Skin inflammatory (nontumor)
Dermal granulomatous and necrobiotic reaction patterns
Necrobiotic xanthogranuloma


Topic Completed: 1 August 2011

Revised: 19 April 2019

Copyright: 2002-2019, PathologyOutlines.com, Inc.

PubMed Search: Necrobiotic xanthogranuloma

Mowafak Hamodat, M.B.Ch.B., M.Sc.
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Cite this page: Hamodat M. Necrobiotic xanthogranuloma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/skinnontumornecrobioticxanthogranuloma.html. Accessed December 6th, 2019.
Definition / general
  • Head, neck and trunk lesions similar to necrobiosis lipoidica, but associated with IgG paraproteinemia and not diabetes
Case reports
Gross description
  • Yellowish papules / nodules
Microscopic (histologic) description
  • Marked necrobiosis alternating with foci of xanthogranulomatous infiltration through the reticular dermis with extension into subcutaneous fat
  • Septal distribution may mimic panniculitis
  • Granulomatous infiltrate is associated with epithelioid and foamy histiocytes in addition to conspicuous giant cells, many of Touton type; also foreign body giant cells, lymphocytes and plasma cells, cholesterol clefts
  • Asteroid bodies often found in cytoplasm of giant cells
  • Granulomatous and necrobiotic process may also affect muscular arteries
Microscopic (histologic) images

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Necrobiotic xanthogranuloma

Various images

Positive stains
  • Oil Red O may reveal focal lipid droplets
  • Direct immunofluorescence shows IgM, C3 and fibrinogen deposits in blood vessel wall
  • Alcian blue staining may reveal small amount of interstitial mucin
Negative stains
  • No elastic fibers in necrobiotic areas
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