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Lee SH, Shin JY, Lee SH, Park YL. Diffuse Normolipemic Plane Xanthomatosis with Immunoglobulin-Lambda Light-Chain Deposition in a Patient with Multiple Myeloma. Ann Dermatol 2019; 31:238-240. [PMID: 33911580 PMCID: PMC7992667 DOI: 10.5021/ad.2019.31.2.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 02/10/2018] [Accepted: 04/08/2018] [Indexed: 11/09/2022] Open
Affiliation(s)
- Sul Hee Lee
- Department of Dermatology, Soon Chun Hyang University Bucheon Hospital, Bucheon, Korea
| | - Ji Yeoun Shin
- Department of Dermatology, Soon Chun Hyang University Bucheon Hospital, Bucheon, Korea
| | - Sang-Hoon Lee
- Department of Dermatology, Soon Chun Hyang University Bucheon Hospital, Bucheon, Korea
| | - Young Lip Park
- Department of Dermatology, Soon Chun Hyang University Bucheon Hospital, Bucheon, Korea
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Cohen YK, Elpern DJ. Diffuse normolipemic plane xanthoma associated with monoclonal gammopathy. Dermatol Pract Concept 2015; 5:65-7. [PMID: 26693095 PMCID: PMC4667607 DOI: 10.5826/dpc.0504a16] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 09/21/2015] [Indexed: 11/03/2022] Open
Abstract
Diffuse normolipemic plane xanthoma (DNPX) was first described by Altman and Winkelmann in 1962. It is a rare and non-inherited form of xanthomatosis. Clinically, the dermatosis is characterized by the presence of symmetric yellowish-orange plaques that favor the neck, upper trunk, flexural folds and periorbital region. It has been recognized to be associated with hematological diseases, especially with multiple myeloma and monoclonal gammopathy. We present a patient with diffuse plane xanthoma, normal lipid level, and monoclonal gammopathy.
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Kim KJ, Lee DP, Suh HS, Lee MW, Choi JH, Moon KC, Koh JK. Diffuse Plane Xanthoma in a Patient with Chronic Myeloid Leukemia. J Dermatol 2014; 31:503-5. [PMID: 15235195 DOI: 10.1111/j.1346-8138.2004.tb00543.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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van de Donk NWCJ, Palumbo A, Johnsen HE, Engelhardt M, Gay F, Gregersen H, Hajek R, Kleber M, Ludwig H, Morgan G, Musto P, Plesner T, Sezer O, Terpos E, Waage A, Zweegman S, Einsele H, Sonneveld P, Lokhorst HM. The clinical relevance and management of monoclonal gammopathy of undetermined significance and related disorders: recommendations from the European Myeloma Network. Haematologica 2014; 99:984-96. [PMID: 24658815 PMCID: PMC4040895 DOI: 10.3324/haematol.2013.100552] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 03/14/2014] [Indexed: 12/18/2022] Open
Abstract
Monoclonal gammopathy of undetermined significance is one of the most common pre-malignant disorders. IgG and IgA monoclonal gammopathy of undetermined significance are precursor conditions of multiple myeloma; light-chain monoclonal gammopathy of undetermined significance of light-chain multiple myeloma; and IgM monoclonal gammopathy of undetermined significance of Waldenström's macroglobulinemia and other lymphoproliferative disorders. Clonal burden, as determined by bone marrow plasma cell percentage or M-protein level, as well as biological characteristics, including heavy chain isotype and light chain production, are helpful in predicting risk of progression of monoclonal gammopathy of undetermined significance to symptomatic disease. Furthermore, alterations in the bone marrow microenvironment of monoclonal gammopathy of undetermined significance patients result in an increased risk of venous and arterial thrombosis, infections, osteoporosis, and bone fractures. In addition, the small clone may occasionally be responsible for severe organ damage through the production of a monoclonal protein that has autoantibody activity or deposits in tissues. These disorders are rare and often require therapy directed at eradication of the underlying plasma cell or lymphoplasmacytic clone. In this review, we provide an overview of the clinical relevance of monoclonal gammopathy of undetermined significance. We also give general recommendations of how to diagnose and manage patients with monoclonal gammopathy of undetermined significance.
