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Breast-nonmalignant
Benign tumors / changes
Juvenile xanthogranuloma
Reviewer: Hind Nassar, M.D. in January 2009 (see Authors page)
Revised: 11 April 2010, last major update April 2010
Copyright: (c) 2002-2010, PathologyOutlines.com, Inc.
Definition
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● Benign histiocytic disorder of skin, very rare in breast tissue itself
● See also topic under Soft Tissue Tumors
Terminology
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● Also called nevoxanthoendothelioma
Epidemiology
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● Benign histiocytic disorder of infants and children; 15% occur in adults (usually young)
Sites
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Etiology
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Clinical features
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Prognostic factors
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Case reports
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● 20 year old woman with clinical extranumerary nipple (Case of the week #5)
● 74 year old woman with prior cutaneous juvenile xanthogranulomas and breast masses (Am J Surg Pathol 2005;29:827)
● Occurring in woman within field of radiation therapy for breast cancer (J Cutan Pathol 2010 Feb 5 [Epub ahead of print])
Treatment
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● Conservative excision
Clinical images
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Gross description (Macroscopy)
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● Cutaneous lesions usually 0.1 to 2.0 cm, yellow-red and papulonodular
Gross images
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Micro description (Histopathology)
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● Dense dermal infiltrate of lymphocytes, histiocytes, Touton giant cells (usually), eosinophils and neutrophils, which may extend into subcutis; late - epidermis thins out and the rete ridges become elongated
● Extracutaneous lesions may lack the Touton giant cells.
● Note: histiocytic giant cells may be Touton type [ring of nuclei surrounding foamy cytoplasm with cytoplasm usually also visible around the nuclei; Langhans type [nuclei form a horseshoe arrangement, not necessary a distinct category from Touton type] or foreign-body type [haphazard nuclear arrangement]
Micro images
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Case of Week #5 images
Skin-site unknown
The infiltrate is composed predominantly of vacuolated histiocytes and chronic
inflammatory cells (A) beneath an attenuated epidermis; many histiocytes
are multinucleated and of the Touton type
Virtual Slides
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Videos
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Cytology description
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Cytology images
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Positive stains
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● Touton giant cells and histiocytes: CD68, HAM56, Factor XIIIa
Negative stains
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● Touton giant cells and histiocytes: S100 and CD1a
Electron microscopy descriptions
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Electron microscopy images
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Molecular / cytogenetics description
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Molecular / cytogenetics images
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Differential Diagnosis
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● Benign fibrous histiocytoma: related entity, usually has a storiform pattern
● Langerhans cell histiocytosis: more common disorder of childhood, coffee bean nuclei / nuclear grooves, no Touton giant cells, Birbeck granules are present on EM, S100+, CD1a+, CD68-, HAM56-, Factor XIIIa-
● Xanthoma: uniform collection of foam cells and variable Touton giant cells, no other inflammatory cells, often associated with hyperlipidemia
Additional references
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● Am J Surg Pathol 2003;27:579, Am J Surg Pathol 2005;29:21
End of Breast-nonmalignant > Benign tumors / changes > Juvenile xanthogranuloma
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