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Plane xanthoma associated with multiple mastocytoma
Masaaki Matsumoto1, Mitsunori Ikeda, Motohiro Takeya
1Department of Dermatology, Kochi Medical School, Kochi, Japan. matsumo@med.kochi-u.ac.jp
Insights
A rare case of cutaneous mastocytoma in an infant transformed into plane xanthoma lesions. These yellowish plaques, characterized by foam cells, regressed spontaneously after corticosteroid treatment cessation.
Area of Science:
- Dermatology
- Pathology
- Immunohistochemistry
Background:
- Cutaneous mastocytoma is a rare neoplastic proliferation of mast cells in the skin.
- Xanthoma refers to the deposition of lipids in the skin, often associated with metabolic disorders.
Observation:
- A 5-month-old infant presented with brown macules that evolved into yellowish plaques after topical corticosteroid treatment.
- The lesions showed increased foam cells, identified as macrophages via immunohistochemistry (HAM56, CD204).
Findings:
- Histopathology revealed mast cell infiltration in early lesions and increased foam cells in later plaques.
- The yellowish plaques resembled xanthelasmoid mastocytosis but were identified as plane xanthoma associated with cutaneous mastocytoma.
- Spontaneous regression of the xanthoma lesions occurred after discontinuation of topical corticosteroids.
Implications:
- This case highlights a potential association between cutaneous mastocytoma and plane xanthoma.
- It suggests that foam cell accumulation in these lesions may be macrophage-mediated.
- The findings underscore the importance of immunohistochemical analysis for accurate diagnosis and understanding the pathogenesis of complex skin lesions.
Abstract:
A 5-month-old boy was noted to have brown macules with palpable infiltration on the head, trunk, and extremities a few weeks after birth, with recurrent episodes of generalized flushing and blistering in some of the macules. These lesions developed into yellowish plaques after 1 year of topical treatment with clobetasol propionate. Serum lipid levels were within normal limits. The appearance of the yellowish lesions was similar to that of the xanthelasmoid type of cutaneous mastocytosis. The brown macules showed infiltration of a large number of mast cells and a small number of scattered foam cells, whereas in the yellowish plaques, the number of foam cells was greatly increased. The yellowish plaques regressed spontaneously within a year after cessation of topical corticosteroid treatment. Immunohistochemical analysis found that the foam cells were stained with monocyte/macrophage markers including HAM56, and with SRA-C6, a monoclonal antibody to macrophage scavenger receptor class A (CD204). Therefore, the yellowish plaques were considered to be plane xanthoma associated with cutaneous mastocytoma.
