Prostate gland & seminal vesicles

Benign mimickers of carcinoma

Xanthoma cells

Topic Completed: 1 October 2016

Minor changes: 21 July 2021

Copyright: 2002-2021,, Inc.

PubMed Search: Xanthoma cells

Andres Matoso, M.D.
Page views in 2020: 2,271
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Cite this page: Matoso A. Xanthoma cells. website. Accessed December 3rd, 2021.
Definition / general
  • Seen in xanthoma or xanthogranulomatous prostatitis
  • Localized collection of cholesterol-laden histiocytes, usually idiopathic
  • No proven association with elevated serum lipids
  • May be interpreted as high grade prostate cancer or prostate cancer with treatment effect, or foamy gland carcinoma, particularly in needle biopsies (Hum Pathol 1994;25:386, Am J Surg Pathol 2007;31:1225)
Essential features
  • Can be arranged in solid nodular pattern or in cords of individual cells
  • Usually very small and single focus (< 0.05 mm)
  • Bland nuclei with inconspicuous nucleoli, no mitosis, rarely focal necrosis
  • Immunohistochemistry for broad spectrum cytokeratins (negative) and CD68 (positive) should help in the differential diagnosis with carcinoma
  • Unknown; very rare
  • More commonly detected in needle biopsies
Clinical features
  • Asymptomatic; not clinically significant
  • Histopathology and immunohistochemistry in cases difficult to differentiate from adenocarcinoma
  • Does not require treatment
Microscopic (histologic) description
  • Abundant vacuolated foamy cytoplasm; small, uniform, benign appearing nuclei, small inconspicuous nucleoli
  • May have infiltration of prostatic stroma by cords and individual cells (Am J Surg Pathol 2007;31:1225)
  • No mitoses, rare / no necrosis
Microscopic (histologic) images

Contributed by Kenneth A. Iczkowski, M.D.
Xanthomatous histiocyte proliferation

Xanthomatous histiocyte proliferation

CD68 positive stain - confirmatory

CD68 positive stain - confirmatory

Positive stains
Negative stains
Differential diagnosis
  • Foamy gland carcinoma: crowded or infiltrative glands with abundant foamy cytoplasm, frequently pink acellular secretions
  • Previously designated hypernephroid adenocarcinoma: Gleason pattern 4; nests of clear cells resembling renal cell carcinoma; small, hyperchromatic nuclei; fusion of acini into more solid sheets with the appearance of back to back glands without intervening stroma
  • Pseudohyperplastic carcinoma with xanthomatous changes: nests of medium to large glands resembling hyperplastic nodules; glands have papillary projections, infoldings, undulations; nuclei are basal, small, hyperchromatic, with only rare nucleomegaly (Actas Urol Esp 2010;34:333)
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