ABSTRACT
A 28-year-old male patient presented with a 4-year history of a solitary brown mass, and a 1-year history of multiple small papules on the left chest. Skin examination showed a quasi-round brown firm mass measuring about 1.2 cm × 1.1 cm × 1.0 cm in size on the left chest, and several brown papules with diameters ranging from 3 to 5 mm on the right side of the mass; no enlarged lymph nodes were detected in the left axilla on palpation. The mass and papules were completely resected, and histopathological examination showed clustered nevus cells in the superficial dermis of the mass and small papules, and the diagnosis of intradermal nevus was considered. There was a desmoplastic nodule in the mass, nevus cells were scattered among the fibers in the nodule, and giant nevus cells were also observed; the nevus cells in the nodule were relatively larger, epithelioid or spindle-shaped with round or spindle-shaped nuclei, obvious nucleoli, and rare mitotic figures. Immunohistochemical study showed that the nevus cells in both the intradermal nevus and proliferative nodule were positive for S100; the nevus cells in the superficial dermis of the intradermal nevus were positive for Melan-A and HMB45, while the nevus cells in the proliferative nodule were negative for Melan-A and HMB45; both the intradermal nevus and proliferative nodule tissues showed a Ki-67 index of 1%, positive staining for CD34, but negative staining for P16 and P63. Finally, the patient was diagnosed with intradermal nevus associated with desmoplastic nodule.
ABSTRACT
A 74-year-old man presented with yellowish red nodules and plaques on the trunk for more than one year.Physical examination showed more than 20 scattered,irregularly shaped,well-demarcated,yellowish red nodules and plaques measuring 0.5-15 cm in diameter on the trunk.The plaques on the right lower abdomen showed central ulceration and atrophy with scar formation.Plasma protein electrophoresis revealed that the levels of immunoglobulin G (IgG) and kappa light chain were 18.3 g/L and 20.70 g/L respectively.Histopathologically,large necrobiotic areas and granuloma were observed alternately in the dermis and subcutis.There were numerous Touton giant cells,foreign body giant cells and foamy histiocytes in the granuloma,and many cholesterol clefts were found in the center of necrobiotic areas with the formation of lymphoid follicles in some regions.Both eyes of the patient were involved to different degrees.He was diagnosed as necrobiotic xanthogranuloma with IgG kappa paraproteinemia and eve involvement.