Multimodality imaging features of primary xanthoma of the calcaneus

Xanthoma of rib: a case report and review of the literature

BACKGROUND

Xanthomas are well-circumscribed benign proliferative lesions seen mainly in soft tissues. Usually, they are found in hyperlipidemia and familial hyperlipoproteinemia. Histologically, are characterized by macrophage-like mononuclear cells, multinucleated giant cells and abundant foam cells. The bone involvement, however, is notoriously rare and rib localization is extremely rare.

CASE PRESENTATION

A 55-year-old man performed a chest X-ray and a subsequent chest Computed Tomography scan showing a rib lesion that was surgically removed and a diagnosis of rib xanthoma was made. The patient presented an unknown condition of hyperlipidemia.

CONCLUSION

Rib xanthoma can be discovered accidentally and can be helpful in identifying an unrecognized condition of hyperlipidemia.

Primary Mandibular Condyle Xanthoma: Case Report and Literature Review

Bone xanthoma is a rare benign primary bone lesion histologically characterized by sheets of foamy cells which are macrophages with a cytoplasm filled with droplets of fat. It is usually associated with endocrine or metabolic diseases, in the absence of which the lesion is called primary xanthoma. Because of the lack of pathognomonic radiologic and clinical features, they require a differential diagnosis with a broad spectrum of lesions with a varying degree of malignant potential. We describe a case of primary mandibular xanthoma of a 16-year-old girl without typical cutaneous manifestations and alterations in lipid values. The temporomandibular joint involvement at the mandibular condyle is peculiar in the case described here. We present even a qualitative systematic review of the literature on primary xanthoma of the jaws in others to draw up treatment guidelines.

Recurrence of a primary xanthoma of the humerus in a 9-year-old normolipidemic child

Xanthomas are rare bone tumors that occur more often in patients with hyperlipidemia or metabolic disorders. We report the case of a 9-year-old child presenting with right shoulder pain after a trauma. A benign osteolytic lesion was found in the proximal humeral metaphysis. Curettage of the lesion was performed. Histologic findings confirmed intraosseous xanthoma. Although there was no evidence of dyslipidemia or metabolic disease, the patient suffered local recurrence at the 8-month follow-up, requiring a second surgery with bone grafting. This difficult and rare diagnosis must be kept in mind with osteolytic lesions.

Primary tumours of the calcaneus

The calcaneus is a rare location for the occurrence and development of primary tumour types. Clinicians are unfamiliar with calcaneal tumour types, which may result in a delay in diagnosis or a missed diagnosis, resulting in unnecessary morbidity and amputation. Heel pain and localized swelling of the ankle are the most common symptoms. X-ray is the first choice for a tentative diagnosis of a calcaneal tumour. The final diagnosis depends on a histological examination. The treatment of calcaneal tumour types varies depending on the Enneking system. The majority of patients with benign tumours heal, except for a few with a palindromia. For malignant tumours, the prognosis is comparatively poor, resulting in disability and a high rate of metastasis. This review describes the spectrum of calcaneal tumour types and specifically illustrates the epidemiology, symptomatology, imagology, histopathology and treatment options that may facilitate diagnosis and improve prognosis.

Primary Intraosseus Xanthoma Involving the Proximal Femur in a Normolipidemic Patient: A Case Report

We report the case of a 25-year-old woman presenting with left hip pain. A lesion was found in the proximal femoral metaphysis. Benign bone tumor, such as intraosseous lipoma or liposclerosing myxofibrous tumor, was suspected based on simple radiographs and magnetic resonance images. Curettage of the lesion and bone grafting was performed. Histologic findings reflected primary intraosseous xanthoma of the proximal femur. Laboratory tests revealed the patient to be normolipidemic, while immunoelectrophoretic fractionation of lipoproteins revealed normal values for alpha, pre-beta, beta, and chylomicrons. At the one-year follow-up, there was no evidence of local recurrence. This is the first reported case of primary intraosseous xanthoma of the proximal femur in a normolipidemic patient.

