1
|
Majtanova N, Kolar P, Takacova A, Kurilova V, Majtan J, Szep Z. Xenograft: a suitable treatment of eyelid complications in long-standing necrobiotic xanthogranuloma. Clin Exp Dermatol 2024; 49:280-282. [PMID: 37940107 DOI: 10.1093/ced/llad383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/07/2023] [Indexed: 11/10/2023]
Abstract
A porcine xenograft was successfully used as a temporary biological cover for severe xanthogranulomatous defects of the eyelid. Xenografts were successfully used in both upper and lower eyelid reconstructions. Other surgical techniques or the use of full-thickness skin grafts were not possible.
Collapse
Affiliation(s)
- Nora Majtanova
- Department of Ophthalmology, Slovak Medical University and University Hospital
| | - Petr Kolar
- Department of Ophthalmology, Slovak Medical University and University Hospital
| | - Adriana Takacova
- Department of Ophthalmology, Slovak Medical University and University Hospital
| | - Veronika Kurilova
- Department of Ophthalmology, Slovak Medical University and University Hospital
| | - Juraj Majtan
- Institue of Molecular Biology, Slovak Academy of Sciences
- Departments of Microbiology
| | - Zoltan Szep
- Dermatovenerology, Faculty of Medicine, Slovak Medical University, Bratislava, Slovakia
| |
Collapse
|
2
|
Fourmond S, Pham-Ledard A, Vergier B, Peyrot I, Beylot-Barry M, Ducharme O. Extrafacial necrobiotic xanthogranuloma and a disseminated marginal zone B lymphoma: a unique tissue collision. Int J Dermatol 2024; 63:113-114. [PMID: 37830310 DOI: 10.1111/ijd.16879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 09/12/2023] [Accepted: 09/29/2023] [Indexed: 10/14/2023]
Affiliation(s)
| | - Anne Pham-Ledard
- Dermatology Department, CHU de Bordeaux, Bordeaux, France
- Translational Research on Oncodermatology and Rare Skin Diseases, INSERM U1312, Bordeaux Institute of Oncology, Bordeaux University, Bordeaux, France
| | - Beatrice Vergier
- Translational Research on Oncodermatology and Rare Skin Diseases, INSERM U1312, Bordeaux Institute of Oncology, Bordeaux University, Bordeaux, France
- Pathology Department, CHU Bordeaux, Bordeaux, France
| | - Itzia Peyrot
- Dermatology Department, CHU de Bordeaux, Bordeaux, France
| | - Marie Beylot-Barry
- Dermatology Department, CHU de Bordeaux, Bordeaux, France
- Translational Research on Oncodermatology and Rare Skin Diseases, INSERM U1312, Bordeaux Institute of Oncology, Bordeaux University, Bordeaux, France
| | - Océane Ducharme
- Dermatology Department, CHU de Bordeaux, Bordeaux, France
- Translational Research on Oncodermatology and Rare Skin Diseases, INSERM U1312, Bordeaux Institute of Oncology, Bordeaux University, Bordeaux, France
| |
Collapse
|
3
|
Lan X, Yang X, Jiang Y. Concurrent acquired cutis laxa and necrobiotic xanthogranuloma without paraproteinemia. J Dermatol 2023; 50:e299-e300. [PMID: 37082805 DOI: 10.1111/1346-8138.16807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 02/11/2023] [Accepted: 03/31/2023] [Indexed: 04/22/2023]
Affiliation(s)
- Xuemei Lan
- Department of Dermatopathology, Hospital for Skin Diseases and Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, Jiangsu, China
| | - Xianhong Yang
- Department of Dermatopathology, Hospital for Skin Diseases and Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, Jiangsu, China
- Center for Plastic & Reconstructive Surgery, Department of Dermatology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
| | - Yiqun Jiang
- Department of Dermatopathology, Hospital for Skin Diseases and Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, Jiangsu, China
| |
Collapse
|
4
|
