Case of the Month

torso

face

A 15-year-old boy presents with an enlarging bump on his back. He was otherwise healthy. He first noticed the lesion 6 months ago. The bump has gradually increased in size to the point that it irritates him when he sits back in a chair.

On examination, he had an approximate 1.4 x 0.9 cm nodule on his left lower back. The lesion was flesh colored with a slight central orange hue with a darker peripheral rim.

What's Your Diagnosis?

Diagnosis: Juvenile xanthogranuloma  

A juvenile xanthogranuloma (JXG), is a benign nodule composed of histiocytes. Initially they may appear as red papules or nodules. Over time they may become more yellow in color. In lighter colored skin, the orange color is more prominent. JXG’s presentation will vary depending on the hue of skin, as seen represented above.

JXG usually appears on the head, neck, and trunk. JXG may be solitary or occur in groups. They are usually harmless. If they are symptomatic, as in this case, removal was completed. For additional information, see the reference below.

Touton Giant cell is circled

Pathology

The dermis contains an infiltrate of histiocytes, many of which have pale, vacuolated cytoplasm. Foreign body and Touton giant cells are present. The latter show a wreath arrangement of nuclei around a small island of non-foamy cytoplasm. There is some fibrosis and an infiltrate of lymphocytes and eosinophils.

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