. We report the clinical, laboratory, radiographic, histopathologic, immunohistochemical, and ultrastructural studies of a mandibular lesion discovered in an asymptomatic 16-year-old male, and associated with 2 previously unreported comorbidities, namely hyperlipidemia and vitamin D deficiency.
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Affiliation(s)
- John K Brooks
- Department of Oncology and Diagnostic Sciences, University of Maryland School of Dentistry, Baltimore, MD, United States.
| | - Behzad Mostoufi
- Department of Oral and Maxillofacial Surgery, University of Maryland School of Dentistry, Baltimore, MD, United States.
| | - Ahmed S Sultan
- Graduate Program in Oral and Experimental Pathology, Department of Oncology and Diagnostic Sciences, University of Maryland School of Dentistry, Baltimore, MD, United States.
| | - Zaid H Khoury
- Graduate Program in Oral and Experimental Pathology, Department of Oncology and Diagnostic Sciences, University of Maryland School of Dentistry, Baltimore, MD, United States.
| | - Jeffery B Price
- Director of Oral and Maxillofacial Radiology, Department of Oncology and Diagnostic Sciences, University of Maryland Dental School, Baltimore, MD, United States.
| | - John C Papadimitriou
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, United States.
| | - John R Basile
- Department of Oncology and Diagnostic Sciences, University of Maryland School of Dentistry, Baltimore, MD, United States; Molecular and Structural Biology Branch, The Marlene and Stewart Greenebaum Center, Baltimore, MD, United States.
| | - Cinthia B Drachenberg
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, United States; Electron Microscopy Laboratory, University of Maryland School of Medicine, Baltimore, MD, United States.
| | - Rania H Younis
- Department of Oncology and Diagnostic Sciences, University of Maryland School of Dentistry, Baltimore, MD, United States; Molecular and Structural Biology Branch, The Marlene and Stewart Greenebaum Center, Baltimore, MD, United States.
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Saha A, Tocaciu S, Subramanian B. Primary Xanthoma of the Mandible-A Case Report. J Oral Maxillofac Surg 2017; 76:374.e1-374.e4. [PMID: 29125930 DOI: 10.1016/j.joms.2017.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 10/01/2017] [Accepted: 10/05/2017] [Indexed: 11/17/2022]
Abstract
Xanthomas are common cutaneous and subcutaneous lesions that occur due to altered metabolic or endocrinal function. They are found on skin and around tendon sheaths in individuals with dyslipidemias. In extremely rare cases, they can present as isolated intrabony lesions in otherwise healthy individuals. The isolated intrabony lesions are referred to as primary xanthomas. This report describes a case of an incidentally found primary xanthoma, its management, and follow-up in an otherwise healthy patient.
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Affiliation(s)
- Anik Saha
- Oral Surgery Resident, Department of Oral and Maxillofacial Surgery, Royal Dental Hospital Melbourne, Carlton, VIC, Australia.
| | - Shreya Tocaciu
- Oral and Maxillofacial Registrar, Department of Oral and Maxillofacial Surgery, Royal Dental Hospital Melbourne, Carlton, VIC, Australia
| | - Balanand Subramanian
- Oral Surgery Consultant, Department of Oral and Maxillofacial Surgery, Royal Dental Hospital Melbourne, Carlton, VIC, Australia
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Abstract
Extragnathic xanthomas are seen in the bones or as soft tissue masses. They are often associated with hyperlipidemia and are considered as reactive or metabolic lesions. Only 19 cases of xanthomas of the jaws have been reported so far in the English literature. A total of ten cases of central xanthoma of the jaw bones were identified from the Oral and Maxillofacial Pathology biopsy services of the University of Washington and the Tufts University School of Dental Medicine, between the years 2000-2016. The demographic and clinical information on these cases was tabulated logically on the basis of age, gender, location and presence or absence of symptoms, extragnathic lesions and serum hyperlipidemia. Radiographic and histopathological features were also examined. The findings in these cases were correlated with those available from the previously reported cases. Majority of cases are seen in the second and third decades of life. There is no gender predilection. Jaw lesions presented as solitary radiolucencies with a predilection for the posterior mandible. Unlike maxillary lesions, pain and expansion are inconsistent findings in mandibular lesions. Jaw lesions are not associated with extragnathic bone or soft tissue involvement or a hyperlipidemia. The central xanthoma of the jaws is a unique benign tumor. Histopathologically, many other jaw lesions contain variable numbers of foamy histiocytes. Therefore, a diagnosis of a central xanthoma of the jaws must be made after excluding all other such histiocyte containing lesions. This requires correlation of histopathological findings with clinical and radiographic features.
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