Multiple Tuberous Xanthomas: A Diagnostic Dilemma on Cytology

Richa Bhartiya,Pallavi Agrawal,Rajnish Kumar,Rajendra Prasad Dwivedi

doi:10.21276/apalm.1406

Abstract

Tuberous xanthomas are large nodular lesions that develop in patients with underlying hyperlipoproteinemias. A patient was referred to us for fine needle aspiration cytology (FNAC) from multiple lesions over extensor aspect of upper and lower limbs, which yielded scanty aspirate despite several attempts. This case is being reported to emphasize how such lesions can present as diagnostic challenge on cytology, the role of which has not clearly been described in the previous case reports. DOI: 10.21276/APALM.1406

Highlights

Xanthoma is a localized collection of tissue histiocytes containing lipid
We present a case of multiple tuberous xanthomas diagnosed on Fine Needle Aspiration Cytology (FNAC)
The most commonly xanthomas among patients with familial hypercholesterolemia are tendinous xanthomas, which are subcutaneous tumours located within the tendons used for extension.[5, 6]

Summary

Introduction

Xanthoma is a localized collection of tissue histiocytes containing lipid. It is not a true tumour but, rather, a reactive histiocyte proliferation that occurs in response to alterations in serum lipids.[1]. Xanthomas occur in skin and subcutis, but occasionally involve deep soft tissue such as tendons or synovium.[2] we present a case of multiple tuberous xanthomas diagnosed on Fine Needle Aspiration Cytology (FNAC). This case is being reported to emphasize the challenge faced while diagnosing such lesions on FNAC. Smears were sparsely cellular and showed predominantly foamy histiocytes in clusters and scattered singly, few benign mesenchymal cells and occasional inflammatory cells in a hemorrhagic background(Fig 4) Histopathological examination from one of the lesions revealed infiltration of dermis by foamy histiocytes along with giant cells, fibrosis and cholesterol clefts confirming the diagnosis (Fig 6, 7 & 8)

Discussion

Conclusion

AlvesCandBraidZ:Homozygousfamilialhypercholesterolemia