Punyamurthy NT, Tjahjono LA, Harris GJ, Wanat KA. Necrobiotic Xanthogranuloma With Associated Monoclonal Gammopathy Presenting as an Eyelid Nodule. Ophthalmic Plast Reconstr Surg 2023; 39:e148-e150. [PMID: 37279015 DOI: 10.1097/iop.0000000000002399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Necrobiotic xanthogranuloma (NXG) is a progressive non-Langerhans cell histiocytosis with a predilection for the periorbital area. NXG is most commonly associated with monoclonal gammopathy and ophthalmic complications. The authors present a 69-year-old man who was evaluated for a left upper eyelid nodule and plaques on the lower extremities, trunk, abdomen, and right upper extremity. Biopsy of the eyelid was supportive for NXG. Serum protein electrophoresis was positive for a monoclonal gammopathy, IgG light chain kappa. MRI showed preseptal involvement. The periocular nodules cleared with a high dose of prednisone; however, the other skin lesions persisted. Bone marrow biopsy showed kappa-restricted 6% plasma cells and he was treated with intravenous immunoglobulin. This case illustrates the importance of clinicopathologic correlations to render an NXG diagnosis.
Collapse
Affiliation(s)
| | | | - Gerald J Harris
- Department of Ophthalmology, Section of Orbital and Oculoplastic Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Karolyn A Wanat
- Department of Dermatology, Section of Dermatopathology, Medical College of Wisconsin, Milwaukee, WI
| |
Collapse
|
5
|
Popoola D, Housley SB, Jacoby WT, Lim J, Cappuzzo JM, Levy EI. Non-dermatologic isolated intracranial necrobiotic xanthogranuloma. BMJ Case Rep 2023; 16:e254122. [PMID: 37648279 PMCID: PMC10471863 DOI: 10.1136/bcr-2022-254122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023] Open
Abstract
Necrobiotic xanthogranuloma is a condition that was first identified in 1980 based on its characteristic histological identity, and it has been known since then as a dermatologic manifestation of an underlying systemic dysproteinemia. Intracranial manifestation is a rare presentation of this condition and has been reported only once in its more than 40 years of existence. Herein and to our knowledge, we report the second observation of an intracranial manifestation and, surprisingly, the first case without the expected dermatologic and systemic dysproteinemia associations. This case identifies an existing knowledge gap in our understanding of necrobiotic xanthogranuloma and emphasises the need for further research into understanding the presentation, comorbidities and management of this condition.
Collapse
Affiliation(s)
- Daniel Popoola
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Steven B Housley
- Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
- Neurosurgery, Buffalo General Medical Center, Buffalo, New York, USA
| | - Wady T Jacoby
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Jaims Lim
- Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
- Neurosurgery, Buffalo General Medical Center, Buffalo, New York, USA
| | - Justin M Cappuzzo
- Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
- Neurosurgery, Buffalo General Medical Center, Buffalo, New York, USA
| | - Elad I Levy
- Neurosurgery and Radiology and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
- Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
| |
Collapse
|
6
|
Adam Z, Pour L, Řehák Z, Dvořáková K, Koukalová R, Feit J, Kameník P, Krejčí M, Štork M, Krejčí M, Sandecká V, Boichuk I, Král Z. Complete remission of necrobiotic xanthogranuloma after disappearance of monoclonal immunoglobulin induced by bortezomib, lenalidomid and dexamethasone. Vnitr Lek 2021; 67:352-356. [PMID: 35459378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Necrobiotic xanthogranuloma (NXG) is a rare chronic condition, belonging to the group non-Langerhans cell histiocytoses, which is relevant due to the possibility of extracutaneous involvement and association with systemic diseases, particularly monoclonal gammopathy, MGUS and multiple myeloma. The case reported here NXG was diagnosed after 1 years of evolution in patient with asymptomatic multiple myeloma. After treatment with bortezomib, lenalidomid and dexamethasone, there was evident abrupt decrease of monoclonal immunoglobulin to not measurable level (complete remission of multiple myeloma) and in the same time was evident disappearance of cutaneous and hepatic lesions of NXG on FDG-PET/CT. The etiopathogenetic association of monoclonal immunoglobulin with NXG is documented in this case report with disappearance of NXG in the time of disappearance of monoclonal immunoglobulin.
