Juvenile xanthogranuloma of the hand

Giant Juvenile Xanthogranuloma of face in an adult: A rare complexity

Juvenile xanthogranuloma, a form of non-Langerhans cell histiocytosis can be defined as the proliferation of cells with macrophage like characteristics. It has been described as a benign, asymptomatic and common self-healing disorder of non-Langerhans cell histiocytosis (LCH), affecting mostly infants, children and rarely adults. We have documented a case of a 40 year old male who presented to us with extensive insidious papulonodulous growth over the face. The facial disfigurement caused was catastrophic. An extensive surgical excision and reconstruction was performed followed by histopathological evaluation. Microscopic study and immune histochemistry revaled Juvenile Xanthogranuloma of adult. The article highlights the presentation, diagnosis and management of this mammoth, rare disease.

Congenital-type juvenile xanthogranuloma: A case series and literature review

BACKGROUND/OBJECTIVES

Congenital juvenile xanthogranulomas are infrequently described in the medical literature. We report three previously unpublished cases and systematically review the literature to better characterize this variant.

METHODS

We surveyed English-language articles indexed in MEDLINE (1951-March 2017) and EMBASE (1974-March 2017) for cases of congenital-onset juvenile xanthogranulomas confirmed on histopathology. Cases were divided into two categories: cutaneous only or cutaneous with systemic involvement.

RESULTS

We identified 31 cases of congenital juvenile xanthogranulomas involving only the skin and 16 cases with systemic involvement. Congenital juvenile xanthogranulomas involving only the skin were large (> 3 cm), presented with various clinical morphologies, and showed signs of regression by 1 year of age. Atypical clinical presentations included exophytic tumors, infiltrative plaques, agminated plaques, and subcutaneous tumors. Complications included ulceration and anetodermic scarring. Infants with congenital cutaneous juvenile xanthogranulomas who also had systemic involvement typically had multiple cutaneous tumors and hepatic involvement and showed signs of spontaneous regression independent of treatment.

CONCLUSIONS

The medical literature supports that congenital juvenile xanthogranulomas behave in a fashion similar to that of juvenile xanthogranulomas of infancy or childhood. Congenital cutaneous juvenile xanthogranulomas with or without systemic involvement spontaneously regress. The varied clinical presentations in the skin may lead to misdiagnosis, inappropriate examination, and unnecessary treatments. Infants with multiple congenital cutaneous juvenile xanthogranulomas should be evaluated for systemic involvement, with a particular focus on the liver, because 72.2% of these children were found to have hepatic juvenile xanthogranulomas.

Multifocal juvenile xanthogranuloma presenting with a hand mass and bilateral vitreous hemorrhage in a neonate

PURPOSE

To describe a rare case of multifocal juvenile xanthogranuloma (JXG) in a neonate presenting with a large hand mass, bilateral vitreous hemorrhage, and posterior segment involvement.

METHODS

Biopsy of hand lesion led to the diagnosis of JXG. Further systemic workup and ocular examination revealed bilateral vitreous hemorrhage and a small, creamy yellowish subretinal lesion above the fovea in the macula of the left eye. In addition, there was a subretinal lesion with overlying vitreous fibrosis in the inferonasal quadrant of the left eye.

RESULTS

Treatment with prednisone (2 mg/kg/day) for 2 weeks was initiated before final diagnosis of hand lesion. Steroids were then tapered off over the course of a week with no additional treatment. Follow-up examinations were performed over the course of the next 17 months. On the last follow-up examination at the age of 20 months, the child had central steady and maintained fixation in each eye. The findings of an external ocular examination were unremarkable except for a mild myopic shift in the right eye secondary to trace cataract changes. Dilated fundus examination showed resolution of the lesions in the macula and inferonasal quadrant of the left eye.

CONCLUSION

Although rare, JXG should be included in the differential diagnosis of spontaneous vitreous hemorrhage in children under the age of 2 years. Topical, periocular, and oral steroids may improve the ocular signs and symptoms in this condition and should be considered in the management of ophthalmic manifestations of JXG.

Case series of volar juvenile xanthogranuloma: clinical observation of a peripheral rim of hyperkeratosis

Juvenile xanthogranuloma is a benign histiocytic tumor predominantly occurring in children as yellowish papules on the head and trunk. Presentations on the volar surfaces are rare and may cause diagnostic confusion with pyogenic granuloma, eccrine poroma and digital fibrokeratoma. We report two patients with unusual presentations of solitary juvenile xanthogranuloma on the palm or sole. Both had lesions lacking the classic yellowish color and demonstrating a well-defined, peripheral hyperkeratotic rim. Histopathological evaluation revealed prominent orthokeratosis corresponding to the rim. Additional histological features, including dermal histiocytes and Touton giant cells, were consistent with the diagnosis of juvenile xanthogranuloma. Given the unusual locations and colors of the lesions, we conclude that histopathological evaluation is central to diagnosing volar juvenile xanthogranuloma. We additionally suggest that juvenile xanthogranuloma should be included in the differential diagnoses of volar lesions displaying a peripheral hyperkeratotic rim.

