Xanthomas

Erosive Xanthomas

= Eruptive

Xanthomas or Xanthomata

A deposition of yellowish cholesterol-rich material

Eruptive Xanthomas

Abrupt onset crops yellow papules with erythematous halos on extremities wax and wane with triglyceride and cholesterol levels Buttocks, shoulders, ext. surfaces of extremeties. Rarely oral mucosa and face. Can be any where on the body Pruritus is common, may be tender small, yellowish-orange to reddish-brown papules ● Associated with: Hyypertriglyceridemia particularly type I, IV, V Secondary: diabetes

Xanthoma disseminatum

Adults Red-yellow papules and nodules Predilection for flexures Upper respiratory and digestive tracts is usually involved

Xanthelasma palpebrarum

Asymptomatic, usually bilateral and asymmetric May be associated with hyperlipidemia of any type

Xanthoma planum

Macules and plaques spread diffusely over large areas of the body Any site ● Linear yellow lesions in skinfolds, including palmar creases ● Associated with primary biliary cirrhosis

Palmar Xanthomas

Palms and flexural surfaces of the fingers (skin folds, especially the palmar creases) Flat macules or slightly elevated plaques ● Associated with: Hyperlipoproteinaemia type III and type IIA Biliary cirrhosis ● indicative of hypercholesterolemia

Tuberoeruptive xanthoma

Red papules and nodules that appear inflamed and tend to coalesce Same disease spectrum as Eruptive Xanthomas

Adult orbital xanthogranulomatous disease

• Adult-onset xanthogranuloma • Necrobiotic xanthogranuloma • Adult-onset asthma and periocular xanthogranuloma • Erdheim-Chester disease

Xanthogranulomatous Inflammation

● A form of acute and chronic inflammation ● Foamy macrophages ● Site: - Kidney and renal pelvis: pyelonephritis - Gallbladder: cholecystitis - Many other places ● Mistaken for tumour ● Examples of this inflammation: • Xanthoma disseminatum • Ceroid granuloma of the gallbladder, • Whipple's disease • Inflammatory pseudotumor of the lung • Plasma cell granuloma of the lung • Malakoplakia • Verruciform xanthoma • Foamy histiocytosis of the spleen in thrombocytopenic purpura • Isolated xanthoma of the small bowel • Xanthofibroma of bone • Gastric xanthelasma • xanthogranulomatous osteomyelitis

Xanthomatous pseudotumor

● A large primary breast carcinoma was significantly reduced in size clinically and replaced by a mass lesion that was composed almost entirely of foamy histiocytes after non-adjuvant chemotherapy

plexiform xanthomatous tumors

● A normolipemic xanthomatous tumor with a distinctive plexiform pattern, composed of a variable admixture of uniform epithelioid and xanthomatous cells. ● Usually solitary but can be multiple up to four lesions

Xanthoma tuberosum

● Over joints, pressure areas ● Yellow nodules on Achilles tendon and extensor tendons of fingers ● Associated with: Hypercholesterolemia and inc. LDL, Familial dysbetalipoproteinemia Familial hypercholesterolemia Secondary causes: nephrotic syndrome, hypothyroidism

Verruciform Xanthomas

● Papillomatous, verruca-like change of overlying epidermis ● Normolipemic ● Predominantly occurs in the oral cavity of adults as a single papillomatous yellow lesion

Xanthelasmas

● Sharply demarcated, arround eyelids ● Soft yellow papules and plaques in eyelid ● Some cases lack lipid abnormalities

Cerebrotendinous Xanthomatosis

● Unknown pathophysiology ● Clinical picture: Neurologic symptoms cataracts, diarrhea Achilles tendon xanthoma atherosclerotic vascular disease ● Pathophysiology: Excess production and consequent accumulation of cholestanol in tissues ● Rx: Chenodeoxycholic acid

Tendinous Xanthomatas

● indicative of hypercholesterolemia ● Yellow nodules on Achilles tendon and extensor tendons of hands and feet, Achilles tendons. Related to trauma ● Associated with: Severe hypercholesterolemia inc. LDL especially type IIa Secondary: cholestasis