Collapse
|
7
|
de Mello RB, do Vale ECS. Necrobiotic xanthogranuloma associated with smoldering multiple myeloma: satisfactory response to cyclophosphamide, dexamethasone, and thalidomide. An Bras Dermatol 2019; 94:337-340. [PMID: 31365665 PMCID: PMC6668937 DOI: 10.1590/abd1806-4841.20198500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 11/22/2018] [Indexed: 11/25/2022] Open
Abstract
Necrobiotic xanthogranuloma is a rare chronic condition, belonging to the group C non-Langerhans cell histiocytoses, which is relevant due to the possibility of extracutaneous involvement and association with systemic diseases, particularly hematologic malignancies. The case reported here was only diagnosed after nine years of evolution and was associated with plasma cell dyscrasia. After treatment with cyclophosphamide, dexamethasone, and thalidomide, there was a reduction of cutaneous lesions and serum levels of monoclonal protein.
Collapse
Affiliation(s)
- Renan Bernardes de Mello
- Dermatology Service, Hospital das Clínicas, Universidade
Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | |
Collapse
|
8
|
Pomponio G, Olivari D, Mattioli M, Angeletti A, Rossetti G, Goteri G, Gabrielli A. Sustained clinical response after single course of rituximab as first-line monotherapy in adult-onset asthma and periocular xanthogranulomas syndrome associated with IgG4-related disease: A case report. Medicine (Baltimore) 2018; 97:e11143. [PMID: 29952960 PMCID: PMC6039602 DOI: 10.1097/md.0000000000011143] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
RATIONALE IgG4-related disease (IgG4-RD) is an emerging immune-mediated disease characterized by multi-organ involvement and variable clinical behavior. PATIENT CONCERNS We describe the case of a 50-year-old woman affected by a rare variant of IgG4-RD, characterized by eyelid xanthelasmas, adult-onset asthma and salivary and lacrimal glands enlargement. Multiple lymphadenopathies and a pulmonary mass were present at initial evaluation. INTEVENTIONS After a single course of rituximab (2g in 2 refracted doses), an almost complete clinical remission was achieved without chronic steroid administration. OUTCOMES Magnetic resonance imaging (MRI), high-resolution computed tomography (HRCT) of the thorax, and positron emission tomography (18FDG-PET-CT) confirmed good response to treatment. Circulating plasmablasts dropped to undetectable levels as well. Xanthelasmas only remained unchanged. Remission persisted at 1-year follow-up. LESSONS Steroid therapy is still considered standard first-line therapy in IgG4-RD. However, high doses are generally required and relapses are common during the tapering phase. Rituximab is a well described steroid-sparing strategy, so far reserved to refractory cases only. In our experience, rituximab has been used as first-line monotherapy, showing great and sustained efficacy and optimal tolerability. The peculiar variant of IgG4-RD affecting our patient, the relatively low baseline plasmablast concentration, and the early placement of rituximab therapy may have facilitated the good response.
