Frederick A Jakobiec1,2, Lina Ma1,2, Natalie Wolkow1,2, Francis C Sutula2, Suzanne K Freitag2,3. 1. David G. Cogan Laboratory of Ophthalmic Pathology, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA. 2. Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA. 3. Ophthalmic Plastic Surgery Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA.
Abstract
BACKGROUND/AIMS: Xanthelasma is an unreliable indicator of systemic hyperlipidemia. A review in search of unusual histopathologic features of cellular composition that might correlate with systemic hyperlipidemia was conducted. METHODS: An observational case series of 3 cases was performed. Slides were stained and analyzed with hematoxylin and eosin, Masson trichrome, and periodic acid-Schiff as well as for iron. Three lesions displayed an atypical morphologic finding and were subjected to immunohistochemical analysis for CD3, CD20, CD68, CD163, S100, and adipophilin. RESULTS: The three lesions comprised in this study had classical xanthoma cells with densely packed fine vacuoles. The xanthoma cells were CD68, CD163, and adipophilin positive and S100 negative. In case 1, extracellular, nonpolarizing cholesterol crystalloids displayed totally negative staining for all biomarkers. In cases 2 and 3, the cholesterol granulomas were surrounded and permeated by CD68- or CD163-positive epithelioid and giant cells and by CD3-positive T lymphocytes. The 3 cases each harbored squamous cysts. CONCLUSION: In case 1, the uninflamed extracellular cholesterol crystalloids were associated with severely dysregulated systemic hyperlipidemia. In cases 2 and 3, the cholesterol granulomas were interpreted as a local manifestation of a cyst that might have partially ruptured and did not portend serious hyperlipidemia.
BACKGROUND/AIMS: Xanthelasma is an unreliable indicator of systemic hyperlipidemia. A review in search of unusual histopathologic features of cellular composition that might correlate with systemic hyperlipidemia was conducted. METHODS: An observational case series of 3 cases was performed. Slides were stained and analyzed with hematoxylin and eosin, Masson trichrome, and periodic acid-Schiff as well as for iron. Three lesions displayed an atypical morphologic finding and were subjected to immunohistochemical analysis for CD3, CD20, CD68, CD163, S100, and adipophilin. RESULTS: The three lesions comprised in this study had classical xanthoma cells with densely packed fine vacuoles. The xanthoma cells were CD68, CD163, and adipophilin positive and S100 negative. In case 1, extracellular, nonpolarizing cholesterol crystalloids displayed totally negative staining for all biomarkers. In cases 2 and 3, the cholesterol granulomas were surrounded and permeated by CD68- or CD163-positive epithelioid and giant cells and by CD3-positive T lymphocytes. The 3 cases each harbored squamous cysts. CONCLUSION: In case 1, the uninflamed extracellular cholesterol crystalloids were associated with severely dysregulated systemic hyperlipidemia. In cases 2 and 3, the cholesterol granulomas were interpreted as a local manifestation of a cyst that might have partially ruptured and did not portend serious hyperlipidemia.
Authors: J A Sivak-Callcott; J Rootman; S L Rasmussen; R A Nugent; V A White; D Paridaens; Z Currie; G Rose; B Clark; A A McNab; F V Buffam; J M Neigel; M Kazim Journal: Br J Ophthalmol Date: 2006-05 Impact factor: 4.638