Cytological Diagnosis of Multiple Normolipemic Tuberous Xanthoma: An Unusual Occurrence

Xanthomas are lesions characterised by accumulations oflipid laden macrophages within the dermis. Tuberousxanthomas are large nodular lesions those develop inpatients with underlying hyperlipoproteinemias. A 26-yearold female presented to our hospital with multiple tuberousswellings on the extensor surface of the body since 15 years.We also incidentally detected presence of Nodular thyroidswelling while examining the patient in our lab. Routineinvestigations along with Lipid profile were within normalrange and serum protein electrophoresis showed normalpattern. FNAC from few Tuberous nodules and multiple sitesof thyroid nodule was then performed. Cytosmears in alltuberous nodules showed good number of foamy histiocytesin clusters and discretely admixed with plenty of giant cellsand collections of cholesterol crystals over a dirtyhaemorragic background. Surprisingly FNAC done fromthyroid smears shows good number of epithelioid cellclusters, group of benign follicular cells and other featuressimilar to aspiration of tuberous nodules. Thyroid functionrevealed increased TSH with low normal T3,T4. Histopathology from a single excised nodular lesionshowed attenuated epidermal lining with collection of foamymacrophages in the dermis with plenty of giant cell reactionand cholesterol crystals that confirmed our findings to beTuberous xanthoma. We present a case of normolipemictuberous xanthomas with its association with thyroid disorder(hypothyroidism), which is an uncommon occurrence.

A Case of Tuberous Xanthoma in Early Childhood / 대한피부과학회지

We report a 6-year-old male with primary hypercholesterolemia who had tuberous xanthoma. Yellowish nodules first appeared on the knees 3 years ago and gradually increased in size and number and also occurred on the left elbow. The laboratory findings showed markedly increased serum cholesterol and slightly increased triglyceride. Serum lipoprotein electrophoresis showed a marked increase in beta-fraction, suggesting type II hyperlipoproteinemia. Histopathology showed many aggregates of foam cells in the dermis and subcutaneous fat.