Collapse
Affiliation(s)
| | | | | | | | | | - Gaia Goteri
- Section of Pathological Anatomy, Università Politecnica delle Marche, Ospedali Riuniti, Ancona, Italy
| | | |
Collapse
|
9
|
Seastrom S, Bookout A, Hogan DJ. Necrobiotic xanthogranuloma without a monoclonal gammopathy. Cutis 2014; 94:293-296. [PMID: 25566570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Necrobiotic xanthogranuloma (NXG) is an indolent non-Langerhans cell histiocytosis characterized by yellow xanthomatous plaques that tend to ulcerate. Necrobiotic xanthogranulomas have a predilection for the bilateral periorbital region and often present with consequential ophthalmic findings. Histopathology usually reveals a distinctive pattern of histiocytic xanthogranuloma with hyaline necrobiosis. Necrobiotic xanthogranuloma has been documented to have a close association with paraproteinemia. We report the case of a 76-year-old man with periorbital NXG without development of a monoclonal gammopathy. Clinically, the patient presented with dry eyes and substantial periorbital edema with multiple yellow indurated plaques. He developed the condition 30 years prior to presentation at which time it was initially diagnosed as xanthelasma. He underwent surgical excision of the lesions 10 years prior to the current presentation and biopsy results revealed a diagnosis of NXG. The periorbital lesions recurred several years prior to presentation, prompting annual computed tomography scans to rule out ocular invasion. Periorbital edema and plaques improved during a 6-month regimen of acitretin but returned to baseline just months after discontinuation.
Collapse
Affiliation(s)
| | - Angela Bookout
- Nova Southeastern University College of Osteopathic Medicine, Largo Medical Center, 201 14th St, Largo, FL 33770, USA.
| | | |
Collapse
|
10
|
Sanz-Marco E, España E, López-Prats MJ, Chirivella-Casanova M, Aviño J, Díaz-Llopis M. [Necrobiotic xanthogranuloma. Differential diagnosis, treatment and systemic involvement. Case report]. Arch Soc Esp Oftalmol 2014; 89:186-189. [PMID: 24269389 DOI: 10.1016/j.oftal.2012.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Revised: 10/07/2012] [Accepted: 11/07/2012] [Indexed: 06/02/2023]
Abstract
CASE REPORT A 48-year-old male was referred to our hospital for further evaluation of eyelid edema with bilateral yellowish ulcerated nodules. Suspecting a xanthogranulomatosis, imaging tests and biopsy were performed with diagnosis of necrobiotic xanthogranuloma. IgG monoclonal gammapathy was diagnosed in a systemic study. Systemic corticosteroids and cyclosporine were initiated unsuccessfully; therefore intra-lesional injections of triamcinolone were started, which controlled the orbital disease. DISCUSSION Necrobiotic xanthogranuloma is a rare condition that usually affects the eyelids and anterior orbit. Its diagnosis is important as it is associated with malignant lymphoproliferative processes. Intra-lesional corticosteroids were effective in our patient.
Collapse
Affiliation(s)
- E Sanz-Marco
- Servicio de Oftalmología, Hospital Universitario La Fe, Valencia, España.
| | - E España
- Servicio de Oftalmología, Hospital Universitario La Fe, Valencia, España; Facultad de Óptica, Universidad de Valencia, Valencia, España
| | - M J López-Prats
- Servicio de Oftalmología, Hospital Universitario La Fe, Valencia, España
| | | | - J Aviño
- Servicio de Oftalmología, Hospital Universitario La Fe, Valencia, España
| | - M Díaz-Llopis
- Servicio de Oftalmología, Hospital Universitario La Fe, Valencia, España; Departamento de Cirugía, Facultad de Medicina, Universidad de Valencia, Valencia, España; Centro de Investigación de Enfermedades Raras (CIBERER), Valencia, España
| |
Collapse
|
11
|
Hashemi P, Rashidi A, Chapas AM, Balfour EM. Necrobiotic xanthogranuloma of the extremities with paraproteinemia and without periorbital involvement at presentation. Cutis 2012; 89:41-44. [PMID: 22439311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We report a rare case of necrobiotic xanthogranuloma (NXG) of the extremities with paraproteinemia and without periorbital involvement at presentation in a 58-year-old white woman. A combination of oral cyclophosphamide and oral dexamethasone was attempted, but the patient then developed a left intraorbital lesion. Treatment was not successful in that the gammopathy did not improve and the patient continued to develop more lesions.
