Anubha Bajaj*
Department of Histopathology, Panjab University/A.B. Diagnostics, India
*Corresponding Author: Anubha Bajaj, Department of Histopathology, Panjab University/A.B. Diagnostics, India.
Received: September 09, 2024; Published: October 24, 2024
Citation: Anubha Bajaj. “Suety and Blubbery-Xanthelasma" Acta Scientific Clinical Case Reports 5.11 (2024):35-37.
Xanthelasma configures as a soft, bilateral, symmetric, yellow, lipid laden plaque implicating cutaneous surface of medial aspect of upper and lower eyelids. The condition may concur with primary hypercholesterolemia.
Additionally designated as xanthelasma palpebrarum or cutaneous xanthoma, neoplasm characteristically emerges within middle aged to elderly subjects. Morphologically, foamy histiocytes appear confined to superficial dermis.
Xanthelasma appears as symmetric lesions confined to the eyelids.
A female preponderance is observed. Age of disease onset is between 15 years to 73 years with peak age of disease occurrence at 30 years to 50 years. An estimated 50% subjects depict concurrent hyperlipidemia. Subjects with age of initial disease representation < 40 years are associated with enhanced possible occurrence of familial hyperlipidemia. Additionally, condition is concurrent with atherosclerosis, diabetes mellitus or thyroid disorders [1,2].
Xanthelasma is associated with certain primary hyperlipidemias, especially type 2a. Serum levels of high density lipoprotein (HDL) appear decimated.
Besides, secondary hyperlipidemia concurrent with conditions as hypothyroidism, diabetes mellitus or ingestion of drugs as glucocorticoids, oestrogens may induce the lesion.
Xanthelasma emerges in subjects consuming diet rich in saturated fats, cholesterol and excessive alcohol intake. Neoplasm is characterized by intracellular accumulation of cholesterol rich substances [2,3].
Clinically, xanthelasma represents as yellowish, attenuated papules and plaques. Lesions are symmetrically disseminated upon cutaneous surfaces of medial aspect of upper or lower eyelids [2,3].
Majority (>80%) of female subjects depicting xanthelasma display periorbital hyperpigmentation.
Xanthelasma appears concordant with systemic diseases as cirrhosis, thyroid disorders or nephrotic syndrome.
Upon microscopy, tumefaction is comprised of foamy macrophages impregnated with lipids. Constituent lipid laden, foamy histiocytes are confined to superficial dermal region and accumulate while circumscribing walls of vascular articulations [3,4].
![Figure 1: Xanthelasma depicting clusters of lipid laden histiocytes and foamy macrophages accumulated within the dermis and surrounding vascular structures [7].](https://actascientific.com/ASCR/images/ASCR-05-0595_figure1.png)
Figure 1: Xanthelasma depicting clusters of lipid laden histiocytes and foamy macrophages accumulated within the dermis and surrounding vascular structures [7].
![Figure 2: Xanthelasma delineating aggregates of lipid laden histiocytes and foamy macrophages accumulated within the dermal region and circumscribing blood vessels [8].](https://actascientific.com/ASCR/images/ASCR-05-0595_figure2.png)
Figure 2: Xanthelasma delineating aggregates of lipid laden histiocytes and foamy macrophages accumulated within the dermal region and circumscribing blood vessels [8].
Xanthelasma is graded as
![Table 1: TNM classification of Malignant Melanoma [3,4].](https://actascientific.com/ASCR/images/ASCR-05-0595_table1.png)
Table 1: TNM classification of Malignant Melanoma [3,4].
Xanthelasma appears immune reactive to CD68 and CD163. Lipid rich tumour cells may be highlighted by Oil red O stains.
Tumour cells appear immune non reactive to BRAF V600E, CD1a or Langerin [5,6].
Xanthelasma requires distinction from neoplasms as periorbital Erdheim Chester disease, periorbital Langerhans cell histiocytosis or injected foreign material and poly-L lactic acid (tissue filler) paraffinoma. Additionally, distinction from lesions as sebaceous hyperplasia, juvenile xanthogranuloma, nodular basal cell carcinoma, adult-onset asthma and periocular xanthogranuloma (AAPOX), palpebral sarcoidosis, lipoid proteinosis or necrobiotic xanthogranuloma is necessitated. Besides, pseudo-xanthogranuloma may ensue following surgical vitrectomy along with deposition of silicon oil within subcutaneous tissue planes [5,6].
Xanthelasma may be appropriately discerned with the occurrence of characteristic clinical countenance.
Serum lipid profile may be employed to evaluate hypercholesterolemia.
Ultrasonography of xanthelasma is optimal in assessing depth of lesion and echotexture. Aforesaid features are essential for adopting appropriate therapeutic strategies.
Generally, surgical tissue sampling for precise histological examination remains superfluous [5,6].
Xanthelasma may be subjected to conservative management as frequent reoccurrence of tumour nodules is observed. Nevertheless, surgical extermination of lesion or laser ablation therapy appears beneficial. Topical therapy may be suitably employed for superior cosmetic outcomes. Administration of lipid lowering agents appears advantageous.
Enhanced possible reoccurrence of xanthelasma is associated with
Copyright: © 2024 Anubha Bajaj. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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