Xanthoma of the temporal bone: case report

Xanthoma of rib: a case report and review of the literature

BACKGROUND

Xanthomas are well-circumscribed benign proliferative lesions seen mainly in soft tissues. Usually, they are found in hyperlipidemia and familial hyperlipoproteinemia. Histologically, are characterized by macrophage-like mononuclear cells, multinucleated giant cells and abundant foam cells. The bone involvement, however, is notoriously rare and rib localization is extremely rare.

CASE PRESENTATION

A 55-year-old man performed a chest X-ray and a subsequent chest Computed Tomography scan showing a rib lesion that was surgically removed and a diagnosis of rib xanthoma was made. The patient presented an unknown condition of hyperlipidemia.

CONCLUSION

Rib xanthoma can be discovered accidentally and can be helpful in identifying an unrecognized condition of hyperlipidemia.

[Bilateral temporal bone xanthoma associated with hyperlipidemia]

Presented clinical observation of a 42-year-old patient with bilateral xanthoma of the temporal bone, who has been treated for a long time for bilateral external otitis media, repeatedly mastoiditis. In this case, hyperlipidemia was detected only after the diagnosis of xanthoma was established. In this case, histological and clinical data helped to diagnose xanthomas and exclude chronic otitis media: the preservation of the auditory ossicles and hearing despite a large destruction of the temporal bone; satisfactory condition of the patient for many years in the presence of volumetric formations in both temporal areas extending into the cranial cavity, spreaded from the brain substance and not accumulating contrast according to computer and magnetic resonance imaging; normalization of hearing against the background of prolonged heating of the body - 'melting' of fats and opening the ear canal. Fistulas, through which a yellowish secret stood out either in the external auditory canal or in the behind-the-ear area, served as a kind of 'whisper valve', which made it possible to stop the pain syndrome and did not lead to the development of cerebral symptoms.

Endoscopic endonasal resection of clival xanthoma: case report and literature review

Bone xanthoma is an extremely rare and benign tumor in terms of its nature and growth over time. We describe the first case coexisting with ventriculomegaly secondary to aqueduct stenosis (non-tumoral hydrocephalus), the second xanthoma of the clivus described to date. The patient was a 51-year-old woman with headaches and absence seizures. Axial T1-weighted MRI showed a well-demarcated, hypointense, osteolytic, 25 × 18 × 15 mm lesion with cortical erosion located at the right margin of the clivus. Sagittal T2-weighted MRI demonstrated a hypointense mass without associated edema. Sagittal gadolinium-enhanced T1-weighted MRI showed contrast uptake with a partially hypointense rim. The increased ventricular size without periventricular edema was associated with aqueduct stenosis, and there was no contiguity with the tumor. A neuronavigation image-guided transsphenoidal approach was chosen to perform a macroscopically complete resection. Intraoperative histopathological study showed a chordoma of the clivus. Exhaustive postsurgical study revealed the benign nature of a bone xanthoma. Given the finding of a clival lesion, the differential diagnosis is essentially with other malignant entities with a rapidly fatal outcome, such as metastases, or with a possible invasive evolution, such as clivus chordomas. This report describes the clinical, radiological, and pathological keys for such differentiation in order to avoid unnecessarily aggressive treatment with ablative surgery and radiotherapy.

Xanthoma of the occipital bone and with preserved inner and outer bone cortex: case report

Objective We present a unique case of a midline xanthoma of the occipital bone exhibiting atypical imaging characteristics with preserved bone cortex that has not previously been described.

Participant This man presented with refractory headaches and suboccipital pain and a mass within the diploe of the occipital bone but with preserved inner and outer cortex of the bone. Magnetic resonance imaging showed a midline, enhancing, and marrow-replacing process in the occipital bone measuring 1.5 cm in anteroposterior (AP) diameter, resulting in mild indentation of the dorsal aspect of the cerebellar vermis.

Results The patient underwent a suboccipital craniectomy. Tumor resection was from the foramen magnum to the inion and laterally until normal bone was encountered. The xanthoma was yellowish and bled a moderate amount upon resection.

Conclusion An isolated cranial xanthoma with preserved inner and outer bone cortex involving the occipital bone and of midline location has yet to be described. The differential diagnosis of osteoexpansile skull lesion with preserved bone cortex should now include xanthoma. Given the broad spectrum of imaging characteristics exhibited by this unusual diagnosis, surgical intervention is indicated from a diagnostic as well as a therapeutic standpoint.

Multimodality imaging features of primary xanthoma of the calcaneus

Secondary xanthomatous features are histologically observed in various bone lesions, but primary xanthoma of bone is rare. We present a primary xanthoma of the right calcaneus in a 51-year-old woman who had no aberrant lipid metabolism. Roentgenograms showed a small osteolytic lesion in the calcaneal triangle, partially surrounded by bone sclerosis. Computed tomographic scans of the calcaneus showed multiple osteolytic areas, with an irregular trabecular pattern in the surrounding sclerotic bone. T1-weighted magnetic resonance images showed a lesion with central low signal intensity, surrounded by a peripheral ring with high signal intensity. The entire lesion showed high signal intensity on T2-weighted images, partially surrounded by areas with low signal intensity, concordant with reactive bone sclerosis. Histologically, the lesion consisted of numerous lipid-laden histiocytes arranged in sheets, scattered multinucleated giant cells and lymphocytes, and granulation tissues. There was no evidence of pre-existing lesions. Total excision of the tumor was curative.