Collapse
Affiliation(s)
- Pantea Hashemi
- Ackerman Academy of Dermatopathology, New York, New York, USA
| | | | | | | |
Collapse
|
12
|
Chen KY, Leslie W, Mahon B, Venugopal P. A patient with necrobiotic xanthogranuloma presenting with an anterior mediastinal mass, plasma cell dyscrasia, and a lymphoproliferative disorder. Clin Adv Hematol Oncol 2011; 9:696-700. [PMID: 22402515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Kevin Y Chen
- Division of Hematology, Oncology and Stem Cell Transplantation, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612, USA.
| | | | | | | |
Collapse
|
13
|
Adam Z, Zahradová L, Krejcí M, Pour L, Koukalová R, Rehák Z, Feit J, Kren L, Mechl M, Vasků V, Sirotková A, Hájek R, Mayer J. [Diffuse plane normolipemic xanthomatosis and necrobiotic xanthogranuloma associated with monoclonal gammopathy--determining the disease stage with PET-CT and treatment experience. Two case studies and literature review]. Vnitr Lek 2010; 56:1158-1168. [PMID: 21250495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
UNLABELLED Monoclonal gammopathy may manifest itself through a range of skin disorders, including plane normolipemic xanthoma and necrobiotic xanthogranuloma. The present paper describes two patients with these cutaneous symptoms. The first has extensive areas of skin affected by flat xanthomas, monoclonal gammopathy with > 10% infiltration of bone marrow with clonal plasmocytes and, according to PET-CT, unclear lymphadenopathy in the retroperitoneal area. The size of this lymphadenopathy (histologically no malignant infiltration and no confirmed infectious aetiology) has not changed significantly over a 4-year follow-up. Repeated PET-CT scans showed decrease in SUV value in this infiltration from 7.5 to 3.8. Four cycles of treatment with a combination of bortezomib, cyclophosphamide and dexamethasone brought neither reduction in monoclonal immunoglobulin nor change to skin morphology. We believe that the abdominal lymphadenopathy is associated with xanthomatosis but have been unable to confirm this unequivocally. The second patient is being followed up for more than 10 years, originally for MGUS, later for asymptomatic multiple myeloma. Last year, painful subcutaneous and cutaneous infiltrates, isolated on an upper limb and more frequent on lower limb, started to occur. These infiltrates are palpable. PET-CT imaging provided an excellent depiction of these infiltrates, showing no pathology on the head, chest and abdomen and no osteolytic foci on the skeleton. CT imaging showed clearly numerous infiltrates in the skin and subcutaneous tissue of lower limbs, particularly both shanks, reaching up to 2 cm in depth. The largest infiltrate, measuring 3.5 by 2 by 10 cm, was identified in the distal dorsal part of the right shank. PET imaging of lower limbs showed distinctly pathological accumulation in all infiltrates described above; the accumulation of glucose in the lower part of the right shank reached 10.0 SUV. CT images of lower limbs showed increased density saturated hypodermis even in the areas where there is no increased accumulation of 18 fluoroglucose. Following 40 Gy irradiation, the size of infiltrate in the radiated area decreased and their soreness ceased. CONCLUSION PET-CT imaging offered information on extra-cutaneous signs of plane normolipemic xanthomas and provided excellent depiction of the areas of the skin and hypodermis affected by necrobiotic xanthogranuloma. Chemotherapy with cyclophosphamide, bortezomib and dexamethasone brought no reduction in monoclonal immunoglobulin concentration, and no reduction in plane normolipemic xanthomas. Radiotherapy targeted at large foci of xanthogranulomas led to partial regression and ceased infiltrate soreness.
Collapse
Affiliation(s)
- Z Adam
- Interní hematologická klinika Lékarské fakulty MU a FN Brno.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|