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Skin-nontumor / Clinical Dermatology

Other dermatoses

Necrobiotic xanthogranuloma

Reviewer: Mowafak Hamodat, MB.CH.B, MSc., FRCPC, Eastern Health, St. Johns, Canada (see Reviewers page)
Revised: 1 August 2011, last major update August 2011
Copyright: (c) 2002-2011, PathologyOutlines.com, Inc.


● Head, neck and trunk lesions similar to necrobiosis lipoidica, but associated with IgG paraproteinemia and not diabetes

Micro 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

Micro images

Various images

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

End of Skin-nontumor / Clinical Dermatology > Other dermatoses > Necrobiotic xanthogranuloma

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