Juvenile xanthogranuloma: a rare benign histiocytic disorder

Juvenile xanthogranuloma (JXG) is a rare histiocytic disorder that typically affects children. The clinical presentation of this disease is characterized by single or, rarely, multiple yellow and brown skin nodules, most often found on the face and neck. Internal organ involvement has been sporadically observed in JXG and is associated with an increased risk of serious complications. We report two cases with a small and large nodular form of JXG.

Juvenile xanthogranuloma of the ear: A case report

Juvenile xanthogranuloma is a relatively uncommon, benign histiocytic proliferative disorder. A case of juvenile xanthogranuloma in a 13-month-old girl with an unusual clinical form is described. She presented with a yellow-red projecting nodule over the helical rim of her right ear. The lesion was histologically diagnosed as juvenile xanthogranuloma after excisional biopsy. Although primarily a dermatological curiosity, plastic surgeons should be familiar with this entity, and should consider it in the differential diagnosis of benign soft tissue tumours of the ear.

Juvenile xanthogranuloma of the finger

We present an unusual instance of juvenile xanthogranuloma occurring in the hand. A 23-month-old girl had a mass on the radial aspect of the right third finger at the distal interphalangeal joint that extended to the collateral ligament. The lesion was histologically diagnosed as a juvenile xanthogranuloma after resection of the mass. Juvenile xanthogranuloma is uncommon in the hand, and only three patients with this condition occurring in the digits have been reported in the English language literature. The clinical presentation, diagnosis, and treatment are discussed.

Juvenile xanthogranuloma on the sole

Juvenile xanthogranulomas are benign, typically self-limiting tumors that most commonly occur on the head and trunk. We report one such tumor with an atypical clinical appearance, occurring at an unusual site, the sole of the foot.

Juvenile xanthogranuloma

Juvenile xanthogranuloma (JXG) is a benign, self-healing disorder characterized by solitary or multiple yellow-red nodules on the skin and, occasionally, in other organs. It is predominantly a disease of infancy or early childhood, although adults may also be affected. Histologically, JXG represents an accumulation of histiocytes lacking Birbeck granules (non-Langerhans cells), which can be differentiated from Langerhans cells by specific staining techniques. Affected persons have normal lipid metabolism. JXG is therefore classified as a normolipemic non-Langerhans cell histiocytosis. The patient's general health is not impaired and, in the absence of associated conditions, the prognosis is excellent. Diagnosis is readily made in typical cases, but may be more difficult in unusual variants.

Juvenile xanthogranuloma: forms of systemic disease and their clinical implications

OBJECTIVE

Juvenile xanthogranuloma (JXG) with systemic (extracutaneous) involvement is a rare histiocytic disorder in which significant morbidity and occasional deaths may occur. The objective of this study was to characterize the spectrum of anatomic involvement, associated clinical problems, and management considerations in children with systemic JXG.

STUDY DESIGN

Two current cases and literature reports of 34 children with various forms of systemic AG were analyzed with respect to age, clinical presentation, site(s) of involvement, therapy, and outcome.

RESULTS

The median age of the 36 patients was 0.3 years (range, birth to 12 years). Symptoms were usually referable to bulky or infiltrative disease. Twenty patients had disease in two or more sites. Cutaneous lesions were present in fewer than half the patients. The most frequent extracutaneous sites of disease were the subcutaneous soft tissue (12); central nervous system (8); liver/spleen (8); lung (6); eye/orbit, oropharynx, and muscle (4 each); with three or fewer instances of disease in each of several other sites. Most patients were treated with excision or had spontaneous regression (some with organ involvement). However, 12 patients received treatment that included radiation or systemic chemotherapy. Survivors, some with long-term disabilities, included young children who had received radiation therapy to the brain, eye, skin, or heart. Two patients died of disease.

CONCLUSIONS

Systemic AG may involve varying numbers and combinations of extracutaneous sites. The extent of disease should be determined in patients with AG who are suspected to have systemic involvement. In contrast to the cutaneous form, systemic AG may be associated with significant complications requiring aggressive medical care. When feasible, surgical excision of lesions may be curative. Optimal treatment for symptomatic, unresectable disease is currently undefined but should be selected to minimize toxic effects in these children who are typically younger than 1 year old at presentation.

Juvenile xanthogranuloma on the palm

Juvenile xanthogranuloma is a xanthomatous and granulomatous condition that frequently arises before 1 year of age and mainly occurs on the head and trunk. We report a rare solitary juvenile xanthogranuloma on the right palm of a 10-year-old girl, present for one year. This solitary involvement of the palm has been reported only twice before.

Juvenile xanthogranuloma of the paravertebral soft tissue in infancy: a report of two cases

We report 2 cases of paravertebral soft tissue lesions with the histologic features of juvenile xanthogranuloma, both of which occurred in infants. Juvenile xanthogranuloma situated in the soft tissue is rare. We describe 2 cases with similar clinical and pathologic features; there has been no recurrence at 1 and 2 years after excision, respectively.