Mervak Julie, Amadi Ugochukwu, Khandpur Ritika, Ha Lan Thanh T, Hristov Alexandra, Do Thy Thy, Maier Lisa, Wang Frank
Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA.
J Dermatol. 2014 Oct;41(10):933-6. doi: 10.1111/1346-8138.12617. Epub 2014 Sep 16.
Juvenile xanthogranuloma is a benign histiocytic tumor predominantly occurring in children as yellowish papules on the head and trunk. Presentations on the volar surfaces are rare and may cause diagnostic confusion with pyogenic granuloma, eccrine poroma and digital fibrokeratoma. We report two patients with unusual presentations of solitary juvenile xanthogranuloma on the palm or sole. Both had lesions lacking the classic yellowish color and demonstrating a well-defined, peripheral hyperkeratotic rim. Histopathological evaluation revealed prominent orthokeratosis corresponding to the rim. Additional histological features, including dermal histiocytes and Touton giant cells, were consistent with the diagnosis of juvenile xanthogranuloma. Given the unusual locations and colors of the lesions, we conclude that histopathological evaluation is central to diagnosing volar juvenile xanthogranuloma. We additionally suggest that juvenile xanthogranuloma should be included in the differential diagnoses of volar lesions displaying a peripheral hyperkeratotic rim.
幼年性黄色肉芽肿是一种主要发生于儿童的良性组织细胞肿瘤，表现为头颈部和躯干上的淡黄色丘疹。手掌表面出现该病症较为罕见，可能会与化脓性肉芽肿、小汗腺汗孔瘤及指状纤维角化瘤造成诊断混淆。我们报告了两例手掌或足底出现不寻常表现的孤立性幼年性黄色肉芽肿患者。二者的皮损均缺乏典型的淡黄色，边界清晰，周边有角化过度边缘。组织病理学评估显示，对应边缘处有明显的正角化。其他组织学特征，包括真皮组织细胞和图顿巨细胞，均符合幼年性黄色肉芽肿的诊断。鉴于皮损的位置和颜色不同寻常，我们得出结论，组织病理学评估对于诊断手掌幼年性黄色肉芽肿至关重要。我们还建议，对于有周边角化过度边缘的手掌皮损，鉴别诊断时应考虑幼年性黄色肉芽肿。
