Case Number : Case 4154 - 22 December Posted By: Saleem Taibjee

Xanthogranuloma with many siderophages ~ sometimes called xanthosiderohistiocytosis in the appropriate clinical context.

Agree with hemosiderotic juvenile xanthogranuloma..

A dermal infiltrate of foamy macrophages and Touton-type giant cells with background angiectatic blood vessels and haemosiderin-laden macrophages. Solitary adult xanthogranuloma?

Agree with xanthogranuloma

Why not a fibrous papula of the nose?

There are special stains and immunos shown below. The haemosiderin staining is nicely highlighted by Perls. Although the CD68 is impressive, so is the Factor XIIIa. 

Hence, I too grappled with a variant of fibrous papule versus xanthogranuloma. Common things being common ...... I slightly favour fibrous papule, and of course there are a large number of variants described. This includes a clear cell variant with variable staining for CD68 and FXIIIa. There is a nice review in Am J Derm Path 2018 Fibrous Papule: A Histopathologic Review - PubMed (nih.gov)

BW

Saleem