Dr Sarmas Dermpath Deba P Sarma, MD, Dermatopathologist, Lakeside Hospital, Omaha

Clinical:
M 60 with 8/Y history of red annular lesions of various sizes and plaques with central depression on the periorbital area, nose, ears, neck, chest, back, abdomen, arms and legs.

Fig 1. Dermal dense inflammatory infiltration.

Fig 2. Necrobiosis (arrow) with granulomatous inflammation.

Fig 3. Necrobiosis, high power.

Fig 4. Numerous Touton giant cells.

Fig 5

Fig 6. Giant cells, high power.

Comment
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Necrobiotic xanthogranuloma (NXG) is a rare destructive histiocytic and xanthomatous granulomatosis with chronic, indolent course. Strong association with monoclonal gammopathy and multiple myeloma in 80% of cases. Clinically, multiple yellow-brown nodules and plaques on periorbital regions, trunk, and extremities. Microscopically, areas of necrobiosis, granulomatous infiltration, Touton giant cells, foamy histiocytes, and cholesterol clefts are seen in dermis and subcutis.