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Affiliation(s)
| | - Antonio Palumbo
- Divisione di Ematologia dell'Università di Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Turin, Italy
| | - Hans Erik Johnsen
- Department of Hematology, Aalborg University Hospital, Aalborg, Denmark
| | - Monika Engelhardt
- Department of Hematology and Oncology, University of Freiburg Medical Center, Germany
| | - Francesca Gay
- Divisione di Ematologia dell'Università di Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Turin, Italy
| | - Henrik Gregersen
- Department of Hematology, Aalborg University Hospital, Aalborg, Denmark
| | - Roman Hajek
- Department of Haemato-oncology, University Hospital Ostrava and Faculty of Medicine, Czech Republic
| | - Martina Kleber
- Department of Hematology and Oncology, University of Freiburg Medical Center, Germany
| | - Heinz Ludwig
- Department of Medicine I, Wilhelminenspital Wien, Austria
| | - Gareth Morgan
- Institute of Cancer Research, Royal Marsden Hospital, London, UK
| | - Pellegrino Musto
- Scientific Direction, Centro di Riferimento Oncologico della Basilicata, Istituto di Ricovero e Cura a Carattere Scientifico, Rionero in Vulture, Italy
| | | | - Orhan Sezer
- Department of Hematology, Memorial Hospital, Istanbul, Turkey
| | - Evangelos Terpos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Greece
| | - Anders Waage
- Department of Hematology, St. Olavs Hospital, Norwegian University of Science and Technology, Trondheim, Norway
| | - Sonja Zweegman
- Department of Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - Hermann Einsele
- Universitätsklinik Würzburg, Medizinische Klinik und Poliklinik II, Würzburg, Germany
| | - Pieter Sonneveld
- Department of Hematology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Henk M Lokhorst
- Department of Hematology, University Medical Center Utrecht, The Netherlands
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Rosmaninho A, Fernandes I, Guimas A, Amorim I, Selores M. Diffuse plane xanthomatosis associated with monoclonal gammopathy. An Bras Dermatol 2011; 86:S50-2. [DOI: 10.1590/s0365-05962011000700012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2010] [Accepted: 10/06/2010] [Indexed: 11/22/2022] Open
Abstract
Diffuse plane normolipemic xanthomatosis (DPNX) is a rare, non-inherited disease that is often associated with systemic diseases, mainly malignant hematological (especially multiple myeloma) or lymph proliferative disorders. The DPNX can precede the appearance of such conditions by several years, so careful follow-up and periodic laboratory examinations are recommended even for patients that seemed to have no underlying disease. We describe a case associated with monoclonal gammopathy. This case shows that dermatological lesions can be the first manifestation of important hematological diseases and so physicians should be familiarized with this entity
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Abstract
Xanthomas are a common manifestation of lipid metabolism disorders. They include hyperlipemic xanthoma, normolipemic xanthoma, and a related condition, necrobiotic xanthogranuloma (NXG). All 3 forms can be associated with monoclonal immunoglobulin (MIg). In an attempt to improve diagnosis, understanding, and treatment of this association, we retrospectively analyzed a personal series of 24 patients (2 hyperlipemic xanthoma, 11 normolipemic xanthoma, and 11 NXG) and 230 well-documented reports from the literature. With the exception of the nodules and plaques featured in NXG, the clinical presentation of xanthomatous lesions usually resembled that seen in common hyperlipidemic forms and could not be used to suspect MIg-associated xanthomas. Extracutaneous sites were not rare. The MIg was an IgG in 80% of cases. Myeloma was diagnosed in 35%. Hypocomplementemia with low C4 fraction was present in 80% of studied patients. Low C1 inhibitor serum levels were found in 53%. Cryoglobulinemia was detected in 27%. These abnormalities suggest immune complex formation because of interactions between the MIg and lipoproteins and argue in favor of a causal link between MIg and xanthomas. Monoclonal gammopathy therapy could thus be an option. Indeed, among the patients who received chemotherapy, hematologic remission was accompanied by improvement in xanthoma lesions in several cases.
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Ferrara G, Palombi N, Lipizzi A, Zalaudek I, Argenziano G. Nonnecrobiotic Necrobiotic Xanthogranuloma. Am J Dermatopathol 2007; 29:306-8. [PMID: 17519634 DOI: 10.1097/dad.0b013e3180332b8b] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Gerardo Ferrara
- Pathologic Anatomy Service Gaetano Rummo General Hospital, Benevento, Italy.
