Giant juvenile xanthogranuloma: exophytic and endophytic variants

Xanthogranulomas larger than 2 cm are rarely reported variants of this otherwise common, benign lesion usually measuring 1 mm to 1 cm in diameter. The natural history of such macronodular xanthogranulomas is uncertain, but appears to parallel the generally predictable course toward involution seen in micronodular lesions. Two patients with macronodular xanthogranuloma illustrate exophytic and endophytic variants, as well as the problems of managing this unusual tumor. Nonoperative observation is advisable if possible, but complicating factors may necessitate surgical excision in some cases.