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

Author: Mowafak Hamodat, M.D., MB.CH.B, MSc., FRCPC (see Authors page)

Revised: 16 October 2018, last major update August 2011

Copyright: (c) 2002-2018,, Inc.

PubMed Search: Necrobiotic xanthogranuloma

Cite this page: Hamodat, M. Necrobiotic xanthogranuloma. website. Accessed December 15th, 2018.
Definition / general
  • Head, neck and trunk lesions similar to necrobiosis lipoidica, but associated with IgG paraproteinemia and not diabetes
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

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