Case Number : CT0034 Adam_Bates

Juvenile xanthogranuloma with beautifuuly demonstrated cute touton giant cells!!!
 

JXG

JXG WITH TOUTON GIANT CELLS. NICE CASE!
 

Others seem to have already confidently diagnosed JXG based on the Touton-type giant cells, and I accept that is probably most likely. However, not all the giant cells in the image appear to be classical Touton-type, some are more irregular. There also appears to be admixed inflammatory cells, mainly lymphocytes. I might want to see a bit more to ensure this isn't part of a more extensive process such as necrobiotic xanthogranuloma.
 

Juvenile xanthogranuloma .
 

AS most have come to the actual diagnosis (xanthogranuloma) I may as well post the answer now. It is probably best to leave the prefix juvenile out as these leasions can also present in adults. I think that necrobiotic xanthogranuloma is a good differential diagnosis as it would be very easy to photograph an identical field with absent necrobiosis (and angulated) giant cells from an example. Mind you, plasma cells are ofetn very numerous in necrobiotic xanthogranuloma and would be a helpful distinguishing feature. Other differential diagnoses that you could have mentioned include xanthoma disseminatum, generalized eruptive histiocytoma etc. It is now thought that these all belong to a spectrum of disease. Scalloped cell xanthogranuloma, benign cepahalic histiocytosis and progressive nodular histiocytosis also fall into this spectrum.