Skin nontumor

Dermal granulomatous and necrobiotic reaction patterns

Necrobiotic xanthogranuloma

Last author update: 1 August 2011
Last staff update: 9 November 2021

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PubMed Search: Necrobiotic xanthogranuloma

Mowafak Hamodat, M.B.Ch.B., M.Sc.
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Cite this page: Hamodat M. Necrobiotic xanthogranuloma. website. Accessed November 29th, 2023.
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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