ePoster listing and sessions

Topic: ESOPRS 2021 ePoster sessions
Time: Sep 17, 2021 16:00 Amsterdam, Berlin, Rome, Stockholm, Vienna, 15:00 London

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Necrobiotic Xanthogranuloma: another great masquerader

Author: Vladimir Kratky
ePoster Number: 105


Purpose

We present a case series describing the characteristics, management and outcomes of Necrobiotic Xanthogranuloma masquerading as inflammatory, infectious and neoplastic lesions.


Methods

Retrospective analysis of 4 patients with varying presentations and a review of literature was performed. Clinical and operative notes, imaging and histopathology are discussed.


Results

Case-1. An 80-year-old female with history of GCA and CLL presented with yellowish periocular deposits, initially diagnosed as xanthelasma by biopsy. A third biopsy was consistent with NXG. She was successfully treated with Chlorambucil, prednisone and CO2 surface ablation. Case-2. A 72-year-old female with multiple myeloma had a lesion suspicious for BCC. Two biopsies were interpreted as ruptured follicles, a third was consistent with NXG. Despite treatment with Chlorambucil and steroid injections, she recurred.Case-3. A 65-year-old male with COPD presented with right ptosis, swelling and palpable orbital mass which showed NXG on biopsy. Case-4. A 29-year-old healthy female presenting with right upper lid swelling initially diagnosed as cellulitis. Following no resolution on antibiotics, surgical exploration revealed tissue, histopathology showed NXG. Her condition resolved with no further intervention.


Conclusion

Necrobiotic xanthogranuloma is a rare chronic granulomatous disease involving the skin andsubcutaneous tissues. It is associated with paraproteinemias which may progress to hematologic malignancies such as CLL, multiple myeloma, non-Hodgkin’s lymphoma and others. Associations with autoimmune conditions such as GCA and polymyalgia rheumatica may also occur. Our four cases had initial diagnosis of xanthelasma, cutaneous neoplasm, orbital mass or cellulitis. We highlight the need to keep NXG as part of differential diagnosis in patients with periocular lesions and history of hematologic malignancy. Also, new diagnosis of NXG should be screened for systemic disease. When initial histopathology does not fit the clinical picture, a second pathology opinion and/or repeat biopsy should be considered.


Additional Authors

First nameLast nameBase Hospital / Institution
GabrielaLahaie LunaQueen’s University, Canada
ZdenekKaslCharles University -Plzen Campus, Czech Republic

Abstract ID: 21-204