Primary Xanthoma of the Mandible: Report of a Rare Case

Xanthoma is a lesion most commonly seen in soft tissues such as the skin, subcutis, or tendon sheaths. Xanthoma formation is often associated with primary or secondary hyperlipidemia. Primary bone xanthomas are extremely rare benign bone lesions not associated with hyperlipidemia, histopathologically characterized by histiocytes, abundant lipid containing macrophages (foam cells), and multinucleated giant cells. Cholesterol clefts can be found in the medullary bone. Less than ten cases of xanthoma in the mandible have been reported. We present a rare primary intrabony xanthoma in a normolipidemic patient.

Primary xanthoma of calcaneus bone: Case report

INTRODUCTION

Xanthoma (or xanthofibroma) is a benign proliferative lesion, mostly seen in soft tissue. Xanthoma of bone is very rare benign primary bone tumor, more frequently seen in men and in patients over 20 years of age. Histologically, it is characterized by mononuclear macrophage-like cells, abundant foam cells, and multinucleated giant cells. It is sometimes discovered coincidentally and the most frequent symptom is pain.

PRESENTATION OF CASE

We present a 50-year-old healthy male patient with primary xanthoma of the calcaneus, who was treated by curettage and bone cement. He presented with a pathological fracture in a calcaneus bone lesion. Giant cell tumor was suspected on X-ray and MRI. Curettage and bone cementing was done through the posterolateral approach. Lipid profile was normal and histological examination revealed findings consistent with primary xanthoma of calcaneus bone.

DISCUSSION

To avoid an erroneous diagnosis, all material should be examined microscopically, the radiological features of the lesion should be studied properly and lipid profile should be investigated to differentiate between primary and secondary xanthoma. Primary xanthoma may be treated with curettage and bone graft while secondary xanthoma is treated nonsurgically and the skeletal manifestations will disappear with systemic treatment of hyperlipidemia.

CONCLUSION

We present this case to raise the suspicion of this lesion that is rarely described in the literatures. This is the first case of primary xanthoma of calcaneus bone that has been reported in Qatar.

Bilateral primary xanthoma of the humeri with pathologic fractures: A case report

Xanthomas are rare bone tumors that occur more often in the appendicular skeleton and typically appear radiographically benign, with a narrow zone of transition and a sclerotic rim. We report the case of a 57-year-old woman with hyperlipidemia presenting with bilateral shoulder pain after minor trauma. Radiographic and histopathologic investigation demonstrated intraosseous xanthoma with atypical features, including multifocality, a wide zone of transition and pathologic fractures-characteristics more commonly associated with aggressive lesions such as multiple myeloma or metastasis. The diagnosis, imaging, and histological appearance of xanthoma of bone are reviewed.

Xanthoma of bone associated with lipoprotein lipase deficiency

Lipoprotein lipase (LPL) deficiency is an extremely rare congenital metabolic disorder with an accumulation of chylomicrons in the blood. We encountered a patient with an LPL deficiency leading to multiple bone xanthomas associated with hyperlipidemia. Radiographs and MRI of the humerus and femur revealed symmetrical bone lesions, and there is a possibility that these symmetrical lesions may therefore be a characteristic feature for this disorder.

Lesions of the Bones of the Hands and Feet: A Study of 50 Cases

Context.—The bones of the hands and feet constitute more than half of the bones in the human skeleton (106/ 206), but lesions occurring in them are infrequently reported. Although many of the lesions that occur in the rest of the skeletal bones can occur in bones of the hands or feet, their distribution and frequency differ.

Objective.—To study lesions involving bones of the hands or feet.

Design.—Retrospective study of all lesions involving bones of the hands or feet during the period from January 2000 to September 2006 from a university hospital in southern India. Clinical, radiologic, and pathologic features were reviewed.

Results.—The 50 lesions encountered included 23 (46.0%) infections/inflammatory lesions, 16 (32.0%) benign tumors, 6 (12.0%) malignant tumors, and 5 (10.0%) tumorlike lesions. Giant cell tumor was the most common benign tumor. Malignant tumors involved the nonphalangeal bones, with chondrosarcoma the most common.

Conclusions.—Lesions of the bones of the hands or feet are uncommon. Awareness and correlation of clinical, radiologic, and pathologic features help in making correct diagnoses.