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Kourou K, Suga Y, Muramatsu S, Yaguchi H, Ogawa H. A case of diffuse plane normolipemic xanthomatosis associated with pancytopenia and monoclonal gammopathy. J Dermatol 2006; 33:64-7. [PMID: 16469089 DOI: 10.1111/j.1346-8138.2006.00013.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We report a case of diffuse plane normolipemic xanthomatosis (DPNX) which showed poorly demarcated, uncommon, yellow macules symmetrically distributed on the nape, axillae and inguinal folds accompanied by severe, persistent itching. Histopathological and ultrastructural studies of skin biopsy specimens revealed the existence of some foamy cells and the deposition of neutral fat in the upper papillary dermis. Laboratory investigations and bone marrow aspirate smears showed that our patient had myelodysplastic syndrome (MDS) associated with pancytopenia and monoclonal gammopathy of undetermined significance. Because our patient had neither a malignant hematological disorder nor a severe systemic disease, monoclonal gammopathy might explain the pathogenesis of DPNX in the present case.
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Affiliation(s)
- Kazuhiro Kourou
- Department of Dermatology, Juntendo University School of Medicine, Tokyo, Japan
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Giménez S, Gallardo F, Curcó N, Marcoval J, Romagosa V, Servitje O, Pujol RM. Dystrophic Xanthomatosis in Primary CD30-Positive Cutaneous T-Cell Lymphoma. Dermatology 2005; 211:267-72. [PMID: 16205073 DOI: 10.1159/000087022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2004] [Accepted: 11/26/2004] [Indexed: 11/19/2022] Open
Abstract
The development of xanthomatous changes in lesions of primary cutaneous T-cell lymphomas (CTCL) is a rare event. It is usually observed in regressing skin tumours or plaques spontaneously or after a specific treatment. The pathogenetic mechanisms implicated in these changes are poorly understood. We are reporting 2 cases of extensive dystrophic xanthomatous changes, developing in regressing lesions of primary cutaneous CD30-positive T-cell lymphoproliferative disorders. Previously reported cases of primary CTCL developing secondary (dystrophic) xanthomata are reviewed.
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Affiliation(s)
- Sonia Giménez
- Department of Dermatology, Hospital de Bellvitge, Barcelona, Spain
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Broeshart JH, Prens EP, Habets WJM, de Bruijckere LM. Normolipemic plane xanthoma associated with adenocarcinoma and severe itch. J Am Acad Dermatol 2003; 49:119-22. [PMID: 12833022 DOI: 10.1067/mjd.2003.232] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Normolipemic plane xanthomas are yellow-red-colored flat patches or plaques with barely palpable borders, under normolipemic conditions usually involving the eyelids, the lateral sides of the neck, the upper aspect of the trunk, or the flexural folds. Histologically the lesions are characterized by an infiltrate consisting of foamy macrophages in the papillary and middermis with a distinct perivascular localization. Plane xanthoma has been associated with monoclonal gammopathy, cryoglobulinemia, and myeloproliferative disorders. We present a patient in whom plane xanthoma developed on the upper aspect of the back, which was accompanied by severe itch in the affected area. These symptoms started 1 month after resection of an adenocarcinoma of the rectum that was complicated by recurrent abdominal abscesses and, currently, by ongoing inflammatory bowel disease. A hypothetic pathophysiologic scheme of events leading to xanthoma formation in this patient is presented.
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Akhyani M, Daneshpazhooh M, Seirafi H, Naraghi ZS. Diffuse plane xanthoma in an otherwise healthy woman. Clin Exp Dermatol 2001; 26:405-7. [PMID: 11488827 DOI: 10.1046/j.1365-2230.2001.00846.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We report a case of diffuse plane xanthoma in a 40-year-old otherwise healthy woman. Her disease began 18 years ago as xanthelasma and progressed to involve large areas of her face, neck and trunk. No associated diseases were detected on repeated laboratory testing.
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Affiliation(s)
- M Akhyani
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Daoud MS, Lust JA, Kyle RA, Pittelkow MR. Monoclonal gammopathies and associated skin disorders. J Am Acad Dermatol 1999; 40:507-35; quiz 536-8. [PMID: 10188670 DOI: 10.1016/s0190-9622(99)70434-2] [Citation(s) in RCA: 147] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The monoclonal gammopathies are characterized by clonal proliferation of plasma cells and other clonally related cells in the B-cell lineage. These disorders include monoclonal gammopathy of undetermined significance, multiple myeloma, Waldenström macroglobulinemia, heavy chain diseases, plasmacytoma, and primary amyloidosis. Many skin disorders have been described in association with monoclonal gammopathies. This article provides an introduction to the definition, detection, natural course, and spectrum of monoclonal gammopathies and a brief discussion of pathogenesis. The article also reviews the skin disorders associated with monoclonal gammopathies, categorizes the association, and evaluates the strength of the association.
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Affiliation(s)
- M S Daoud
- Department of Dermatology, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA
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