Xanthoma of the sacrum

Abstract

Xanthoma is a lesion containing abundant foamy histiocytes most commonly occurring in superficial soft tissues such as skin, subcutis, or tendon sheaths. The involvement of deep skeletal structures, however, is rare and has only been infrequently reported in the English literature. Most xanthomas occur in patients with hyperlipidemic disorders. We report a case of a xanthoma in the sacrum and ilium of a patient with hyperlipidemia type IIa, who had chronic lower back pain for more than 20 years. On radiographs the lesion appeared multiloculated and osteolytic with a thin sclerotic border and containing multiple nodular calcifications within its matrix. Computed tomographic images revealed a presacral soft-tissue mass that also infiltrated the adjacent sacroiliac joint and iliac fossa. On histologic examination, abundant areas of xanthoma cells and cholesterol clefts, typical of xanthoma, were present. The patient received simple curettage of the lesion, and his symptoms were markedly relieved.

Primary Xanthoma of the Mandible: Report of a Rare Case

“…The radiographic appearance may range from a small, well-demarcated radiolucent lesion with sclerotic margins to diffuse appearance with small ill-defined radiolucencies and areas of increased density [3,4,12]. Calcifications have been reported in the osteolytic areas [1,13]. The lesion can expand the cortices, as in the reported case, and when lytic it may mimic a malignant process [9,14].…”

“…The medical literature is replete with records of xanthomatous lesions of the skin and tendons, usually associated with hyperlipidemia type II and III and lipid storage or metabolism disorders [1]. Primary intraosseous xanthoma of the gnathic bones is rare, especially an intra-bony lesion containing lipid-laden macrophages in patients without lipid disorders [7].…”

“…Most documented cases were seen between the third and fifth decades [3,5,8]. Male are affected twice as much as females [1,3]. The lesion is almost always solitary and occurs most frequently in the hand and flat bones [7,[9][10][11].…”

“…Xanthomas are benign lesions of soft tissue commonly seen in skin or over subcutaneous tissue of tendon sheaths and extensor surfaces after minor trauma or friction [1,2]. Xanthoma formation occurs most frequently in patients with endocrine and metabolic diseases [1][2][3][4].…”

“…Xanthoma formation occurs most frequently in patients with endocrine and metabolic diseases [1][2][3][4]. Xanthoma is derived from the Greek xanthós, which means yellow, and is related to the altered metabolism of lipids and the accumulation of yellow pigment in skin and other internal organs [3].…”