Primary xanthoma of calcaneus bone: Case report

Abstract

INTRODUCTIONXanthoma (or xanthofibroma) is a benign proliferative lesion, mostly seen in soft tissue. Xanthoma of bone is very rare benign primary bone tumor, more frequently seen in men and in patients over 20 years of age. Histologically, it is characterized by mononuclear macrophage-like cells, abundant foam cells, and multinucleated giant cells. It is sometimes discovered coincidentally and the most frequent symptom is pain.PRESENTATION OF CASEWe present a 50-year-old healthy male patient with primary xanthoma of the calcaneus, who was treated by curettage and bone cement. He presented with a pathological fracture in a calcaneus bone lesion. Giant cell tumor was suspected on X-ray and MRI. Curettage and bone cementing was done through the posterolateral approach. Lipid profile was normal and histological examination revealed findings consistent with primary xanthoma of calcaneus bone.DISCUSSIONTo avoid an erroneous diagnosis, all material should be examined microscopically, the radiological features of the lesion should be studied properly and lipid profile should be investigated to differentiate between primary and secondary xanthoma. Primary xanthoma may be treated with curettage and bone graft while secondary xanthoma is treated nonsurgically and the skeletal manifestations will disappear with systemic treatment of hyperlipidemia.CONCLUSIONWe present this case to raise the suspicion of this lesion that is rarely described in the literatures. This is the first case of primary xanthoma of calcaneus bone that has been reported in Qatar.

Primary Bone Xanthoma: A Case Report

“…Primary bone xanthoma is a rare bone disorder which usually presents in patients above 20 years of age and has a male to female ratio of 2:1. [1] Primary xanthomas of bone more often involve the flat bones than the long bones with the mandible, temporal bone, ribs, and pelvic bones being most commonly involved by the condition. [7] There www.pacificejournals.com/apalm eISSN: 2349-6983; pISSN: 2394-6466 are reported cases of Primary intraosseous xanthomas of the jaws, which affect the posterior mandible (86%) of normolipemic patients, with a mean age of 30 years and no gender predilection.…”

“…It is sometimes discovered coincidentally and the most frequent symptom is pain. [1] It has been reported in association with hyperlipidaemia and hypo-lipoproteinemia and occasionally with diabetes mellitus. [10] So diet control, lifestyle modification, and treatment of associated condition may help in regression of the bone xanthoma with lipid disorders.…”

“…Xanthoma is a rare bone disorder which is mostly associated with endocrine or metabolic diseases having increased cholesterol levels, hypolipoproteinemia Type II & III, hypothyroidism, diabetes mellitus and lipoprotein lipase deficiency, hence called secondary bone xanthoma. [1][2][3][4] A few cases have been reported in non-hyperlipidemic states termed as primary bone xanthoma. [3][4][5] Various bone lesions can present with xanthomatous appearance histologically, e.g., fibrous dysplasia, giant cell tumor, simple bone cyst, fibroma, chondroblastoma, fibrous histiocytoma, histiocytosis X and chronic osteomyelitis, [1][2]6] which makes it necessary to rule out these disorders before giving a diagnosis of bone xanthoma.…”

Intraosseous leiomyoma of the calcaneum: An unusual bone tumor of foot and review of literature

“…14 Xanthofibroma of calcaneum shows a well demarcated expansile lesion with hypointense signal on T1 weighted images and hyperintense signal on T2-weighted Images. 15 Histopathological examination shows areas of bone and soft tissue infiltrated by multinucleated giant cells, hemosiderin laden macrophages, cholesterol cleft and hemorrhages. 15 Monostotic fibrous dysplasia shows an expansile, well-marginated osteolytic lesion.…”

“…15 Histopathological examination shows areas of bone and soft tissue infiltrated by multinucleated giant cells, hemosiderin laden macrophages, cholesterol cleft and hemorrhages. 15 Monostotic fibrous dysplasia shows an expansile, well-marginated osteolytic lesion. Monostotic fibrous dysplasia is having isointensities and high intensities on T1 and T2 weighted images, respectively and the lesion was enhances with gadolinium.…”