Case Number : 119 Posted By: Guest

Phillip McKee - Overseas consultations (Sedona, Arizona, USA) Wrote:

The angulated giant cell and the plasma cell-rich infiltrate are clues to the diagnosis of necrobiotic xanthogranuloma. It is however very difficult to make this diagnosis on the basis of one image. Clinicopathological is of course essential. However, these odd giant cells are regularly present in NXG.

Submitted on 23/11/2010 19:48
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Wayne Grayson - (Johannesburg, South Africa) Wrote:

Tricky case in the absence of clinical details. I think I can see fibrinoid change or necrobiosis in relation to dermal collagen on the right of the field, while the opposite half of the field shows a plasma cell-rich inflammatory infiltrate with occasional admixed histiocytic giant cells. Could this be necrobiosis lipoidica or necrobiotic xanthogranuloma?

Submitted on 23/11/2010 16:29
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Eman EL-Nabarawy - Cairo Univrsity (Egypt) Wrote:

Necrobiosis lipoidica.

Submitted on 23/11/2010 15:20
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Marcela Saeb Lima - Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (Mexico City) Wrote:

Agree with Mona, necrobiosis lipoidica.

Submitted on 23/11/2010 13:35
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Marwa Fawzi - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

Nicrobiosis lipoidica

Submitted on 23/11/2010 11:37
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Mona Abdel-Halim - Dermatology Department, Faculty of Medicine, Cairo University. (Egypt) Wrote:

I can see somehow altered collagen on the right side with a granulomatous reaction around it including giant cells, epithelioid cells, histiocytes, lymphocytes and lots of plasma cells. In the context of plenty of plasma cells I am thinking of necrobiosis lipoidica or granulomatous secondary syphilis. Could not find foamy histiocytes or sharply defined cholesterol clefts so I think NXG will be a less likely possibility. However, in the context of a granulomatous reaction with many giant cells one should polarize to exclude the possibility of a foreign body reaction which still could be the case here.

Submitted on 23/11/2010 11:01
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