Table: Differential diagnosis of cutaneous xanthomas [1, 4, 16, 20].

 

 

Type                 Pattern*           Cytology           Lipid metabolism                Clinical clues

 

 

Eruptive         Perivascular         few foam cells             Abnormal                         Buttocks or other sites

                       Interstitial             few neutrophils

                       Acanthosis (-)      lymphocytes

                                                    eosinophils

 

Tuberous       Perivascular          foam cells                     Abnormal                       Elbows, knees

                       Nodular                few lymphocytes

                       Acanthosis (-)      few neutrophils

 

Tendinous     Perivascular          foam cells                      Abnormal                       Hand and feet tendon

                       Interstitial             few lymphocytes

                       Acanthosis (-)      few neutrophils

 

Plexiform      Plexiform              foam cells                     May be abnormal            Middle aged

                       Nodular                spindle cells

                       Acanthosis (-)      lymphocytes

                                                    plasmacytes

 

Papular           Nodular               foam cells                       Normal                            Infants, children

                        Diffuse                Touton-type giant cells

                        Acanthosis (-)      No inflammatory cells

 

Xanthalesma  Perivascular         foam cells                        Usually abnormal            Eyelids

                        Interstitial            few lymphocytes

                        Acanthosis (-)      few neutrophils

 

Verruciform   Nodular                foam cells                         Normal                          Genital or other sites

                       Acanthosis (+)      scant lymphocytes                                                                            

 

(*): Dermal pattern of cellular infiltrate and the presence of acanthosis