睑黄瘤中细胞外胆固醇晶体或胆固醇肉芽肿的意义
The Significance of Extracellular Cholesterol Crystals or a Cholesterol Granuloma in Xanthelasma.
作者信息
Jakobiec Frederick A, Ma Lina, Wolkow Natalie, Sutula Francis C, Freitag Suzanne K
机构信息
David G. Cogan Laboratory of Ophthalmic Pathology, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA.
Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA.
出版信息
Ocul Oncol Pathol. 2018 Nov;4(6):345-354. doi: 10.1159/000486532. Epub 2018 Feb 21.
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.
背景/目的：睑黄瘤并非系统性高脂血症的可靠指标。本研究旨在探寻细胞组成方面可能与系统性高脂血症相关的异常组织病理学特征。
方法
对3例病例进行观察性病例系列研究。切片采用苏木精-伊红染色、Masson三色染色、过碘酸-希夫染色以及铁染色进行分析。3个病变呈现出非典型形态学表现，并对其进行CD3、CD20、CD68、CD163、S100和脂联素的免疫组化分析。
结果
本研究中的3个病变均有典型的黄色瘤细胞，其含有密集排列的细小空泡。黄色瘤细胞CD68、CD163和脂联素呈阳性，S100呈阴性。病例1中，细胞外非极化胆固醇结晶对所有生物标志物均呈完全阴性染色。病例2和病例3中，胆固醇肉芽肿被CD68或CD163阳性的上皮样细胞和巨细胞以及CD3阳性的T淋巴细胞包绕并浸润。3例均伴有鳞状囊肿。
结论
病例1中，未发炎的细胞外胆固醇结晶与严重失调的系统性高脂血症相关。病例2和病例3中，胆固醇肉芽肿被认为是囊肿的局部表现，囊肿可能部分破裂，并不预示严重的高脂血症。
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