A 70 year old man has a history of gradually expanding and ulcerating nodules of the neck areas.
Case 10 - Figure 1 - There are confluent nodular histiocytic infiltrates in the mid and deep reticular dermis
Case 10 - Figure 2 - There is an irregular palisading granulomatous process involving the deep dermis; granulomas include giant cells with Touton forms as well as foam cells. Cholesterol clefts completed the picture (not illustrated).
|near normal epidermis and papillary dermis|
|irregular palisading granulomatous process involving the deep dermis and subcutaneous fat|
|see necrotizing and sclerotic foci within the involved zones with cholesterol clefts|
|granulomas principally of the giant cell type with bizarre features, touton-forms as well as foam cells|
|variable vascular changes?|
Paraneoplastic syndrome of indurated cutaneous plaques and nodules associated with paraproteinemia
and hematopoetic malignancy.
|Also associated with scleritis and keratitis|
|Normolipemic plane xanthoma|
Pathogenesis is unknown.
Dermatologic findings consist of yellow-to-erythematous nodules and plaques that preferentially
involve the face and particularly the periorbital area. Well-developed lesions show central atrophy with
Laboratory findings include paraproteinemia (invariable), leukopenia, plasmacytosis,
Differential diagnosis includes
|other palisading granulomatous processes (granuloma annulare, rheumatoid nodule, necrobiosis lipoidica)|
|ruptured epidermal inclusion cyst reaction|
- Finan M. Necrobiotic xanthogranuloma with paraproteinemia. A review of 22 cases. Medicine 1986; 65:376-88.
- McGregor J. Necrobiotic xanthogranuloma without periorbital lesions. J Am Acad Dermatol 1993; 29: 466-69.
- Macfarlane A. Necrobiotic xanthogranuloma with paraproteinemia. Br J Dermatol 113: 339-43.
- Mehregan D. Necrobiotic xanthogranuloma. Arch Dermatol 1992; 128: 94-100.